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Research ArticleOriginal Research

Preserved Ratio Impaired Spirometry in a Spirometry Database

Andrei Schwartz, Nicholas Arnold, Becky Skinner, Jacob Simmering, Michael Eberlein, Alejandro P Comellas and Spyridon Fortis
Respiratory Care January 2021, 66 (1) 58-65; DOI: https://doi.org/10.4187/respcare.07712
Andrei Schwartz
Department of Internal Medicine, Division of General Internal Medicine, University of Iowa, Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa.
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Nicholas Arnold
Department of Internal Medicine, Division of General Internal Medicine, University of Iowa, Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa.
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Becky Skinner
Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Hospital and Clinics, Iowa City, Iowa.
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Jacob Simmering
Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Hospital and Clinics, Iowa City, Iowa.
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Michael Eberlein
Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Hospital and Clinics, Iowa City, Iowa.
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Alejandro P Comellas
Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Hospital and Clinics, Iowa City, Iowa.
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Spyridon Fortis
Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Hospital and Clinics, Iowa City, Iowa.
Center for Access & Delivery Research & Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa.
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Abstract

BACKGROUND: Spirometry results can yield a diagnosis of normal air flow, air flow obstruction, or preserved ratio impaired spirometry (PRISm), defined as a reduced FEV1 or FVC in the setting of preserved FEV1/FVC. Previous studies have estimated the prevalence of PRISm to be 7–12%. Our objective was to examine the prevalence of PRISm in a spirometry database and to identify factors associated with PRISm.

METHODS: We performed a retrospective analysis of 21,870 spirometries; 1,616 were excluded because of missing data or extremes of age, height, or weight. We calculated the prevalence of PRISm in prebronchodilator and postbronchodilator pulmonary function tests. Subsequently, we calculated the prevalence of PRISm by various age, race, body mass index, and diagnosis categories, as well as by gender and smokers versus nonsmokers. Finally, in the subset of the cohort with FEV1 < lower limit of normal, we performed a multivariable logistic regression analysis to identify factors associated with PRISm.

RESULTS: We identified 18,059 prebronchodilator spirometries, and 22.3% of these yielded a PRISm diagnosis. This prevalence remained stable in postbronchodilator spirometries (17.7%), after excluding earlier pulmonary function tests for subjects with multiple pulmonary function tests (20.7% in prebronchodilator and 24.3% in postbronchodilator), and when we limited the analysis to prebronchodilator spirometries that met American Thoracic Society criteria (20.6%). The PRISm prevalence was higher in subjects 45–60 y old (24.4%) and in males (23.7%) versus females (17.9%). The prevalence rose with body mass index and was higher for those with a referral diagnosis of restrictive lung disease (50%). PRISm prevalence was similar between races and smokers versus nonsmokers. In a multivariable analysis, higher % of predicted FEV1 (odds ratio 1.51, 95% CI 1.42–1.60), body mass index (odds ratio 1.52, 95% CI 1.39–1.68), and restrictive lung disease (odds ratio 4.32, 95% CI 2.54–7.57) were associated with a diagnosis of PRISm. Smoking was inversely associated (odds ratio 0.55, 95% CI 0.46–0.65) with PRISm.

CONCLUSIONS: In a spirometry database at an academic medical center, the PRISm prevalence was 17–24%, which is higher than previously reported.

  • preserved ratio impaired spirometry (PRISm)
  • chronic obstructive pulmonary disease
  • lung volume measurements
  • plethysmography
  • respiratory function tests
  • spirometry

Footnotes

  • Correspondence: Spyridon Fortis MD, UIHC Internal Medicine, 200 Hawkins Drive, C33 GH, Iowa City, IA 52242. Email: spyridon-fortis{at}uiowa.edu
  • The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States Government.

  • Dr Fortis is supported by the Department of Veterans Affairs (Award # 14380), the Comprehensive Access and Delivery Research and Evaluation Center (CIN 13-412), and has received grants from the American Thoracic Society, and Fisher & Paykel. The other authors have disclosed no conflicts of interest.

  • Copyright © 2021 by Daedalus Enterprises
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Respiratory Care: 66 (1)
Respiratory Care
Vol. 66, Issue 1
1 Jan 2021
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Preserved Ratio Impaired Spirometry in a Spirometry Database
Andrei Schwartz, Nicholas Arnold, Becky Skinner, Jacob Simmering, Michael Eberlein, Alejandro P Comellas, Spyridon Fortis
Respiratory Care Jan 2021, 66 (1) 58-65; DOI: 10.4187/respcare.07712

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Preserved Ratio Impaired Spirometry in a Spirometry Database
Andrei Schwartz, Nicholas Arnold, Becky Skinner, Jacob Simmering, Michael Eberlein, Alejandro P Comellas, Spyridon Fortis
Respiratory Care Jan 2021, 66 (1) 58-65; DOI: 10.4187/respcare.07712
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Keywords

  • preserved ratio impaired spirometry (PRISm)
  • chronic obstructive pulmonary disease
  • lung volume measurements
  • plethysmography
  • respiratory function tests
  • spirometry

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