Spirometric Pattern Research Articles

Update of prognosis and characteristics of chronic obstructive pulmonary disease in a real-world setting: a 5-year follow-up analysis of a multi-institutional registry

BackgroundWe conducted a prospective observational study to elucidate the long-term prognosis and management of chronic obstructive pulmonary disease (COPD) in clinical practice in Japan in the mid-2010s.MethodsThis prospective cohort study included 29 facilities. Data from 427 patients clinically diagnosed with COPD, enrolled between September 2013 and April 2016, were analyzed. Interstitial pneumonia was excluded through a central multidisciplinary discussion. Follow-up data were collected for up to 5 years after patient registration.ResultsAt the time of registration, 53 patients clinically diagnosed with COPD did not have airflow limitation (AFL). In the cohort with AFL (n = 374), 232 patients completed a 5-year follow-up, while 49 patients died during the 1576.6 person-years of observation. The mean age was 71.7 years with an overall 5-year survival rate of 85.4%. Stratified by % forced expiratory volume in one second (FEV1), survival rates were 93.6% in the mild and moderate AFL group, 82.5% in the severe AFL group, and 66.1% in the very severe AFL group. The prognosis of the subpopulation without AFL was poor with a 5-year survival of 81.6%. This subpopulation exhibited respiratory symptoms, low vital capacity and total lung capacity, and emphysematous changes.ConclusionsOur study presents the 5-year survival and real-world clinical practice scenario of a prospective cohort of patients clinically diagnosed with COPD in Japan in the mid-2010s. The survival rates of our cohort were numerically better than the Japanese cohort in the 1990s, regardless of the high median age of this cohort. Overall, 12.4% of the patients in this cohort with no AFL at registration exhibited respiratory symptoms and distinct spirometric patterns, and had a poor prognosis.

Living with a chronic disease: tertiary prevention tools in asbestos-exposed patients

Abstract Background The main asbestos-related pathology is asbestosis, frequently associated with pleural plaques. The spirometric pattern is mainly restrictive, with reduction in all lung volumes (FEV1, FVC, TLC). Also a reduction in alveolus-capillary diffusion of carbon monoxide (DLCO) may be added, related to the fibrotic process. The aim of the study is to analyze the health surveillance data, correlating the spirometric finding and its variation over time with the clinical and radiological picture. Methods The study is conducted on 372 patients with asbestosis from occupational exposure diagnosed in the period 2017-2023, as part of the Tuscany Region’s program for former asbestos exposures (DGR 396/2016). The investigation is at the second level of surveillance, which includes chest CT and Respiratory Functionality Testing (RFT). Data are obtained from patients’ medical records and processed through a database. Results Out of 372 patients with asbestosis, 213 had pleural plaques (57.25%). Out of those, there is a progressive worsening of RFTs in a restrictive direction (TLC <80%, FEV1/FVC >70%) in 71 patients (33.3%), with a mean TLC loss of 8.7 ± 5.9 mL over subsequent follow-ups on a yearly basis. The FEV1/FVC ratio also declines, with a mean reduction of 5 ± 2.4%. Out of those 71 patients, 14 (19.7%) also show a mean reduction in DLCO of 6.7 ± 5 mL/min/mmHg. The negative trend in RFTs correlates with the worsening clinical and radiological picture attributable to the occurrence of plaques on a fibrotic framework. Conclusions The health surveillance protocol that we adopted has as objective the ascertainment of pulmonary pleura-parenchymal alterations correlated with occupational exposure, investigating their evolution over time through the analysis of spirometric data, and to optimize the management of the functional disability, with a view to the tertiary prevention of patients with asbestos-related disease. Key messages • The negative trend in asbestosis PFRs correlates with the worsening of the clinical and radiological picture attributable to the appearance of pleural plaques on an interstitial fibrosis. • Health surveillance is essential in order to optimize the management of functional disability, with a view to tertiary prevention of patients with asbestos-related disease.

Abnormal spirometric patterns and respiratory symptoms in HIV patients with no recent pulmonary infection in a periurban hospital in Ghana.

