Different Risks of Mortality and Longitudinal Transition Trajectories in New Potential Subtypes of the Preserved Ratio Impaired Spirometry: Evidence From the English Longitudinal Study of Aging
Background: Preserved ratio impaired spirometry (PRISm), characterized by the decreased forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) with a preserved FEV1/FVC ratio, is highly prevalent and heterogeneous. We aimed to identify the subtypes of PRISm and examine their differen...
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Frontiers Media S.A.
2021
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oai:doaj.org-article:79566ddeb68d47bfb12b62395e02c3f82021-11-11T06:31:25ZDifferent Risks of Mortality and Longitudinal Transition Trajectories in New Potential Subtypes of the Preserved Ratio Impaired Spirometry: Evidence From the English Longitudinal Study of Aging2296-858X10.3389/fmed.2021.755855https://doaj.org/article/79566ddeb68d47bfb12b62395e02c3f82021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fmed.2021.755855/fullhttps://doaj.org/toc/2296-858XBackground: Preserved ratio impaired spirometry (PRISm), characterized by the decreased forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) with a preserved FEV1/FVC ratio, is highly prevalent and heterogeneous. We aimed to identify the subtypes of PRISm and examine their differences in clinical characteristics, long-term mortality risks, and longitudinal transition trajectories.Methods: A total of 6,616 eligible subjects were included from the English longitudinal study of aging. Two subtypes of the PRISm were identified as mild PRISm (either of FEV1 and FVC <80% predicted value, FEV1/FVC ≥0.7) and severe PRISm (both FEV1 and FVC <80% predicted values, FEV1/FVC ≥0.7). Normal spirometry was defined as both FEV1 and FVC ≥80% predicted values and FEV1/FVC ≥0.7. Hazard ratios (HRs) and 95% CIs were calculated by the multiple Cox regression models. Longitudinal transition trajectories were described with repeated spirometry data.Results: At baseline, severe PRISm had increased respiratory symptoms, including higher percentages of phlegm, wheezing, dyspnea, chronic bronchitis, and emphysema than mild PRISm. After an average of 7.7 years of follow-up, severe PRISm significantly increased the risks of all-cause mortality (HR=1.91, 95%CI = 1.58–2.31), respiratory mortality (HR = 6.02, 95%CI = 2.83–12.84), and CVD mortality (HR = 2.11, 95%CI = 1.42–3.13) compared with the normal spirometry, but no significantly increased risks were found for mild PRISm. In the two longitudinal transitions, mild PRISm tended to transition toward normal spirometry (40.2 and 54.7%), but severe PRISm tended to maintain the status (42.4 and 30.4%) or transition toward Global Initiative for Chronic Obstructive Lung Disease (GOLD)2–4 (28.3 and 33.9%).Conclusion: Two subtypes of PRISm were identified. Severe PRISm had increased respiratory symptoms, higher mortality risks, and a higher probability of progressing to GOLD2–4 than mild PRISm. These findings provided new evidence for the stratified management of PRISm.Di HeDi HeYilan SunMusong GaoQiong WuQiong WuZongxue ChengZongxue ChengJun LiJun LiYong ZhouKejing YingYimin ZhuYimin ZhuFrontiers Media S.A.articlepreserved ratio impaired spirometrylung functionheterogeneitysubtypesmortalitylongitudinal transitionMedicine (General)R5-920ENFrontiers in Medicine, Vol 8 (2021) |
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preserved ratio impaired spirometry lung function heterogeneity subtypes mortality longitudinal transition Medicine (General) R5-920 |
| spellingShingle |
preserved ratio impaired spirometry lung function heterogeneity subtypes mortality longitudinal transition Medicine (General) R5-920 Di He Di He Yilan Sun Musong Gao Qiong Wu Qiong Wu Zongxue Cheng Zongxue Cheng Jun Li Jun Li Yong Zhou Kejing Ying Yimin Zhu Yimin Zhu Different Risks of Mortality and Longitudinal Transition Trajectories in New Potential Subtypes of the Preserved Ratio Impaired Spirometry: Evidence From the English Longitudinal Study of Aging |
