medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2025-350medsovet-9645Research ArticleХРОНИЧЕСКИЕ ЗАБОЛЕВАНИЯ ЛЕГКИХCHRONIC PULMONARY DISEASESРасширение представления о понятии хронической обструктивной болезни легких: концепция Preserved Ratio Impaired Spirometry (PRISm)Expanding the concept of chronic obstructive pulmonary disease: The concept of Preserved Ratio Impaired Spirometry (PRISm)https://orcid.org/0000-0002-1171-2746БудневскийА. В.BudnevskyA. V.

Будневский Андрей Валериевич, д.м.н., профессор, заведующий кафедрой факультетской терапии, проректор по научно-инновационной деятельности, заслуженный изобретатель РФ

394036, Воронеж, ул. Студенческая, д. 10

Andrey V. Budnevsky, Dr. Sci. (Med.), Professor, Head of the Department of Faculty Therapy, Vice-Rector for Research and Innovation, Honored Inventor of the Russian Federation

10, Studencheskaya St., Voronezh, 394036

budnev@list.ruhttps://orcid.org/0000-0002-5999-2150АвдеевС. Н.AvdeevS. N.

Авдеев Сергей Николаевич, д.м.н., профессор, академик РАН, главный внештатный пульмонолог Министерства здравоохранения Российской Федерации, заведующий кафедрой пульмонологии Института клинической медицины имени Н.В. Склифосовского, Первый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет); директор, Национальный медицинский исследовательский центр по профилю «Пульмонология»;  руководитель клинического отдела, Научно-исследовательский институт пульмонологии Федерального медикобиологического агентства

119048, Москва, ул. Трубецкая, д. 8, стр. 2; 119048, Москва, ул. Доватора, д. 15, стр. 2; 115682, Москва, Ореховый бульвар, д. 28, стр. 10

Sergey N. Avdeev, Dr. Sci. (Med.), Professor, Academician of the Russian Academy of Sciences, Chief Pulmonologist of the Russian Ministry of Health, Head of the Pulmonology Department, N.V. Sklifosovsky Institute of Clinical Medicine, Sechenov First Moscow State Medical University (Sechenov University); Director, National Medical Research Center for Pulmonology; Head of the Clinical Department, Research Institute for Pulmonology of the Federal Medical Biological Agency;

8, Bldg. 2, Trubetskaya St., Moscow, 119991; 15, Bldg. 2, Dovator St., Moscow, 119048; 28, Orekhovy Boulevard, Moscow, 115682

serg_avdeev@list.ruhttps://orcid.org/0000-0003-2182-1310СауринаО. С.SaurinaO. S.

Саурина Ольга Семеновна, д.м.н., профессор, профессор кафедры управления в здравоохранении, проректор по дополнительному профессиональному образованию

394036, Воронеж, ул. Студенческая, д. 10

Olga S. Saurina, Dr. Sci. (Med.), Professor, Professor of the Department of Healthcare Management, Vice-Rector for Continuing Professional Education

10, Studencheskaya St., Voronezh, 394036

 

saurina051@mail.ruhttps://orcid.org/0000-0002-8259-840XСимионА. Ю.SimionA. Yu.

Симион Алексей Юрьевич, к.м.н., ассистент кафедры факультетской терапии

394036, Воронеж, ул. Студенческая, д. 10

Aleksey Yu. Simion, Cand. Sci. (Med.), Assistant, Department of Faculty Therapy

10, Studencheskaya St., Voronezh, 394036

al-simion@yandex.ruВоронежский государственный медицинский университет имени Н.Н. БурденкоРоссияBurdenko Voronezh State Medical UniversityRussian FederationПервый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет); Национальный медицинский исследовательский центр по профилю «Пульмонология»; Научно-исследовательский институт пульмонологии Федерального медико-биологического агентстваРоссияSechenov First Moscow State Medical University (Sechenov University); National Medical Research Center for Pulmonology; Research Institute for Pulmonology of the Federal Medical Biological AgencyRussian Federation2025121220250203038Copyright © Будневский А.В., Авдеев С.Н., Саурина О.С., Симион А.Ю., 20252025Будневский А.В., Авдеев С.Н., Саурина О.С., Симион А.Ю.Budnevsky A.V., Avdeev S.N., Saurina O.S., Simion A.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/9645Введение

Введение. Хроническая обструктивная болезнь легких имеет высокую распространенность, заболеваемость и смертность, что делает актуальной проблему ранней диагностики предшествующих состояний, включая PRISm. Несмотря на растущий интерес к PRISm, патогенез и клинические последствия данного состояния остаются недостаточно изученными.

Цель

Цель. Провести поиск и анализ научных данных о PRISm, включая эпидемиологию, патогенез, диагностику, связь данного состояния с другими заболеваниями.

