Prevalence of preserved ratio impaired spirometry: A systematic review and meta-analysis.
Yiting Li, Peng Zhang, Yan Wang et al.
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In 30 seconds
This systematic review and meta-analysis pooled cohort studies reporting preserved ratio impaired spirometry (PRISm) prevalence and related outcomes. Of 33 initially eligible studies, 24 were included; pooled PRISm prevalence was 10% (95% CI: 0.08, 0.12). Smoking was a significant risk factor, and PRISm was associated with hypertension, diabetes, cardiovascular disease, and stroke. The review also found higher cardiovascular mortality among people with PRISm (OR 1.82, 95% CI: 1.35, 2.44), while lung function trajectories varied, including reversion to normal, stability, or progression to COPD.
Key findings
- Pooled PRISm prevalence was 10% (95% CI: 0.08, 0.12) across 24 included studies.
- Smoking was a significant risk factor; PRISm was associated with hypertension, diabetes, cardiovascular disease, and stroke.
- Cardiovascular mortality was higher in people with PRISm (OR 1.82, 95% CI: 1.35, 2.44).
- Across studies, 10-50% reverted to normal, 20-60% remained stable, and 6-53% progressed to COPD.
Why it matters
PRISm was common in the pooled evidence and was linked to cardiometabolic comorbidities and cardiovascular mortality, not solely to COPD-related outcomes. Its heterogeneous lung function trajectories also indicate that a single spirometric pattern may encompass differing courses. These findings support attention to PRISm as a clinically relevant phenotype, while the observational evidence does not establish that PRISm causes the associated outcomes.
What to keep in mind
The review pooled cohort studies, so reported associations do not establish causation. Lung function trajectories varied substantially across studies.