Human immunodeficiency virus (HIV) infection is associated with chronic airway obstruction, even in patients who have achieved viral suppression from combination antiretroviral treatment (cART). Spirometry is a supplementary test that aids in diagnosing pulmonary dysfunction in people living with HIV. To compare the prevalence of spirometric abnormalities among cART-treated HIV patients and cART-naïve HIV patients with non-HIV controls with no recent history of pulmonary infection in a peri-urban hospital in Ghana. In a case-control design, spirometry was performed in 158 cART-treated HIV patients, 150 cART-naïve HIV patients and 156 non-HIV controls. Clinical, sociodemographic data and respiratory symptoms were collected using a structured questionnaire. Spirometric abnormalities were categorised as obstructive (OSP) or restrictive (RSP) spirometric patterns based on the Cameroonian reference equation. The prevalence of OSP was higher in the cART-treated and cART-naïve HIV patients compared to non-HIV controls (13.9% vs 10.7% vs 5.1% respectively, p = 0.026), whereas that of RSP was similar among the study groups. Respiratory symptoms were common among cART-treated and cART-naïve HIV patients compared to non-HIV controls (48.1% vs 40% vs 19.2% respectively, p < 0.001). The major factors associated with OSP were female gender [OR (95% CI) = 2.46 (1.09-5.13), p = 0.031], former cigarette smoking [1.92 (1.04-3.89), p < 0.001], exposure to medium-to-high levels of biomass [3.07 (1.16-8.73), p = 0.019], presence of a respiratory symptom [1.89 (1.11-5.08), p = 0.029] and unemployment [3.26 (1.19-8.95), p = 0.042]. The major determinants of RSP were age, female gender [1.74 (1.05-4.29), p = 0.041], former cigarette smoking [2.31 (1.27-6.77), p < 0.001] and medium-to-high biomass exposure [1.58 (1.06-5.37), p = 0.043]. In HIV patients without any recent pulmonary infection in a peri-urban area of Ghana, there was a higher prevalence of OSP among cART-treated and cART naïve HIV patients compared to the non-HIV control. However, the prevalence of RSP was similar among HIV patients and non-HIV controls.

Debunking the GAMLSS Myth: Simplicity Reigns in Pulmonary Function Diagnostics

RationaleCurrent technical standards advocate using Generalized, Additive Models of Location, Scale, and Shape (GAMLSS) for lung function reference equations. These equations are complicated and require supplementary spline tables. Objective(1) To demonstrate that segmented (piecewise) linear regression (SLR) yields similar prediction accuracies as GAMLSS in pulmonary function diagnostics. (2) To determine the agreement between both SLR and GAMLSS. MethodsThe NHANES 2007-2012 database was utilized to construct spirometric reference equations for FEV1, FVC, and FEV1/FVC using both SLR and GAMLSS modeling techniques. K-fold cross-validation was used to provide the 95% confidence interval (CI) of the root-mean-square error (RMSE) as indicators of prediction accuracy. Additionally, agreement was assessed between the two modeling techniques in classifying spirometric patterns (standard, airflow obstruction, restrictive, or mixed disorder) using an unweighted kappa statistic. ResultsThe RMSE values for FEV1, FVC, and FEV1/FVC and correlation coefficients between predicted values and test data were similar between the two techniques. Agreement in classifying spirometric patterns between the two techniques ranged from 0.78 to 0.80 (95% CI). ConclusionsThe findings suggest that simple linear regression for FEV1/FVC and SLR for FEV1 and FVC offer prediction accuracies on par with GAMLSS while being more straightforward, parsimonious, and accessible to a broader audience in the field of pulmonary function diagnostics.

Association of Preserved Ratio Impaired Spirometry with Arterial Stiffness.

