Abstract Rationale Progressive airway diseases can lead to a reduced quality of life. There remains a significant knowledge gap in accurately determining those at the highest risk of lung function loss. In recent years, the early detection of airway obstruction had also gained concerns and studies on Preserved Ratio Impairment Spirometry (PRISm) kept increasing. This study aimed to analyze the risk factors for lung function decline and early airway obstruction. Methods We retrospectively reviewed and analyze the medical record of patients who have received lung function tests with pre-bronchodilator test at National Taiwan University hospital for at least 2 times between January 2012 and December 2022. Results From January 2012 to December 2022, a total of 12561 patients were eligible. The mean age was 60.3 years (SD:14.9) with male predominant (n = 7110, 57%). We classified these patients into 4 groups (mild airway obstruction: FEV1/FVC0.750; severe airway obstruction: FEV1/FVC0.750; PRISm: FEV1/FVC =0.70.8; Control: FEV1/FVC =0.70.8) based on their baseline lung function test. Control group consist of the majority (n = 7742, 61.6%), followed by mild airway obstruction (n = 2492, 19.8%), PRISm (n = 1689, 13.4%) and severe airway obstruction (n = 638, 5.1%). Active smoking or ex-smoking were mostly observed in the severe airway obstruction group (35.6%) and mild airway obstruction group (31.8%), compared to PRISm group (21.1%) and control group (20.1%). The PRISm group have higher prevalence of heart failure, chronic kidney disease and diabetes mellitus, compared with airway obstruction participants. In the follow up analysis, minority of baseline control group transitioned to PRISm (n = 825, 16.7%) and airflow obstruction group (n = 776, 10.0%) respectively. Multivariable logistic regression suggested transition from control group to non-control group had positive correlation with male (OR 1.50 95% CI 1.33 -1.71, p 0.001), active smoking (OR 1.26 95% CI 1.02 -1.55, p = 0.029), chronic liver disease, diabetes and chronic kidney disease. For baseline PRISm group in follow up analysis, 913 (54.1%) had persistent PRISm, 518 (30.7%) had reverted to normal control spirometry, and 258 (15.3%) had transitioned to airflow obstruction. Multivariable logistic regression revealed older age (OR 1.01 95% CI 1.00 -1.03, p = 0.006)and malignancy (OR 1.36 95% CI 1.01 -1.82, p = 0.042) were associated with transition from PRISm to airflow obstruction group. Conclusion PRISm is associated with multimorbidity and transition between different lung function status is common. Early detection of associated risk factors with subsequent specific strategy may assist in preventing potential longitudinal lung function decline. This abstract is funded by: None
Wu et al. (Fri,) studied this question.