CHEST Guidelines-Risk-Factors,-Morbidity,-and-Mortality-in-Associat

Risk-Factors,-Morbidity,-and-Mortality-in-Associat

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The study investigates the differences between Preserved Ratio Impaired Spirometry (PRISm) and Restrictive Spirometric Pattern (RSP) regarding risk factors, morbidity, and mortality in a cohort of 26,091 Norwegian men aged 30-46, followed for 26 years. PRISm is defined as a normal FEV1/FVC ratio with a reduced FEV1, while RSP involves a normal FEV1/FVC with a reduced FVC.

Key findings include:

- <strong>Prevalence</strong>: PRISm alone was found in 1.4% of participants, RSP alone in 1.7%, and both PRISm + RSP in 3.5%. Normal spirometry was present in 82.4%, while obstruction accounted for 11%.

- <strong>Risk Factors</strong>: PRISm alone was predominantly associated with obesity, smoking, low education, asthma, and symptoms like cough, phlegm, and wheeze. RSP alone had associations with both obesity and being underweight, breathlessness, but showed similar smoking habits to those with normal lung function.

- <strong>Morbidity</strong>: Patients with PRISm reported higher incidences of cough, phlegm, and respiratory symptoms similar to those found in obstructive lung diseases. RSP was mainly characterized by breathlessness and had a lower prevalence of smoking and typical respiratory symptoms but shared similarities with PRISm regarding cardiovascular issues.

- <strong>Mortality</strong>: RSP alone was linked to increased mortality from all causes, cardiovascular diseases, diabetes, and non-lung cancer. PRISm was significantly associated with respiratory disease mortality. The combined pattern of PRISm + RSP showed the worst prognosis with the highest all-cause and disease-specific mortality.

The study concludes that PRISm and RSP, though often seen as interchangeable, have distinct risk profiles. PRISm is associated with preobstructive conditions, while RSP is more indicative of extrapulmonary disease possibly rooted in early life factors. These differences highlight the need to distinguish between these patterns in clinical assessments to better understand their pathophysiology and implications for patient care.

The study’s results support differentiating PRISm and RSP in future respiratory health research, emphasizing their unique etiologies and clinical manifestations.

Keywords

PRISm

RSP

spirometry

morbidity

mortality

risk factors

Norwegian cohort

obesity

respiratory symptoms

cardiovascular disease