Rationale: Preserved ratio impaired spirometry (PRISm) is a recently recognized spirometric pattern defined by a ratio of forced expiratory volume in 1 second to forced vital capacity of at least 0.70 and a forced expiratory volume in 1 second <80% of reference. For unclear reasons, PRISm is associated with increased cardiovascular (CV) morbidity and mortality. Arterial stiffness is a major mechanism of CV disease, which can be measured by carotid-femoral pulse-wave velocity (cfPWV). Objectives: We explored the hypothesis that cfPWV would be increased in individuals with PRISm and airflow limitation (AL). Methods: We measured forced spirometry, lung volumes by body plethysmography, and cfPWV in 9,466 subjects recruited from the general population in the Austrian cross-sectional LEAD (Lung, Heart, Social, Body) study and tested the association of arterial stiffness with PRISm and AL by multivariable linear regression analysis. Individuals younger than 18 years were excluded from the study. Results: Individuals with PRISm (n = 431; 4.6%) were of similar age to those with normal spirometry (n = 8,136; 85.9%) and significantly younger than those with AL (n = 899; 9.5%). Arterial hypertension, diabetes mellitus, coronary artery disease, heart failure, and peripheral arterial occlusive disease were significantly more common in individuals with PRISm than in those with normal lung function and similar to those with AL. There was a significant association between PRISm and arterial stiffness on bivariate linear regression analysis (crude model, β = 0.038; 95% confidence interval [CI], 0.016-0.058), which persisted after robust adjustment for clinical confounders upon multivariable analysis (final model, β = 0.017; 95% CI, 0.001-0.032). cfPWV was significantly higher in individuals with PRISm irrespective of the presence of established CV disease or pulmonary restriction. AL also showed a significant association with arterial stiffness on multivariable linear regression analysis (final model, β = 0.025; 95% CI, 0.009-0.042). Conclusions: Arterial stiffness measured by cfPWV is increased in individuals with PRISm independent of CV disease and risk factors. The pathobiological mechanisms underlying this association deserve further research.

Risk Factors, Morbidity, and Mortality in Association With Preserved Ratio Impaired Spirometry and Restrictive Spirometric Pattern: Clinical Relevance of Preserved Ratio Impaired Spirometry and Restrictive Spirometric Pattern

BackgroundPreserved Ratio Impaired Spirometry (PRISm) and Restrictive Spirometric Pattern (RSP) are often considered interchangeable in identifying restrictive impairment in spirometry. Research QuestionDo PRISm and RSP have different individual associations with risk factors, morbidity, and mortality? Study Design and MethodsIn a cross-sectional and longitudinal study, including 26,091 30–46-year-old Norwegian general population men, we explored the association of PRISm and RSP with smoking habits, BMI, education, respiratory symptoms, self-reported cardiopulmonary disease, and mortality after 26 years of follow-up. PRISm was defined as FEV1/FVC ≥ lower limit of normal (LLN) & FEV1<LLN, RSP as FEV1/FVC≥LLN & FVC<LLN. We compared the associations of PRISm and RSP to airflow obstruction and normal spirometry, both as mutually (PRISm-alone, RSP-alone) and non-mutually exclusive (PRISm, RSP) categories, adjusting for age, BMI, smoking, education. We also conducted sensitivity analyses using GOLD criteria to define spirometric abnormalities. ResultsThe prevalence of the mutually exclusive spirometric patterns was: normal 82.4%, obstruction 11.0%, PRISm-alone 1.4%, RSP-alone 1.7%, PRISm+RSP 3.5%. PRISm-alone subjects were frequently obese (11.2%), current or former smokers, commonly reporting cough, phlegm, wheeze, asthma, and bronchitis. RSP-alone subjects were both obese (14.6%) and underweight (2.9%), with increased breathlessness, but similar smoking habits to subjects with normal spirometry. The prevalence of heart disease was 4.6% in PRISm-alone, 2.7% in RSP-alone and 1.6% in obstruction. With normal spirometry as a reference, RSP-alone had increased all-cause (HR 1.57 (1.21–2.04 95%CI), cardiovascular (1.48 (0.88–2.48)), diabetes (6.43 (1.88–21.97)), and cancer (excl. lung) mortality (1.51 (0.95–2.42)). PRISm-alone had increased respiratory disease mortality (HR 4.00 (1.22–13.16 95%CI)). Subjects with PRISm+RSP had intermediate characteristics and the worst prognosis. Findings were overall confirmed with non-mutually exclusive categories and GOLD criteria. InterpretationPRISm and RSP are spirometric patterns with distinct risk factors, morbidity and mortality, which should be differentiated in future studies.

Restrictive Spirometric Pattern and Preserved Ratio Impaired Spirometry in a Population Aged 50-64 Years.

