Characterizing the preserved ratio impaired spirometry phenotype in all severities of asthma

IF 3.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Respiratory medicine Pub Date : 2025-05-27 DOI:10.1016/j.rmed.2025.108180

Marcello Cottini , Remo Poto , Atanu Bhattacharjee , Stanley Galant , Brian Lipworth , Erol A. Gaillard , Robert Greig , Alvise Berti , Carlo Lombardi , Francesco Menzella , Laura Ventura , Pasquale Comberiati , Rory Chan

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引用次数: 0

Abstract

Introduction

The preserved ratio impaired spirometry (PRISm) phenotype is characterized by a maintained FEV₁/FVC ratio ≥70 but an abnormal FEV₁<80 % predicted. Small airways dysfunction (SAD) is common amongst asthmatics and is associated with poorer clinical outcomes. SAD can be assessed using oscillometry as resistance between 5 and 20Hz (Rrs5-20), reactance at 5Hz (X5) and area under the reactance curve (AX). We aimed to investigate the prevalence of PRISm and its relationship with SAD in all severities of asthma with the primary outcome of annual exacerbation rate.

Methods

Data from the Oscillometry Asthma Registry comprising 937 adults with GINA-defined persistent asthma were retrospectively collected from two specialized asthma centres in UK and Italy. Multivariate analyses were performed using binary logistic regression to obtain adjusted odds ratios for the association between PRISm and exacerbation frequency and symptom control.

Results

PRISm had a 19.6 % prevalence in moderate-to-severe asthma and was associated with a greater likelihood of ≥1 exacerbation [OR 95 %CI 3.00 (1.80,5.00) p < 0.001], ≥2 exacerbations [4.00 (1.86,8.59) p < 0.001] and uncontrolled symptoms [14.04 (4.87,40.50) p < 0.001] compared to patients with normal spirometry. Conversely, patients with PRISm were prescribed significantly lower ICS doses and had fewer exacerbations compared to those with airway obstruction.

Conclusion

The PRISm asthma phenotype is associated with greater exacerbation frequency, poorer symptom control and a higher SAD prevalence compared to patients with normal spirometry. Future research should focus on longitudinal follow-up to confirm the progression of PRISm to obstructive patterns and assess potential therapeutic interventions to modify this trajectory.

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表征所有哮喘严重程度中保留比例受损的肺量测定表型

保留比例肺功能受损（PRISm）表型的特征是维持FEV1/FVC比值≥70，但预测FEV1异常<； 80%。小气道功能障碍（SAD）在哮喘患者中很常见，并且与较差的临床结果相关。SAD可以使用振荡测量法评估5- 20Hz之间的电阻（Rrs5-20）、5Hz时的电抗（X5）和电抗曲线下的面积（AX）。我们的目的是调查PRISm在所有哮喘严重程度中的患病率及其与SAD的关系，主要结局为年加重率。方法回顾性收集来自英国和意大利两家专业哮喘中心的937名gina定义的持续性哮喘成人的振荡测量哮喘登记处的数据。采用二元逻辑回归进行多变量分析，以获得PRISm与加重频率和症状控制之间关联的校正优势比。结果sprism在中重度哮喘中的患病率为19.6%，与≥1次发作的可能性相关[OR 95% CI 3.00 (1.80,5.00) p <；0.001),≥2加重[4.00 (1.86,8.59)p & lt;0.001]和未控制症状[14.04 (4.87,40.50)p <；0.001]与肺量正常的患者相比。相反，与气道阻塞患者相比，PRISm患者的ICS剂量明显较低，病情恶化较少。结论与肺量测定正常的患者相比，PRISm哮喘表型与更大的发作频率、更差的症状控制和更高的SAD患病率相关。未来的研究应侧重于纵向随访，以确认PRISm进展到阻塞性模式，并评估潜在的治疗干预措施来改变这一轨迹。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Respiratory medicine 医学-呼吸系统

CiteScore

7.50

自引率

0.00%

发文量

199

审稿时长

38 days

期刊介绍： Respiratory Medicine is an internationally-renowned journal devoted to the rapid publication of clinically-relevant respiratory medicine research. It combines cutting-edge original research with state-of-the-art reviews dealing with all aspects of respiratory diseases and therapeutic interventions. Topics include adult and paediatric medicine, epidemiology, immunology and cell biology, physiology, occupational disorders, and the role of allergens and pollutants. Respiratory Medicine is increasingly the journal of choice for publication of phased trial work, commenting on effectiveness, dosage and methods of action.