Материалы и методы

Материалы и методы. Поиск материала осуществлен в электронных базах данных eLIBRARY.ru, КиберЛенинка, PubMed, Cochrane Library за 2009–2025 гг. по ключевым словам. Для анализа были отобраны публикации результатов оригинальных исследований.

Результаты

Результаты. Анализ современных результатов исследований свидетельствует, что PRISm представляет собой гетерогенное состояние, характеризующееся снижением ОФВ₁ (<80%) при сохранном соотношении ОФВ₁/ФЖЕЛ (>70%). Распространенность PRISm варьирует от 3 до 20% и ассоциирована с такими факторами риска, как курение, ожирение, загрязнение воздуха, метаболические нарушения (например, сахарный диабет 2-го типа) и генетическая предрасположенность. Патогенетические механизмы включают рестриктивные изменения (фиброз, снижение растяжимости легочной ткани), системное воспаление (повышение уровней интерлейкина-6 и фактора некроза опухоли) и окислительный стресс. PRISm ассоциирован с повышенным риском прогрессирования в ХОБЛ, развития сердечно-сосудистых заболеваний и общей смертности, что подчеркивает его клиническую значимость.

Выводы

Выводы. PRISm является гетерогенным и клинически значимым состоянием, требующим междисциплинарного подхода к диагностике и лечению. Дальнейшие исследования необходимы для уточнения его патофизиологии, разработки стандартизированных диагностических критериев и персонализированных терапевтических стратегий. Результаты современных научных исследований подчеркивают важность раннего выявления PRISm для улучшения прогноза пациентов.

Introduction

Introduction. Chronic obstructive pulmonary disease has a high prevalence, morbidity and mortality, which makes the problem of early diagnosis of precursor conditions, including PRISm, relevant. Despite the growing interest in PRISm, the pathogenesis and clinical consequences of this condition remain poorly understood.

Aim

Aim. To conduct а search and analysis of scientific data on PRISm, including epidemiology, pathogenesis, diagnostics, and the relationship of this condition with other diseases.

Materials and methods

Materials and methods. The material was searched in the electronic databases eLIBRARY.ru, CyberLeninka, PubMed, Cochrane Library for 2009–2025 by keywords. Publications of the results of original studies were selected for analysis.

Results

Results. Analysis of modern research results indicates that PRISm is a heterogeneous condition characterized by a decrease in FEV₁ (<80%) with a preserved FEV₁/FVC ratio (>70%). The prevalence of PRISm varies from 3 to 20% and is associated with risk factors such as smoking, obesity, air pollution, metabolic disorders (eg, type 2 diabetes mellitus), and genetic predisposition. Pathogenetic mechanisms include restrictive changes (fibrosis, decreased lung tissue compliance), systemic inflammation (increased IL-6, TNF-α levels), and oxidative stress. PRISm is associated with an increased risk of progression to COPD, cardiovascular disease, and all-cause mortality, which emphasizes its clinical significance.

Conclusion

Conclusion. PRISm is a heterogeneous and clinically significant condition that requires a multidisciplinary approach to diagnosis and treatment. Further research is needed to clarify its pathophysiology, develop standardized diagnostic criteria, and personalized therapeutic strategies. The results of current scientific research emphasize the importance of early detection of PRISm to improve patient prognosis.