Rationale: Knowledge regarding the prevalence and shared and unique characteristics of the restrictive spirometric pattern (RSP) and preserved ratio impaired spirometry (PRISm) is lacking for a general population investigated with post-bronchodilator spirometry and computed tomography of the lungs. Objectives: To investigate shared and unique features for RSP and PRISm. Methods: In the Swedish CArdioPulmonary bioImage Study (SCAPIS), a general population sample of 28,555 people aged 50-64 years (including 14,558 never-smokers) was assessed. The participants answered a questionnaire and underwent computed tomography of the lungs, post-bronchodilator spirometry, and coronary artery calcification score. Odds ratios with 95% confidence intervals (CIs) were calculated using adjusted logistic regression. RSP was defined as forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) ≥0.70 and FVC <80%. PRISm was defined as FEV1/FVC ≥0.70 and FEV1 <80%. A local reference equation was applied. Results: The prevalence of RSP and PRISm were 5.1% (95% CI, 4.9-5.4) and 5.1% (95% CI, 4.8-5.3), respectively, with similar values seen in never-smokers. For RSP and PRISm, shared features were current smoking, dyspnea, chronic bronchitis, rheumatic disease, diabetes, ischemic heart disease, bronchial wall thickening, interstitial lung abnormalities, and bronchiectasis. Emphysema was uniquely linked to PRISm (odds ratio, 1.69; 95% CI, 1.36-2.10) versus 1.10 (95% CI, 0.84-1.43) for RSP. Coronary artery calcification score ≥300 was related to PRISm, but not among never-smokers. Conclusions: PRISm and RSP have respiratory, cardiovascular, and metabolic conditions as shared features. Emphysema is only associated with PRISm. Coronary atherosclerosis may be associated with PRISm. Our results indicate that RSP and PRISm may share more features than not.

Analysis of clinical characteristics of different types of lung function impaiement in TDL patients

AimThe clinical characteristics associated with pulmonary function decline in patients with Tuberculosis-destroyed lung (TDL) remain uncertain. We categorize them based on the pattern of pulmonary function impairment, distinguishing between restrictive spirometric pattern (RSP) and obstructive spirometric pattern (OSP). We aim to compare the severity of these patterns with the clinical characteristics of TDL patients and analyze their correlation.MethodWe conducted a retrospective analysis on the clinical data of TDL patients who underwent consecutive pulmonary function tests (PFT) from November 2002 to February 2023. We used the lower limit formula for normal values based on the 2012 Global Lung Function Initiative. We compared the clinical characteristics of RSP patients with those of OSP patients. The characteristics of RSP patients were analyzed using the tertiles of forced vital capacity percentage predicted (FVC% pred) decline based on PFT measurements, and the characteristics of OSP patients were analyzed using the tertiles of forced expiratory volume in 1 s percentage predicted (FEV1% pred) decline.ResultAmong the RSP patients, those in the Tertile1 group (with lower FVC% pred) were more likely to have a higher of body mass index (BMI), spinal deformities, and C-reactive protein (CRP) compared to the other two groups (P for trend < 0.001, 0.027, and 0.013, respectively). Among OSP patients, those in the Tertile1 group (with lower FEV1% pred) showed an increasing trend in cough symptoms and contralateral lung infection compared to the Tertile 2–3 group (P for trend 0.036 and 0.009, respectively).ConclusionFor TDL patients, we observed that Patients with high BMI, a higher proportion of spinal scoliosis, and abnormal elevation of CRP levels were more likely to have reduced FVC. Patients with decreased FEV1% pred have more frequent cough symptoms and a higher proportion of lung infections on the affected side.

Rheumatoid arthritis and changes on spirometry by smoking status in two prospective longitudinal cohorts

ObjectiveTo compare longitudinal changes in spirometric measures between patients with rheumatoid arthritis (RA) and non-RA comparators.MethodsWe analysed longitudinal data from two prospective cohorts: the UK Biobank and COPDGene. Spirometry was...

Artificial Intelligence Applied to Forced Spirometry in Primary Care

IntroductionThis study aims to create an artificial intelligence (AI) based machine learning (ML) model capable of predicting a spirometric obstructive pattern using variables with the highest predictive power derived from an active case-finding program for COPD in primary care. Material and methodsA total of 1190 smokers, aged 30–80 years old with no prior history of respiratory disease, underwent spirometry with bronchodilation. The sample was analyzed using AI tools. Based on an exploratory data analysis (EDA), independent variables (according to mutual information analysis) were trained using a gradient boosting algorithm (GBT) and validated through cross-validation. ResultsWith an area under the curve close to unity, the model predicted a spirometric obstructive pattern using variables with the highest predictive power: FEV1_theoretical_pre values. Sensitivity: 93%. Positive predictive value: 94%. Specificity: 97%. Negative predictive value: 96%. Accuracy: 95%. Precision: 94%. ConclusionAn ML model can predict the presence of an obstructive pattern in spirometry in a primary care smoking population with no prior diagnosis of respiratory disease using the FEV1_theoretical_pre values with an accuracy and precision exceeding 90%. Further studies including clinical data and strategies for integrating AI into clinical workflow are needed.

