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

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 E. Le Lievre; Alexander Roussos; Neil Skolnik; Joan B.  Soriano; Barbara P Yawn; David Price

doi:10.2147/POR.S478721

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

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 E. Le Lievre, Alexander Roussos, Neil Skolnik, Joan B. Soriano, Barbara P Yawn, David Price^* (Corresponding Author)

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

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% (678/2,866, 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 suffer from emphysema in CT and significant respiratory symptoms.

Original language	English
Pages (from-to)	221-232
Number of pages	12
Journal	Pragmatic and Observational Research
Volume	2024
Issue number	15
Early online date	13 Dec 2024
DOIs	https://doi.org/10.2147/POR.S478721
Publication status	Published - 13 Dec 2024

Bibliographical note

We would also like to acknowledge Shilpa Suresh (MSc) and Thuy Tien Vuong (BSc) of the Observational and Pragmatic Research Institute (OPRI), Singapore, for editorial and formatting assistance which supported the development of this publication.

Keywords

APEX
COPD
PRISm
US primary care
COPD exacerbations
Electronic health records
Patient reported outcomes

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Evans, A., Tarabichi, Y., Pace, W. D., Make, B., Bushell, N., Carter, V., Chang, K.-L., Fox, C., Han, M. K., Kaplan, A., W. H. Kocks, J., Le Lievre, C. E., Roussos, A., Skolnik, N., Soriano, J. B., Yawn, B. P., & Price, D. (2024). Preserved Ratio Impaired Spirometry in US Primary Care Patients Diagnosed with Chronic Obstructive Pulmonary Disease. Pragmatic and Observational Research, 2024(15), 221-232. https://doi.org/10.2147/POR.S478721

Evans, A, Tarabichi, Y, Pace, WD, Make, B, Bushell, N, Carter, V, Chang, K-L, Fox, C, Han, MK, Kaplan, A, W. H. Kocks, J, Le Lievre, CE, Roussos, A, Skolnik, N, Soriano, JB, Yawn, BP & Price, D 2024, 'Preserved Ratio Impaired Spirometry in US Primary Care Patients Diagnosed with Chronic Obstructive Pulmonary Disease.', Pragmatic and Observational Research, vol. 2024, no. 15, pp. 221-232. https://doi.org/10.2147/POR.S478721

@article{10ce4115b452472091120048e28d3b74,

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

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% (678/2,866, 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 suffer from emphysema in CT and significant respiratory symptoms.",

keywords = "APEX, COPD, PRISm, US primary care, COPD exacerbations, Electronic health records, Patient reported outcomes",

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

note = "We would also like to acknowledge Shilpa Suresh (MSc) and Thuy Tien Vuong (BSc) of the Observational and Pragmatic Research Institute (OPRI), Singapore, for editorial and formatting assistance which supported the development of this publication.",

year = "2024",

month = dec,

day = "13",

doi = "10.2147/POR.S478721",

language = "English",

volume = "2024",

pages = "221--232",

journal = "Pragmatic and Observational Research",

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TY - JOUR

T1 - Preserved Ratio Impaired Spirometry in US Primary Care Patients Diagnosed with Chronic Obstructive Pulmonary Disease.

AU - Evans, Alexander

AU - Tarabichi, Yasir

AU - Pace, Wilson D.

AU - Make, Barry

AU - Bushell, Nicholas

AU - Carter, Victoria

AU - Chang, Ku-Lang

AU - Fox, Chester

AU - Han, MeiLan K.

AU - Kaplan, Alan

AU - W. H. Kocks, Janwillem

AU - Le Lievre, Chantal E.

AU - Roussos, Alexander

AU - Skolnik, Neil

AU - Soriano, Joan B.

AU - Yawn, Barbara P

AU - Price, David

N1 - We would also like to acknowledge Shilpa Suresh (MSc) and Thuy Tien Vuong (BSc) of the Observational and Pragmatic Research Institute (OPRI), Singapore, for editorial and formatting assistance which supported the development of this publication.

PY - 2024/12/13

Y1 - 2024/12/13

N2 - 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% (678/2,866, 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 suffer from emphysema in CT and significant respiratory symptoms.

AB - 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% (678/2,866, 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 suffer from emphysema in CT and significant respiratory symptoms.

KW - APEX

KW - COPD

KW - PRISm

KW - US primary care

KW - COPD exacerbations

KW - Electronic health records

KW - Patient reported outcomes

U2 - 10.2147/POR.S478721

DO - 10.2147/POR.S478721

M3 - Article

SN - 1179-7266

VL - 2024

SP - 221

EP - 232

JO - Pragmatic and Observational Research

JF - Pragmatic and Observational Research

IS - 15

ER -

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

Abstract

Bibliographical note

Keywords

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