спирометрияранняя диагностикаэпидемиологияпатогенезфакторы рискаspirometryearly diagnosisepidemiologypathogenesisrisk factorsReferencesWan ES, Castaldi PJ, Cho MH Hokanson JE, Regan EA, Make BJ et al. Epidemiology, genetics, and subtyping of preserved ratio impaired spirometry (PRISm) in COPDGene. Respir Res. 2014;15(1):89. https://doi.org/10.1186/s12931-014-0089-y.Wan ES, Castaldi PJ, Cho MH Hokanson JE, Regan EA, Make BJ et al. Epidemiology, genetics, and subtyping of preserved ratio impaired spirometry (PRISm) in COPDGene. Respir Res. 2014;15(1):89. https://doi.org/10.1186/s12931-014-0089-y.Bhatt SP, Agusti A, Bafadhel M, Christenson SA, Bon J, Donaldson GC et al. Am J Respir Crit Care Med. 2023;208(10):1026–1041. https://doi.org/10.1164/rccm.202209-1748SO.Bhatt SP, Agusti A, Bafadhel M, Christenson SA, Bon J, Donaldson GC et al. Am J Respir Crit Care Med. 2023;208(10):1026–1041. https://doi.org/10.1164/rccm.202209-1748SO.Kaise T, Sakihara E, Tamaki K, Miyata H, Hirahara N, Kirichek O et al. Prevalence and characteristics of individuals with preserved ratio impaired spirometry (PRISm) and/or impaired lung function in Japan: the OCEAN study. Int J Chron Obstruct Pulm Dis. 2021;16:2665–2675. https://doi.org/10.2147/COPD.S32204.Kaise T, Sakihara E, Tamaki K, Miyata H, Hirahara N, Kirichek O et al. Prevalence and characteristics of individuals with preserved ratio impaired spirometry (PRISm) and/or impaired lung function in Japan: the OCEAN study. Int J Chron Obstruct Pulm Dis. 2021;16:2665–2675. https://doi.org/10.2147/COPD.S32204.Washio Y, Sakata S, Fukuyama S, Honda T, Kan-O K, Shibata M et al. Risks of mortality and airflow limitation in Japanese individuals with preserved ratio impaired spirometry. Am J Respir Crit Care Med. 2022;206(5):563–572. https://doi.org/10.1164/rccm.202110-23020.Washio Y, Sakata S, Fukuyama S, Honda T, Kan-O K, Shibata M et al. Risks of mortality and airflow limitation in Japanese individuals with preserved ratio impaired spirometry. Am J Respir Crit Care Med. 2022;206(5):563–572. https://doi.org/10.1164/rccm.202110-23020.Wijnant SRA, De Roos E, Kavousi M, Stricker BH, Terzikhan N, Lahousse L, Brusselle GG. Trajectory and mortality of preserved ratio impaired spirometry: the Rotterdam Study. Eur Respir J. 2020;55(1):1901217. https://doi.org/10.1183/13993003.01217-2019.Wijnant SRA, De Roos E, Kavousi M, Stricker BH, Terzikhan N, Lahousse L, Brusselle GG. Trajectory and mortality of preserved ratio impaired spirometry: the Rotterdam Study. Eur Respir J. 2020;55(1):1901217. https://doi.org/10.1183/13993003.01217-2019.Wan ES, Fortis S, Regan EA, Hokanson J, Han MK, Casaburi R et al. Longitudinal phenotypes and mortality in preserved ratio impaired spirometry in the COPDGene study. Am J Respir Crit Care Med. 2018;198(11):1397–1405. https://doi.org/10.1164/rccm.201804-0663OC.Wan ES, Fortis S, Regan EA, Hokanson J, Han MK, Casaburi R et al. Longitudinal phenotypes and mortality in preserved ratio impaired spirometry in the COPDGene study. Am J Respir Crit Care Med. 2018;198(11):1397–1405. https://doi.org/10.1164/rccm.201804-0663OC.Marott JL, Ingebrigtsen TS, Çolak Y, Vestbo J, Lange P. Trajectory of preserved ratio impaired spirometry: natural history and long-term prognosis. Am J Respir Crit Care Med. 2021;204(8):910–920. https://doi.org/10.1164/rccm.202102-0517OC.Marott JL, Ingebrigtsen TS, Çolak Y, Vestbo J, Lange P. Trajectory of preserved ratio impaired spirometry: natural history and long-term prognosis. Am J Respir Crit Care Med. 2021;204(8):910–920. https://doi.org/10.1164/rccm.202102-0517OC.Higbee DH, Granell R, Davey Smith G, Dodd JW. Prevalence, risk factors, and clinical implications of preserved ratio impaired spirometry: a UK Biobank cohort analysis. Lancet Respir Med. 2022;10(2):149–157. https://doi.org/10.1016/S2213-2600(21)00369-6.Higbee DH, Granell R, Davey Smith G, Dodd JW. Prevalence, risk factors, and clinical implications of preserved ratio impaired spirometry: a UK Biobank cohort analysis. Lancet Respir Med. 2022;10(2):149–157. https://doi.org/10.1016/S2213-2600(21)00369-6.Huang J, Li