All-cause and cause-specific mortality by spirometric pattern and sex - a population-based cohort study.

Chronic airway obstruction (CAO) and restrictive spirometry pattern (RSP) are associated with mortality, but sex-specific patterns of all-cause and specific causes of death have hardly been evaluated. To study the possible sex-dependent differences of all-cause mortality and patterns of cause-specific mortality among men and women with CAO and RSP, respectively, to that of normal lung function (NLF). Population-based prospective cohort study. Individuals with CAO [FEV1/vital capacity (VC) < 0.70], RSP [FEV1/VC ⩾ 0.70 and forced vital capacity (FVC) < 80% predicted] and NLF (FEV1/VC ⩾ 0.70 and FVC ⩾ 80% predicted) were identified within the Obstructive Lung Disease in Northern Sweden (OLIN) studies in 2002-2004. Mortality data were collected through April 2016, totally covering 19,000 patient-years. Cox regression and Fine-Gray regression accounting for competing risks were utilized to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) adjusted for age, body mass index, sex, smoking habits and pack-years. The adjusted hazard for all-cause mortality was higher in CAO and RSP than in NLF (HR, 95% CI; 1.69, 1.31-2.02 and 1.24, 1.06-1.71), and the higher hazards were driven by males. CAO had a higher hazard of respiratory and cardiovascular death than NLF (2.68, 1.05-6.82 and 1.40, 1.04-1.90). The hazard of respiratory death was significant in women (3.41, 1.05-11.07) while the hazard of cardiovascular death was significant in men (1.49, 1.01-2.22). In RSP, the higher hazard for respiratory death remained after adjustment (2.68, 1.05-6.82) but not for cardiovascular death (1.11, 0.74-1.66), with a similar pattern in both sexes. The higher hazard for all-cause mortality in CAO and RSP than in NLF was male driven. CAO was associated with respiratory death in women and cardiovascular death in men, while RSP is associated with respiratory death, similarly in both sexes.

Spirometric Evaluation among Individuals Working in Stone Chip Crushing Factories: A Cross-sectional Study

Introduction: Silicosis is still one of the most serious occupational health diseases in the world because of its potential to cause physical impairment. It is a progressive and debilitating occupational lung disease that primarily affects workers in the manufacturing, construction and mining industries. Silicosis is mostly caused by inhaling crystalline silica dust. Still, a substantial study on the lung health of stone quarry workers in Western Bengal are still lacking. Aim: To determine the alterations in pulmonary function status (by spirometry) and evaluate the gender differences in pulmonary mechanics among workers affected by occupational silica dust. Materials and Methods: A cross-sectional study was conducted for a duration of three months to analyse the spirometric changes in lung function among 62 workers exposed to occupational silica dust, aged 18 to 60 years (both genders), attending the Department of Physiology at Rampurhat Government Medical College, West Bengal, India. After obtaining anthropometric measurements, including height and weight of the subjects, spirometry was carried out on each patient according to the recommendations of American Thoracic Society (ATS) and European Respiratory Society (ERS) (2005). Patients were grouped into categories of normal, Chronic Obstructive Pulmonary Disease (COPD), restrictive pattern, mixed ventilatory defect, and Small Airflow Obstruction (SAO) based on spirometric values of Forced Vital Capacity (FVC), Forced Expiratory Volume in 1 second (FEV1 ), FEV1/ FVC, Forced mid-Expiratory Flow (FEF25%-75%), and Peak Expiratory Flow Rate (PEFR) values. Analysis was performed using GraphPad QuickCalcs software using Chi-square test and Unpaired t-test. Results: The mean age of the subjects was 49.6 years, with 51 (82.26%) males and 11 (17.74%) females among the 62 study subjects. There were 36 (58.06%) smokers and 26 (41.94%) non smokers. The average Body Mass Index (BMI) of the study subjects was 17.268±2.501 kg/m2 (underweight category). A significant reduction in spirometric variables was observed below the lower normal limit of percent predicted, including FVC (80-120%), FEV1 (80-120%), PEFR (&gt;60% predicted value for men; up to 100 L/min lower than predicted for males, and 85 L/min for females), FEF25%-75% (50%-60% and up to 130% of the average), and Forced Expiratory Time (FET) (6 secs), except for the FEV1 /FVC ratio (70-85%), which was higher than the normal limit. The majority of the study subjects belonged to the mixed ventilatory defect category, comprising 36 subjects (58.06%), 17 (27.42%) had a Restrictive Spirometric Pattern (RSP), while the remaining 9 subjects (14.52%) were classified as normal. Conclusion: Detectable spirometric changes have been observed among stone quarry workers, revealing not only restrictive patterns but also mixed ventilatory defects. Necessary preventive and interventional measures should be taken at an early phase to prevent further progression of lung impairment in such a population.

