Data were obtained from two population-based surveys of adults from three cities in Latin America (PLATINO study), conducted on the same individuals 5-9 years after their baseline examination. We estimated the frequency of PRISm defined by FEV1/FVC≥0.70 with FEV1 <80%, describing their clinical characteristics, longitudinal transition trajectories over time, factors associated with the transition.
At baseline, 2942 participants completed post-bronchodilator spirometry, and 2026 at both evaluations. The prevalence of normal spirometry was 78%, GOLD-stage 1 10.6%, GOLD 2-4 6.5%, and PRISm was: 5.0% (95% CI 4.2-5.8). PRISm was associated with less schooling, more reports of physician-diagnosis of COPD, wheezing, dyspnea, missing days at work, having ≥2 exacerbations in the previous year but without accelerated lung function decline. Mortality risk was significantly higher in PRISm (HR 1.97, 95% CI 1.2-3.3) and COPD GOLD 1-4 categories (HR 1.79, 95% CI 1.3-2.4) compared with normal spirometry. PRISm at baseline most frequently transitioned to another category at follow-up (46.5%); 26.7% to normal spirometry and 19.8% to COPD. The best predictors of transition to COPD were closeness of FEV1/FVC to 0.70, older age, current smoking, and a longer FET in the second assessment.
PRISm, is a heterogeneous and unstable condition prone to adverse outcomes that require adequate follow-up.
■数据来自对拉丁美洲三个城市的成年人进行的两次基于人口的调查(PLATINO研究),在基线检查后5-9年对相同的个体进行。我们估计由FEV1/FVC≥0.70定义的PRISm频率,FEV1<80%,描述他们的临床特征,纵向过渡轨迹随着时间的推移,与转型相关的因素。
■在基线时,2942名参与者完成了支气管扩张剂后肺活量测定,和2026在两次评估中。正常肺活量的患病率为78%,黄金阶段110.6%,黄金2-46.5%,PRISm为:5.0%(95%CI4.2-5.8)。PRISm与较少的学校教育有关,更多关于COPD医生诊断的报告,喘息,呼吸困难,在工作中失踪的日子,前一年有≥2次加重,但没有加速肺功能下降。与正常肺活量测定相比,PRISm(HR1.97,95%CI1.2-3.3)和COPDGOLD1-4类别(HR1.79,95%CI1.3-2.4)的死亡风险明显更高。基线时的PRISm在随访时最频繁地过渡到另一个类别(46.5%);26.7%为正常肺活量测定,19.8%为COPD。转变为COPD的最佳预测因素是FEV1/FVC接近0.70,年龄较大,目前吸烟,在第二次评估中,FET更长。
■PRISm,是一种异质性和不稳定的疾病,容易出现不良后果,需要充分的随访。