W, Sun Y, Huang Z, Cong R, Yu C, Tao H. Preserved Ratio Impaired Spirometry (PRISm): A Global Epidemiological Overview, Radiographic Characteristics, Comorbid Associations, and Differentiation from Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis. 2024;19:753–764. https://doi.org/10.2147/COPD.S453086.Huang J, Li W, Sun Y, Huang Z, Cong R, Yu C, Tao H. Preserved Ratio Impaired Spirometry (PRISm): A Global Epidemiological Overview, Radiographic Characteristics, Comorbid Associations, and Differentiation from Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis. 2024;19:753–764. https://doi.org/10.2147/COPD.S453086.Mkorombindo T, Balkissoon R. Journal club-respiratory impairment with a preserved spirometric ratio. Chronic Obstr Pulm Dis. 2022;9(1):103–110. https://doi.org/10.15326/jcopdf.2022.0285.Mkorombindo T, Balkissoon R. Journal club-respiratory impairment with a preserved spirometric ratio. Chronic Obstr Pulm Dis. 2022;9(1):103–110. https://doi.org/10.15326/jcopdf.2022.0285.Зайцев АА, Крюков ЕВ. Обострение хронической обструктивной болезни легких: эпидемиология, основы диагностики, режимы антибактериальной терапии. Практическая пульмонология. 2017;(4):58–62. Режим доступа: https://atmosphere-ph.ru/modules/Magazines/articles/pulmo/pp_4_2017_58.pdf.Zaitsev AA, Kryukov EV. Exacerbation of chronic obstructive pulmonary disease: Epidemiology, diagnosis, antibiotic regimens. Prakticheskaya Pulʹmonologiya. 2017;(4):58–62. (In Russ.) Available at: https://atmosphere-ph.ru/modules/ Magazines/articles/pulmo/pp_4_2017_58.pdf.Wan ES, Hokanson JE, Murphy JR, Regan EA, Make BJ, Lynch DA et al. Clinical and radiographic predictors of GOLD-unclassified smokers in the COPDGene study. Am J Respir Crit Care Med. 2011;184(1):57–63. https://doi.org/10.1164/rccm.201101-0021OC.Wan ES, Hokanson JE, Murphy JR, Regan EA, Make BJ, Lynch DA et al. Clinical and radiographic predictors of GOLD-unclassified smokers in the COPDGene study. Am J Respir Crit Care Med. 2011;184(1):57–63. https://doi.org/10.1164/rccm.201101-0021OC.Fan J, Fang L, Cong S, Zhang Y, Jiang X, Wang N, Chen Y. Potential pre-COPD indicators in association with COPD development and COPD prediction models in Chinese: a prospective cohort study. Lancet Reg Health West Pac. 2023;44:100984. https://doi.org/10.1016/j.lanwpc.2024.100984.Fan J, Fang L, Cong S, Zhang Y, Jiang X, Wang N, Chen Y. Potential pre-COPD indicators in association with COPD development and COPD prediction models in Chinese: a prospective cohort study. Lancet Reg Health West Pac. 2023;44:100984. https://doi.org/10.1016/j.lanwpc.2024.100984.Toren K, Blomberg A, Schiöler L, Malinovschi A, Backman H, Caidahl K et al. Restrictive Spirometric Pattern and Preserved Ratio Impaired Spirometry in a Population Aged 50–64 Years. Ann Am Thor Soc. 2024;21(11):1524–1532. https://doi.org/10.1513/AnnalsATS.202310-883OC.Toren K, Blomberg A, Schiöler L, Malinovschi A, Backman H, Caidahl K et al. Restrictive Spirometric Pattern and Preserved Ratio Impaired Spirometry in a Population Aged 50–64 Years. Ann Am Thor Soc. 2024;21(11):1524–1532. https://doi.org/10.1513/AnnalsATS.202310-883OC.Cadham CJ, Oh H, Han MK, Mannino D, Cook S, Meza R et al. The prevalence and mortality risks of PRISm and COPD in the United States from NHANES 2007–2012. Respir Res. 2024;25(1):208. https://doi.org/10.1186/s12931-024-02841-y.Cadham CJ, Oh H, Han MK, Mannino D, Cook S, Meza R et al. The prevalence and mortality risks of PRISm and COPD in the United States from NHANES 2007–2012. Respir Res. 2024;25(1):208. https://doi.org/10.1186/ s12931-024-02841-y.He D, Yan M, Zhou Y, Ge H, Zhang X, Xu Y et al. Preserved Ratio Impaired Spirometry and COPD Accelerate Frailty Progression: Evidence From a Prospective Cohort Study. Chest. 2024;165(3):573–582. https://doi.org/10.1016/j.chest.2023.07.020.He D, Yan M, Zhou Y, Ge H, Zhang X, Xu Y et al. Preserved Ratio Impaired Spirometry and COPD Accelerate Frailty Progression: Evidence From a Prospective Cohort Study. Chest. 2024;165(3):573–582. https://doi.org/10.1016/j.chest.2023.07.020.Sun C, Kovacs P, Guiu-Jurado E. Genetics of obesity in East Asians. Front Genet. 