Validity of the Espiro Mobile Application in the Interpretation of Spirometric Patterns: An App Accuracy Study.

Spirometry is a pulmonary function test where correct interpretation of the results is crucial for accurate diagnosis of disease. There are online tools to assist in the interpretation of spirometry results; however, as yet none are validated. We evaluated the interpretation accuracy of the Espiro app using pulmonologist interpretations as the gold standard. This is an observational descriptive study in which 118 spirometry results were interpreted by the Espiro app, two pulmonologists, two primary care physicians, and two residents of a primary care training program. We determined the interpretation accuracy of the Espiro app and the concordance of the pattern and severity interpretation between the Espiro app and each of the observers using Cohen's kappa coefficient (k). We obtained a sensitivity and specificity for the Espiro app of 97.5% (95% confidence interval (CI): 86.8-99.9%) and 94.9% (95%CI: 87.4-98.6%) with pulmonologist 1 and 100% (95%CI: 91.6-100%) and 98.7% (95%CI: 92.9-99.9%) with pulmonologist 2. The concordance for the pattern interpretation was greater than k 0.907, representing almost perfect agreement. The concordance of the severity interpretation was greater than k 0.807, representing substantial to almost perfect agreement. We concluded that the Espiro app is a valid tool for spirometry interpretation.

Analysis of pulmonary function in post-Covid-19 patients at a university hospital

Objective: Evaluate the spirometry pattern of patients who persisted with respiratory symptoms after infection with SARS-Cov-2. Methods: Cross-sectional, observational, retrospective study in a single center, approved by the local Ethics Committee (registration number: 5,120,720). Patients who underwent spirometry due to Post-Covid Syndrome were evaluated to analyze the spirometric pattern presented. The following were collected: exam identification data, sex, age, symptom time, the need for mechanical ventilation, and quality of spirometry, in addition to the following exam parameters: FVC, FEV1, FEV1/FVC, FEV 25-75/FVC, and FEV 75, evaluating the Lower Limit of Normality, pre-bronchodilator and post-bronchodilator values. Results: Data from 72 patients were collected.Of these, 55.5% of patients had spirometry results within normal limits. The most frequent respiratory alteration was obstructive respiratory disorder, present in 29.2% of the patients. Conclusions: The presence of dyspnea in patients with normal spirometry may indicate further evaluation of lung function and other etiologies for dyspnea.

Prevalence of preserved ratio impaired spirometry (PRISM) in patients undergoing spirometry in a medical college hospital

Background: Many patients come with respiratory symptoms of cough, expectoration and shortness of breath. They also exhibit history of risk factors like smoking etc. but on spirometry they do not meet spirometric criteria of chronic obstructive pulmonary disease (COPD). GOLD 2023 updates have considered such patients in the category of pre-COPD and preserved ratio impaired spirometry (PRISm) and advised to treat and follow these patients and try to prevent them from progressing to COPD. With this objective we tried to look for PRISm and its characteristics in our area. Material and methods: We analyzed the spirometric pattern of all the patients who underwent spirometry in our institution (GS Medical College &amp; Hospital, Pilkhuwa) from January 2022 to December 2022. After applying inclusion and exclusion criteria, the patients were divided into three groups: (I) Normal Group: Patients having post bronchodilator FEV1/FVC ratio ≥ 0.7 and normal FEV1 and FVC. (II) PRISm Group: Patients having post bronchodilator FEV1/FVC ratio ≥ 0.7 but decreased FEV1 (&lt; 80 %) and / or FVC (&lt; 80 %). (III) Unrevealed COPD Group: Patients having post bronchodilator FEV1/FVC ratio &lt; 0.7 irrespective of FEV1 and FVC. Data observed was compared among various groups and analyzed for various parameters. Results: A total of 986 patients underwent spirometry between 1st January 2022 and 31st December 2022. Of this, 302 patients were not considered for study because of exclusion criteria. 684 patients were considered for the study, of whom 261 (38.16%) had normal spirometry, 207 (30.26%) were in the PRISm group and 216 (31.58%) were found to have unrevealed COPD. Conclusion: Occurrence of PRISm is quite high (30.26%) in patients undergoing spirometry for various reasons in our area. Higher age and higher BMI may have contributed to the observations. Additionally, a considerable number of patients (31.58%) were found to have unrevealed COPD. Another finding is that smoking history is seen in more than 70% of male subjects in both PRISm and unrevealed COPD groups. However, the results need confirmation in more studies from different geographical areas. Keywords: spirometry; PRISm; COPD; pulmonary disease

