PT  - JOURNAL ARTICLE
AU  - Sara Renata Alex Wijnant
AU  - Emmely De Roos
AU  - Maryam Kavousi
AU  - Bruno Hugo Stricker
AU  - Natalie Terzikhan
AU  - Lies Lahousse
AU  - Guy G. Brusselle
TI  - Trajectory and mortality of Preserved Ratio Impaired Spirometry: the Rotterdam Study
AID  - 10.1183/13993003.01217-2019
DP  - 2019 Jan 01
TA  - European Respiratory Journal
PG  - 1901217
4099  - http://erj.ersjournals.com/content/early/2019/09/25/13993003.01217-2019.short
4100  - http://erj.ersjournals.com/content/early/2019/09/25/13993003.01217-2019.full
AB  - Preserved Ratio Impaired Spirometry (PRISm) is a heterogeneous condition but its course and disease progression remain to be elucidated. We aimed to examine its prevalence, trajectories and prognosis in the general population.In the Rotterdam Study (population-based prospective cohort) we examined prevalence, trajectories and prognosis of subjects with normal spirometry (controls; FEV1/FVC≥0.7, FEV1≥80%), PRISm (FEV1/FVC≥0.7, FEV1<80%), and COPD (FEV1/FVC<0.7) at two study visits. Hazard ratios (HR 95%CI) for mortality (until 30/12/2018) were adjusted for age, sex, BMI, current smoking and pack-years.Of 5487 subjects (age 69.1±8.9; 7.1% PRISm), 1603 were re-examined after 4.5 years. Of PRISm subjects with re-examination, 15.7% transitioned to normal spirometry and 49.4% to COPD. Lung function decline (mL·year−1) was highest in subjects with incident PRISm (FEV1: −92.8[−131.9,−65.8]; FVC: −93.3[−159.8,−49.1]), but similar in persistent PRISm (FEV1: −30.2[−67.9,−7.5]; FVC: −20.1[−47.7,+21.7]) and persistent controls (FEV1: −39.6[−64.3,−12.7]; FVC: −20.0[−55.4,+18.8]). Of 5459 subjects with informed consent for follow-up, 692 (12.7%) died during 9.3 years (maximum) follow-up: 10.3% of controls, 18.7% of PRISm subjects and 20.8% of COPD subjects. Relative to controls, subjects with PRISm and COPD GOLD2-4 had increased all-cause and cardiovascular mortality (PRISm: HR 1.6[1.2, 2.0] and 2.8[1.5, 5.1]; COPD GOLD2-4: HR 1.7[1.4, 2.1] and 2.1[1.2, 3.6]). Mortality <1 year was highest in PRISm, often having cardiovascular comorbidity (heart failure or coronary heart disease; 70.0%).PRISm is associated with increased mortality and this population encompasses at least three distinct subsets: one that develops COPD during follow-up, a second with high cardiovascular burden and early mortality, and a third with persistent PRISm and normal age-related lung function decline.FootnotesThis manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.Conflict of interest: Dr. Wijnant reports grants from GalaxoSmithKline (award), outside the submitted work.Conflict of interest: Dr. de Roos has nothing to disclose.Conflict of interest: Dr. Kavousi has nothing to disclose.Conflict of interest: Dr. Stricker has nothing to disclose.Conflict of interest: Dr. Terzikhan has nothing to disclose.Conflict of interest: Dr. Lahousse reports grants from AstraZeneca and Chiesi (both awards), and expert consultation for Boehringer Ingelheim GmbH and Novartis, outside the submitted work.Conflict of interest: Dr. Brusselle reports personal fees from Astra Zeneca, personal fees from Boehringer-Ingelheim, personal fees from Chiesi, personal fees from GlaxoSmithKline, personal fees from Novartis, personal fees from Sanofi, personal fees from Teva, outside the submitted work.