2020;11:575049. https://doi.org/10.3389/fgene.2020.575049.Sun C, Kovacs P, Guiu-Jurado E. Genetics of obesity in East Asians. Front Genet. 2020;11:575049. https://doi.org/10.3389/fgene.2020.575049.Ogden CL, Carroll MD, Fryar CD, Flegal KM. Prevalence of obesity among adults and youth: United States, 2011-2014. NCHS Data Brief. 2015;(219):1–8. Available at: https://www.cdc.gov/nchs/data/databriefs/db219.pdfOgden CL, Carroll MD, Fryar CD, Flegal KM. Prevalence of obesity among adults and youth: United States, 2011-2014. NCHS Data Brief. 2015;(219):1–8. Available at: https://www.cdc.gov/nchs/data/databriefs/db219.pdfYoung KA, Regan EA, Han MK, Lutz SM, Ragland M, Castaldi PJ et al. Subtypes of COPD have unique distributions and differential risk of mortality. Chronic Obstr Pulm Dis. 2019;6(5):400–413. https://doi.org/10.15326/jcopdf.6.5.2019.0150.Young KA, Regan EA, Han MK, Lutz SM, Ragland M, Castaldi PJ et al. Subtypes of COPD have unique distributions and differential risk of mortality. Chronic Obstr Pulm Dis. 2019;6(5):400–413. https://doi.org/10.15326/jcopdf.6.5.2019.0150.Young KA, Strand M, Ragland MF, Kinney GL, Austin EE, Regan EA et al. Pulmonary subtypes exhibit differential global initiative for chronic obstructive lung disease spirometry stage progression: the COPDGene® study. Chronic Obstr Pulm Dis. 2019;6(5):414–429. https://doi.org/10.15326/jcopdf.6.5.2019.0155.Young KA, Strand M, Ragland MF, Kinney GL, Austin EE, Regan EA et al. Pulmonary subtypes exhibit differential global initiative for chronic obstructive lung disease spirometry stage progression: the COPDGene® study. Chronic Obstr Pulm Dis. 2019;6(5):414–429. https://doi.org/10.15326/ jcopdf.6.5.2019.0155.Li D, Ruan Z, Xie S, Xuan S, Zhao H, Wu B. The relationship between preserved ratio impaired spirometry and mortality in the myocardial infarction survivors: a population-based cohort study. BMC Cardiovasc Disord. 2023;23(1):331. https://doi.org/10.1186/s12872-023-03352-2.Li D, Ruan Z, Xie S, Xuan S, Zhao H, Wu B. The relationship between preserved ratio impaired spirometry and mortality in the myocardial infarction survivors: a population-based cohort study. BMC Cardiovasc Disord. 2023;23(1):331. https://doi.org/10.1186/s12872-023-03352-2.Guerra S, Sherrill DL, Venker C, Ceccato CM, Halonen M, Martinez FD. Morbidity and mortality associated with the restrictive spirometric pattern: a longitudinal study. Thorax. 2010;65(6):499–504. https://doi.org/10.1136/thx.2009.126052.Guerra S, Sherrill DL, Venker C, Ceccato CM, Halonen M, Martinez FD. Morbidity and mortality associated with the restrictive spirometric pattern: a longitudinal study. Thorax. 2010;65(6):499–504. https://doi.org/10.1136/thx.2009.126052.Wan ES, Balte P, Schwartz JE, Bhatt SP, Cassano PA, Couper D et al. Association between preserved ratio impaired spirometry and clinical outcomes in US adults. JAMA. 2021;326(22):2287–2298. https://doi.org/10.1001/jama.2021.20939.Wan ES, Balte P, Schwartz JE, Bhatt SP, Cassano PA, Couper D et al. Association between preserved ratio impaired spirometry and clinical outcomes in US adults. JAMA. 2021;326(22):2287–2298. https://doi.org/10.1001/jama.2021.20939.Shiraishi Y, Shimada T, Tanabe N, Terada K, Sakamoto R, Maetani T et al. The prevalence and physiological impacts of centrilobular and paraseptal emphysema on computed tomography in smokers with preserved ratio impaired spirometry. ERJ Open Res. 2022;8(2):00063–002022. https://doi.org/10.1183/23120541.00063-2022.Shiraishi Y, Shimada T, Tanabe N, Terada K, Sakamoto R, Maetani T et al. The prevalence and physiological impacts of centrilobular and paraseptal emphysema on computed tomography in smokers with preserved ratio impaired spirometry. ERJ Open Res. 2022;8(2):00063–002022. https://doi.org/10.1183/23120541.00063-2022.Kim J, Lee CH, Lee HY, Kim H. Association between comorbidities and preserved ratio impaired spirometry: using the Korean national health and nutrition examination survey IV-VI. Respiration. 