Reduced lung function and cause-specific mortality: A population-based study of Norwegian men followed for 26 years

Background and aimReduced lung function is associated with increased mortality, but it is unclear how different spirometric patterns are related to specific deaths. Aim of this study was to investigate these associations in a large general population cohort. MethodsThe study population consisted of 26,091 men aged 30–46 years from the Pneumoconiosis Survey of Western Norway conducted in 1988–1990 with follow-up on date and cause of death for 26 years. Cox proportional hazard models were used to estimate the association between baseline FEV1, FVC, obstructive (OSP) and restrictive spirometric pattern (RSP) (z-scores calculated according to GLI-2012 equations) and mortality (European 2012 shortlist classification (E−2012)), after adjustment for age, body mass index, smoking habits, and education. ResultsIn total, 2462 (9%) subjects died. A predominant reduction of FEV1 (and OSP) were associated with respiratory non-cancer (E−8) (HR for one unit FEV1 z-score decrease 2.29 (95% CI 1.90, 2.77) and lung cancer mortality (E−2.1.8) (1.27(1.12, 1.44)). A similar reduction of FEV1 and FVC (and RSP) were associated with diabetes (E−4.1) (FEV1 2.21(1.67, 2.92), FVC 2.41(1.75, 3.32)), cerebrovascular (E−7.3) (1.52(1.21, 1.91), 1.54(1.19, 1.98)), ischemic heart disease (E−7.1) (1.22(1.10, 1.35), 1.21(1.08, 1.36)), neurological (E−6.3) (1.56(1.21, 2.01), 1.61(1.22, 2.13)), suicide (E−17.2) (1.37(1.13, 1.65), 1.29(1.04, 1.59)) and hematological cancer mortality (E−2.1.19–21) (1.29(1.05, 1.58), (1.26(1.00, 1.58)). No association was found between reduced lung function and mortality due to accidents, alcohol abuse, digestive and genitourinary cancer. ConclusionsSpirometric obstruction was mainly related to pulmonary mortality. Spirometric restriction was mainly related to extra-pulmonary mortality.

Spirometric patterns in young and middle-aged adults: a 20-year European study

BackgroundUnderstanding the natural history of abnormal spirometric patterns at different stages of life is critical to identify and optimise preventive strategies. We aimed to describe characteristics and risk factors of...

Non-cystic fibrosis bronchiectasis: a retrospective review of clinical, radiological, microbiological and lung function profile at a tertiary care center of low-middle income country.

Non-cystic fibrosis (non-CF) bronchiectasis has emerged as a significant respiratory disease in developing countries. Given the variation in causes and clinical characteristics across different regions, it is necessary to conduct studies in regions with limited data such as low-middle income countries (LMIC). The aim of the study was to investigate the underlying causes, clinical presentation, etiology, lung function and imaging in patients with bronchiectasis who sought treatment at a tertiary care hospital in a LMIC. We conducted retrospective observational study at the Aga Khan University, Pakistan. Adult patients diagnosed with non-CF bronchiectasis on high-resolution computed tomography scan between 2000 and 2020 were included. We evaluated the etiology, clinical characteristics, microbiology, radiology and spirometric pattern of these patients. A total of 340 patients were included with 56.5% being female and 44.7% aged over 60 years. Among them, 157 (46.2%) had experienced symptoms for 1-5 years. The most common spirometric pattern observed was obstructive impairment (58.1%). Previous tuberculosis (TB) (52.94%) was the most common etiology followed by allergic bronchopulmonary aspergillosis (7.64%). Bilateral lung involvement on HRCT scan was found in 63.2% of patients. Pseudomonas aeruginosa was the most frequently identified organism (38.75%) among 240 patients with available specimens. Patients with P. aeruginosa infections had a significantly higher number of exacerbations (p=0.016). There was a significant difference (p<0.001) in P. aeruginosa growth among different etiologies. In conclusion, post-TB bronchiectasis was the most common cause of non-CF bronchiectasis in our study population. P. aeruginosa was the predominant organism, and 63.2% of the patients exhibited bilateral lung involvement. Since P. aeruginosa growth and extensive lung involvement have been associated with poor prognosis and increased mortality risk, we recommend close follow ups of these patients to improve quality of life and survival in developing countries like Pakistan.