| description |
Background: Preserved ratio impaired spirometry (PRISm), characterized by the decreased forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) with a preserved FEV1/FVC ratio, is highly prevalent and heterogeneous. We aimed to identify the subtypes of PRISm and examine their differences in clinical characteristics, long-term mortality risks, and longitudinal transition trajectories.Methods: A total of 6,616 eligible subjects were included from the English longitudinal study of aging. Two subtypes of the PRISm were identified as mild PRISm (either of FEV1 and FVC <80% predicted value, FEV1/FVC ≥0.7) and severe PRISm (both FEV1 and FVC <80% predicted values, FEV1/FVC ≥0.7). Normal spirometry was defined as both FEV1 and FVC ≥80% predicted values and FEV1/FVC ≥0.7. Hazard ratios (HRs) and 95% CIs were calculated by the multiple Cox regression models. Longitudinal transition trajectories were described with repeated spirometry data.Results: At baseline, severe PRISm had increased respiratory symptoms, including higher percentages of phlegm, wheezing, dyspnea, chronic bronchitis, and emphysema than mild PRISm. After an average of 7.7 years of follow-up, severe PRISm significantly increased the risks of all-cause mortality (HR=1.91, 95%CI = 1.58–2.31), respiratory mortality (HR = 6.02, 95%CI = 2.83–12.84), and CVD mortality (HR = 2.11, 95%CI = 1.42–3.13) compared with the normal spirometry, but no significantly increased risks were found for mild PRISm. In the two longitudinal transitions, mild PRISm tended to transition toward normal spirometry (40.2 and 54.7%), but severe PRISm tended to maintain the status (42.4 and 30.4%) or transition toward Global Initiative for Chronic Obstructive Lung Disease (GOLD)2–4 (28.3 and 33.9%).Conclusion: Two subtypes of PRISm were identified. Severe PRISm had increased respiratory symptoms, higher mortality risks, and a higher probability of progressing to GOLD2–4 than mild PRISm. These findings provided new evidence for the stratified management of PRISm. |
| format |
article |
| author |
Di He Di He Yilan Sun Musong Gao Qiong Wu Qiong Wu Zongxue Cheng Zongxue Cheng Jun Li Jun Li Yong Zhou Kejing Ying Yimin Zhu Yimin Zhu |
| author_facet |
Di He Di He Yilan Sun Musong Gao Qiong Wu Qiong Wu Zongxue Cheng Zongxue Cheng Jun Li Jun Li Yong Zhou Kejing Ying Yimin Zhu Yimin Zhu |
| author_sort |
Di He |
| title |
Different Risks of Mortality and Longitudinal Transition Trajectories in New Potential Subtypes of the Preserved Ratio Impaired Spirometry: Evidence From the English Longitudinal Study of Aging |
| title_short |
Different Risks of Mortality and Longitudinal Transition Trajectories in New Potential Subtypes of the Preserved Ratio Impaired Spirometry: Evidence From the English Longitudinal Study of Aging |
| title_full |
Different Risks of Mortality and Longitudinal Transition Trajectories in New Potential Subtypes of the Preserved Ratio Impaired Spirometry: Evidence From the English Longitudinal Study of Aging |
| title_fullStr |
Different Risks of Mortality and Longitudinal Transition Trajectories in New Potential Subtypes of the Preserved Ratio Impaired Spirometry: Evidence From the English Longitudinal Study of Aging |
| title_full_unstemmed |
Different Risks of Mortality and Longitudinal Transition Trajectories in New Potential Subtypes of the Preserved Ratio Impaired Spirometry: Evidence From the English Longitudinal Study of Aging |
| title_sort |
different risks of mortality and longitudinal transition trajectories in new potential subtypes of the preserved ratio impaired spirometry: evidence from the english longitudinal study of aging |
| publisher |
Frontiers Media S.A. |
| publishDate |
2021 |
| url |
https://doaj.org/article/79566ddeb68d47bfb12b62395e02c3f8 |
| work_keys_str_mv |
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