2022;101(1):25–33. https://doi.org/10.1159/000517599.Kim J, Lee CH, Lee HY, Kim H. Association between comorbidities and preserved ratio impaired spirometry: using the Korean national health and nutrition examination survey IV-VI. Respiration. 2022;101(1):25–33. https://doi.org/10.1159/000517599.Tang X, Lei J, Li W, Peng Y, Wang C, Huang K, Yang T. The relationship between BMI and lung function in populations with different characteristics: a cross-sectional study based on the enjoying breathing program in China. Int J Chron Obstruct Pulmon Dis. 2022;17:2677–2692. https://doi.org/10.2147/COPD.S378247.Tang X, Lei J, Li W, Peng Y, Wang C, Huang K, Yang T. The relationship between BMI and lung function in populations with different characteristics: a cross-sectional study based on the enjoying breathing program in China. Int J Chron Obstruct Pulmon Dis. 2022;17:2677–2692. https://doi.org/10.2147/COPD.S378247.Mafort TT, Rufino R, Costa CH, Lopes AJ. Obesity: systemic and pulmonary complications, biochemical abnormalities, and impairment of lung function. Multidiscip Respir Med. 2016;11:28. https://doi.org/10.1186/s40248-016-0066-z.Mafort TT, Rufino R, Costa CH, Lopes AJ. Obesity: systemic and pulmonary complications, biochemical abnormalities, and impairment of lung function. Multidiscip Respir Med. 2016;11:28. https://doi.org/10.1186/s40248-016-0066-z.Brazzale DJ, Pretto JJ, Schachter LM. Optimizing respiratory function assessments to elucidate the impact of obesity on respiratory health. Respirology. 2015;20(5):715–721. https://doi.org/10.1111/resp.12563.Brazzale DJ, Pretto JJ, Schachter LM. Optimizing respiratory function assessments to elucidate the impact of obesity on respiratory health. Respirology. 2015;20(5):715–721. https://doi.org/10.1111/resp.12563.Zhang Q, Qiu M, Lai K, Zhong N. Cough and environmental air pollution in China. Pulm Pharmacol Ther. 2015;35:132–136. https://doi.org/10.1016/j.pupt.2015.10.003.Zhang Q, Qiu M, Lai K, Zhong N. Cough and environmental air pollution in China. Pulm Pharmacol Ther. 2015;35:132–136. https://doi.org/10.1016/j.pupt.2015.10.003.Jackson P, Siddharthan T. The global significance of PRISm: how data from lowand middle-income countries link physiology to inflammation. Eur Respir J. 2020;55(4):2000184. https://doi.org/10.1183/13993003.00184-2020.Jackson P, Siddharthan T. The global significance of PRISm: how data from lowand middle-income countries link physiology to inflammation. Eur Respir J. 2020;55(4):2000184. https://doi.org/10.1183/13993003.00184-2020.Hou D, Ge Y, Chen C, Tan Q, Chen R, Yang Y et al. Associations of long-term exposure to ambient fine particulate matter and nitrogen dioxide with lung function: a cross-sectional study in China. Environ Int. 2020;144:105977. https://doi.org/10.1016/j.envint.2020.105977.Hou D, Ge Y, Chen C, Tan Q, Chen R, Yang Y et al. Associations of long-term exposure to ambient fine particulate matter and nitrogen dioxide with lung function: a cross-sectional study in China. Environ Int. 2020;144:105977. https://doi.org/10.1016/j.envint.2020.105977.Godfrey MS, Jankowich MD. The vital capacity is vital: epidemiology and clinical significance of the restrictive spirometry pattern. Chest. 2016;149(1):238–251. https://doi.org/10.1378/chest.15-1045.Godfrey MS, Jankowich MD. The vital capacity is vital: epidemiology and clinical significance of the restrictive spirometry pattern. Chest. 2016;149(1):238–251. https://doi.org/10.1378/chest.15-1045.Lopes TBM, Groth EE, Veras M, Furuya TK, Costa NSX, Ribeiro Júnior G et al. Preand postnatal exposure of mice to concentrated urban PM2.5 decreases the number of alveoli and leads to altered lung function at an early stage of life. Environ Pollut. 2018;241:511–520. https://doi.org/10.1016/j.envpol.2018.05.055.Lopes TBM, Groth EE, Veras M, Furuya TK, Costa NSX, Ribeiro Júnior G et al. Preand postnatal exposure of mice to concentrated urban PM2.5 decreases the number of alveoli and leads to altered lung function at an early stage of life. Environ Pollut. 2018;241:511–520. https://doi.org/10.1016/j.envpol.2018.05.055.D’Amato M, Molino A, Calabrese G, Cecchi L, Annesi-Maesano I, D’Amato G. The impact of cold on the respiratory tract and its consequences to respiratory health. Clin Transl Allergy. 