Background: Chronic Obstructive Pulmonary disease (COPD) is largely underdiagnosed. Active case finding is crucial to establish preventive measures before manifestation of clinical disease. The significance of different spirometric patterns preceding COPD, especially Preserved Ratio Impaired Spirometry (PRISm), has been highlighted but is still unclear.
Research Question: Which clinical characteristics, smoking habits and spirometric patterns, with primary focus on PRISm, precede the development of airway obstruction?
Study Design And Methods: The OLIN COPD COPD Study was established in 2002-04. After re-examinations of population-based cohorts, individuals with airway obstruction (AO) (n=993 cases, FEV/VC<0.70) were identified together with non-obstructive controls (n=993, FEV/VC≥0.70). The majority of these had participated in examinations during the 1980s or 1990s and in total 902 cases and 819 controls had previous clinical data. Logistic regression was performed with case as outcome and spirometric patterns, age, sex, smoking habits and body mass index (BMI) at first examination as covariates.
Results: The mean person-years between first examination and inclusion in the OLIN COPD COPD study was 10.5±4.0y. At first examination, the prevalence of PRISm was higher in cases (18.6%) vs controls (13.4%). Current smoking was more common in cases (45.1% vs 18.2%), while former smoking was similar (31.8 vs. 34.9%). Cases reported more respiratory symptoms (78.0 vs. 44.3%) than controls. At first examination, PRISm, current smoking and former smoking were strongly associated with becoming a case when adjusted for confounders, with adjusted OR (aOR) of 3.5, 4.1 and 1.5, respectively. When stratifying for smoking habits, aORs for PRISm in current smokers, former smokers and non-smokers were 2.9, 3.8 and 3.7, respectively.
Interpretation: PRISm associated with transition into airway obstruction corresponding to COPD within a decade, independent of smoking habits and with similar strength of association among non-, former and current smokers.
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