Frailty in the chronic respiratory patient: association with mortality and clinical features in obstructive, restrictive, and mixed spirometric patterns.

Frailty associates with increased vulnerability to adverse health outcomes and reduced tolerance to medical interventions. Its impact on patients with chronic respiratory diseases, particularly beyond chronic obstructive pulmonary disease (COPD), remains poorly understood. To evaluate the association between frailty index and 5-year mortality across different "spirometric" patterns and the variation in their occurring frailty determinants. This study analyzed data from the SARA study, which enrolled 1968 older adults, to evaluate the association between frailty and 5-year mortality across different spirometric patterns. Frailty was assessed using the frailty index (FI), and spirometry was performed to determine lung function patterns. Hazard ratios (HRs) were calculated using Cox regression models, adjusting for age and sex. Among the study participants, 16% were classified as frail. Frailty was associated with a significantly increased risk of mortality across all spirometric patterns. The 5-year mortality rates were 34.3% in subjects with normal spirometry, 45.1% in those with obstructive defects, 55% in those with restrictive defects, and 42.6% in those with mixed airflow defects. The unadjusted HRs for mortality were 2.64 (95% CI 2.10-3.32) for the overall cohort, 2.24 (95% CI 1.48-3.40) for obstructive defects, 2.45 (95% CI 1.12-5.36) for restrictive defects, and 2.79 (95% CI 1.41-3.17) for mixed airflow defects. After adjusting for age and sex, the HRs remained statistically significant: 2.25 (95% CI 1.37-2.84) for the overall cohort, 2.08 (95% CI 1.37-3.18) for obstructive defects, 2.27 (95% CI 1.04-1.17) for restrictive defects, and 2.21 (95% CI 1.20-3.08) for mixed airflow defects. Frailty is a common syndrome and is associated with a significantly increased risk of mortality. The FI provides valuable information for risk profiling and personalized interventions beyond age and lung function parameters. Including frailty assessment in clinical evaluations can aid in resource allocation and improve patient care in respiratory diseases.

High prevalence of interstitial lung abnormalities in middle-aged never-smokers.

Interstitial lung abnormalities (ILA) are incidental findings on chest computed tomography (CT). These patterns can present at an early stage of fibrotic lung disease. Our aim was to estimate the prevalence of ILA in the Swedish population, in particular in never-smokers, and find out its association with demographics, comorbidities and symptoms. Participants were recruited to the Swedish CArdioPulmonary BioImage Study (SCAPIS), a population-based survey including men and women aged 50-64 years performed at six university hospitals in Sweden. CT scan, spirometry and questionnaires were performed. ILA were defined as cysts, ground-glass opacities, reticular abnormality, bronchiectasis and honeycombing. Out of 29 521 participants, 14 487 were never-smokers and 14 380 were men. In the whole population, 2870 (9.7%) had ILA of which 134 (0.5%) were fibrotic. In never-smokers, the prevalence was 7.9% of which 0.3% were fibrotic. In the whole population, age, smoking history, chronic bronchitis, cancer, coronary artery calcium score and high-sensitive C-reactive protein were associated with ILA. Both ILA and fibrotic ILA were associated with restrictive spirometric pattern and impaired diffusing capacity of the lung for carbon monoxide. However, individuals with ILA did not report more symptoms compared with individuals without ILA. ILA are common in a middle-aged Swedish population including never-smokers. ILA may be at risk of being underdiagnosed among never-smokers since they are not a target for screening.