2018;8:20. https://doi.org/10.1186/s13601-018-0208-9.D’Amato M, Molino A, Calabrese G, Cecchi L, Annesi-Maesano I, D’Amato G. The impact of cold on the respiratory tract and its consequences to respiratory health. Clin Transl Allergy. 2018;8:20. https://doi.org/10.1186/s13601-018-0208-9.Berger KI, Reibman J, Oppenheimer BW, Vlahos I, Harrison D, Goldring RM. Lessons from the World Trade Center disaster: airway disease presenting as restrictive dysfunction. Chest. 2013;144(1):249–257. https://doi.org/10.1378/chest.12-1411.Berger KI, Reibman J, Oppenheimer BW, Vlahos I, Harrison D, Goldring RM. Lessons from the World Trade Center disaster: airway disease presenting as restrictive dysfunction. Chest. 2013;144(1):249–257. https://doi.org/10.1378/chest.12-1411.Jaén A, Zock JP, Kogevinas M, Ferrer A, Marín A. Occupation, smoking, and chronic obstructive respiratory disorders: a cross sectional study in an industrial area of Catalonia, Spain. Environ Health. 2006;5:2. https://doi.org/10.1186/1476-069X-5-2.Jaén A, Zock JP, Kogevinas M, Ferrer A, Marín A. Occupation, smoking, and chronic obstructive respiratory disorders: a cross sectional study in an industrial area of Catalonia, Spain. Environ Health. 2006;5:2. https://doi.org/10.1186/1476-069X-5-2.Perez-Padilla R, Montes de Oca M, Thirion-Romero I, Wehrmeister FC, Lopez MV, Valdivia G et al. Trajectories of spirometric patterns, obstructive and PRISm, in a population-based cohort in Latin America. Int J Chron Obstruct Pulmon Dis. 2023;18:1277–1285. https://doi.org/10.2147/COPD.S406208.Perez-Padilla R, Montes de Oca M, Thirion-Romero I, Wehrmeister FC, Lopez MV, Valdivia G et al. Trajectories of spirometric patterns, obstructive and PRISm, in a population-based cohort in Latin America. Int J Chron Obstruct Pulmon Dis. 2023;18:1277–1285. https://doi.org/10.2147/COPD.S406208.Miura S, Iwamoto H, Omori K, Yamaguchi K, Sakamoto S, Horimasu Y et al. Clinical characteristics of preserved ratio impaired spirometry in Japan. Respirology. 2021;26(S3):81–82. https://doi.org/10.1111/resp.14150_29.Miura S, Iwamoto H, Omori K, Yamaguchi K, Sakamoto S, Horimasu Y et al. Clinical characteristics of preserved ratio impaired spirometry in Japan. Respirology. 2021;26(S3):81–82. https://doi.org/10.1111/resp.14150_29.Wu Y, Vollmer WM, Buist AS, Tsai R, Cen R, Wu X et al. Relationship between lung function and blood pressure in Chinese men and women of Beijing and Guangzhou. Int J Epidemiol. 1998;27(1):49–56. https://doi.org/10.1093/ije/27.1.49.Wu Y, Vollmer WM, Buist AS, Tsai R, Cen R, Wu X et al. Relationship between lung function and blood pressure in Chinese men and women of Beijing and Guangzhou. Int J Epidemiol. 1998;27(1):49–56. https://doi.org/10.1093/ije/27.1.49.Jesus FR, Moraes ACS, Silva ILN, Passos FC, Salles C, Neves MCLC, Baccan GC. Analysis of Endocrine and Inflammatory Markers in Preserved Ratio Impaired Spirometry. Med Sci. 2024;12(2):18. https://doi.org/10.3390/medsci12020018.Jesus FR, Moraes ACS, Silva ILN, Passos FC, Salles C, Neves MCLC, Baccan GC. Analysis of Endocrine and Inflammatory Markers in Preserved Ratio Impaired Spirometry. Med Sci. 2024;12(2):18. https://doi.org/10.3390/medsci12020018.Zhou H, Wu Y, Jin Y, Zhou J, Zhang C, Che L et al. Genetic polymorphism of matrix metalloproteinase family and chronic obstructive pulmonary disease susceptibility: a meta-analysis. Sci Rep. 2013;3:2818. https://doi.org/10.1038/srep02818.Zhou H, Wu Y, Jin Y, Zhou J, Zhang C, Che L et al. Genetic polymorphism of matrix metalloproteinase family and chronic obstructive pulmonary disease susceptibility: a meta-analysis. Sci Rep. 2013;3:2818. https://doi.org/10.1038/srep02818.Lu J, Ge H, Qi L, Zhang S, Yang Y, Huang X, Li M. Subtyping preserved ratio impaired spirometry (PRISm) by using quantitative HRCT imaging characteristics. Respir Res. 2022;23(1):309. https://doi.org/10.1186/s12931-022-02113-7.Lu J, Ge H, Qi L, Zhang S, Yang Y, Huang X, Li M. Subtyping preserved ratio impaired spirometry (PRISm) by using quantitative HRCT imaging characteristics. Respir Res. 2022;23(1):309. https://doi.org/10.1186/s12931-022-02113-7.Serifoglu I, Ulubay G. The methods other than spirometry in the early diagnosis of COPD. Tuberk Toraks. 