Preserved Ratio Impaired Spirometry (PRISm) in Mardan: A Retrospective Prevalence Study of Spirometric Patterns and Associated Comorbidities

Abstract

Background: Preserved Ratio Impaired Spirometry (PRISm) is a unique form of spirometric abnormality that is defined as reduced FEV? (<80% predicted) with a preserved FEV?/FVC ratio of ?0.70. Unlike obstructive and restrictive lung disorders, PRISm is increasingly being recognized as a clinically relevant condition that is linked with respiratory symptoms, metabolic syndrome, cardiovascular disease, and increased mortality. Objective: To determine the prevalence of PRISm among adults undergoing spirometry and to find out its relationship with demographic and comorbid factors. Methodology: A retrospective study design was used to examine 180 spirometric results from adult patients (?18 years old) in a tertiary care hospital in Peshawar from January 2023 to December 2024. The variables collected for analysis were age, gender, BMI, smoking status, comorbidities, and spirometric values. PRISm was defined as FEV1 <80% predicted with FEV1/FVC ?0.70. Results: Out of 180 patients, the mean age was 46.7 ± 13.2 years, and 52.2% of them were males. PRISm prevalence was 15.5% (n=28), normal spirometry 51.6% (n=93), and obstructive pattern 32.7% (n=59). PRISm patients had significantly decreased FVC (72.5 ± 6.7%) compared with normal and obstructive patients (p<0.001). PRISm was significantly associated with hypertension (39.2% vs. 21.7%, p=0.024), diabetes mellitus (35.7% vs. 17.7%, p=0.037), and cardiovascular disease (25% vs. 9.8%, p=0.024), diabetes mellitus, and cardiovascular disease (25% vs. 9.8%, p=0.048). Conclusion: PRISm is a common intermediate spirometric phenotype within this population and has been linked with many cardiometabolic comorbidities and obesity. It may be beneficial to recognize this within clinical practice in order to potentially prevent the progression of this into pulmonary and systemic disorders.