Preserved Ratio Impaired Spirometry in US Primary Care Patients Diagnosed with Chronic Obstructive Pulmonary Disease.

IF 2.3 Q2 MEDICINE, GENERAL & INTERNAL Pragmatic and Observational Research Pub Date : 2024-12-13 eCollection Date: 2024-01-01 DOI:10.2147/POR.S478721

Alexander Evans, Yasir Tarabichi, Wilson D Pace, Barry Make, Nicholas Bushell, Victoria Carter, Ku-Lang Chang, Chester Fox, MeiLan K Han, Alan Kaplan, Janwillem W H Kocks, Chantal Le Lievre, Alexander Roussos, Neil Skolnik, Joan B Soriano, Barbara P Yawn, David Price

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Abstract

Background: Preserved ratio impaired spirometry (PRISm) represents a population with spirometry results that do not meet standardized COPD obstruction criteria, yet present with high respiratory symptom burden and might benefit from respiratory management and treatment. We aimed to determine prevalence of PRISm in US primary care patients diagnosed with COPD, describe their demographic, clinical, and CT scan characteristics.

Methods: An observational registry study utilizing the US APEX COPD registry, composed of patients diagnosed with COPD aged 35+ years. Demographic and clinical data were collected from EHRs and complemented by questionnaires. Multivariable logistic regression was performed to assess whether PRISm predicts lung function decline.

Results: Prevalence of PRISm within a primary care population clinically diagnosed with COPD was 23.6% (678/2866, 95% CI 22.0-25.1). Those with PRISm were more likely female (55.9% vs 46.9%), younger (66.3±11.1 vs 69.2±10.3 years), with a greater mean BMI (33.5±9.2 vs 27.8±7.2 kg/m²), more often African American or Hispanic (37.2% vs 26.3%), and with fewer current smokers (33.1% vs 36.8%) when compared to those meeting COPD spirometry criteria (all p<0.05). Compared to COPD GOLD 0 patients, individuals with PRISm had greater BMI (33.5±9.2 vs 30.6±7.8), and were more likely current smokers (33.1% vs 23.4%), both p<0.05. Patients with PRISm had similar respiratory symptoms (chronic bronchitis, CAT, and mMRC) to overall COPD patients, but more frequently than GOLD 0 COPD patients (p<0.01). Emphysema was more commonly reported in CT scans from patients with PRISm 70.3% (260/369, 95% CI 65.8-75.3) than those with GOLD 0 COPD 64.1% (218/340, 95% CI 58.8-69.2) (p<0.05). PRISm status was not predictive of lung function decline.

Interpretation: One in four primary care patients with clinically diagnosed COPD in a large US registry fulfil the spirometric definition of PRISm rather than COPD, but suffers from emphysema in CT and significant respiratory symptoms.

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美国诊断为慢性阻塞性肺疾病的初级保健患者的保留比值受损肺活量测定法

背景：保留比例受损肺活量（PRISm）代表肺活量测定结果不符合标准化COPD阻塞标准的人群，但存在高呼吸症状负担，可能从呼吸管理和治疗中受益。我们的目的是确定PRISm在美国诊断为COPD的初级保健患者中的患病率，描述他们的人口统计学、临床和CT扫描特征。方法：一项观察性注册研究，利用美国APEX COPD注册表，由35岁以上诊断为COPD的患者组成。从电子病历中收集人口统计和临床数据，并辅以问卷调查。采用多变量logistic回归评估PRISm是否预测肺功能下降。结果：PRISm在临床诊断为COPD的初级保健人群中的患病率为23.6% （678/2866,95% CI 22.0-25.1）。与符合COPD肺活量测定标准的患者相比，PRISm患者更可能是女性（55.9% vs 46.9%），更年轻（66.3±11.1 vs 69.2±10.3岁），平均BMI更高（33.5±9.2 vs 27.8±7.2 kg/m2），更常见的是非裔美国人或西班牙裔（37.2% vs 26.3%），当前吸烟者更少（33.1% vs 36.8%）。在美国的一项大型登记中，四分之一的临床诊断为COPD的初级保健患者符合PRISm的肺活量测定定义，而不是COPD，但CT显示肺气肿和明显的呼吸道症状。

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Pragmatic and Observational Research MEDICINE, GENERAL & INTERNAL-

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期刊介绍： Pragmatic and Observational Research is an international, peer-reviewed, open-access journal that publishes data from studies designed to closely reflect medical interventions in real-world clinical practice, providing insights beyond classical randomized controlled trials (RCTs). While RCTs maximize internal validity for cause-and-effect relationships, they often represent only specific patient groups. This journal aims to complement such studies by providing data that better mirrors real-world patients and the usage of medicines, thus informing guidelines and enhancing the applicability of research findings across diverse patient populations encountered in everyday clinical practice.