2019;67(1):63–70. https://doi.org/10.5578/tt.68162.Serifoglu I, Ulubay G. The methods other than spirometry in the early diagnosis of COPD. Tuberk Toraks. 2019;67(1):63–70. https://doi.org/10.5578/tt.68162.Wei X, Ding Q, Yu N, Mi J, Ren J, Li J et al. Imaging features of chronic bronchitis with preserved ratio and impaired spirometry (PRISm). Lung. 2018;196(6):649–658. https://doi.org/10.1007/s00408-018-0162-2.Wei X, Ding Q, Yu N, Mi J, Ren J, Li J et al. Imaging features of chronic bronchitis with preserved ratio and impaired spirometry (PRISm). Lung. 2018;196(6):649–658. https://doi.org/10.1007/s00408-018-0162-2.Kim SS, Yagihashi K, Stinson DS, Zach JA, McKenzie AS, Curran-Everett D et al. Visual assessment of CT findings in smokers with nonobstructed spirometric abnormalities in the COPDGene® study. Chronic Obstr Pulm Dis. 2014;1(1):88–96. https://doi.org/10.15326/jcopdf.1.1.2013.0001.Kim SS, Yagihashi K, Stinson DS, Zach JA, McKenzie AS, Curran-Everett D et al. Visual assessment of CT findings in smokers with nonobstructed spirometric abnormalities in the COPDGene® study. Chronic Obstr Pulm Dis. 2014;1(1):88–96. https://doi.org/10.15326/jcopdf.1.1.2013.0001.Fortis S, Comellas A, Kim V, Casaburi R, Hokanson JE, Crapo JD et al. Low FVC/TLC in Preserved Ratio Impaired Spirometry (PRISm) is associated with features of and progression to obstructive lung disease. Sci Rep. 2020;10(1):5169. https://doi.org/10.1038/s41598-020-61932-0.Fortis S, Comellas A, Kim V, Casaburi R, Hokanson JE, Crapo JD et al. Low FVC/TLC in Preserved Ratio Impaired Spirometry (PRISm) is associated with features of and progression to obstructive lung disease. Sci Rep. 2020;10(1):5169. https://doi.org/10.1038/s41598-020-61932-0.Margretardottir OB, Thorleifsson SJ, Gudmundsson G, Olafsson I, Benediktsdottir B, Janson C et al. Hypertension, systemic inflammation and body weight in relation to lung function impairment-an epidemiological study. COPD. 2009;6(4):250–255. https://doi.org/10.1080/15412550903049157.Margretardottir OB, Thorleifsson SJ, Gudmundsson G, Olafsson I, Benediktsdottir B, Janson C et al. Hypertension, systemic inflammation and body weight in relation to lung function impairment-an epidemiological study. COPD. 2009;6(4):250–255. https://doi.org/10.1080/15412550903049157.Enright PL, Kronmal RA, Smith VE, Gardin JM, Schenker MB, Manolio TA. Reduced vital capacity in elderly persons with hypertension, coronary heart disease, or left ventricular hypertrophy. The cardiovascular health study. Chest. 1995;107(1):28–35. https://doi.org/10.1378/chest.107.1.28.Enright PL, Kronmal RA, Smith VE, Gardin JM, Schenker MB, Manolio TA. Reduced vital capacity in elderly persons with hypertension, coronary heart disease, or left ventricular hypertrophy. The cardiovascular health study. Chest. 1995;107(1):28–35. https://doi.org/10.1378/chest.107.1.28.Engstrom G, Hedblad B, Valind S, Janzon L. Increased incidence of myocardial infarction and stroke in hypertensive men with reduced lung function.J Hypertens. 2001;19(2):295–301. https://doi.org/10.1097/00004872-200102000-00017.Engstrom G, Hedblad B, Valind S, Janzon L. Increased incidence of myocardial infarction and stroke in hypertensive men with reduced lung function.J Hypertens. 2001;19(2):295–301. https://doi.org/10.1097/00004872-200102000-00017.Robertson NM, Centner CS, Tejwani V, Hossen S, Karmali D, Liu S, Siddharthan T. Preserved Ratio Impaired Spirometry (PRISm) Prevalence, Risk Factors, and Outcomes: A Systematic Review and Meta-Analysis. Chest. 2025;167(6):1591–1614. https://doi.org/10.1016/j.chest.2024.12.025.Robertson NM, Centner CS, Tejwani V, Hossen S, Karmali D, Liu S, Siddharthan T. Preserved Ratio Impaired Spirometry (PRISm) Prevalence, Risk Factors, and Outcomes: A Systematic Review and Meta-Analysis. Chest. 2025;167(6):1591–1614. https://doi.org/10.1016/j.chest.2024.12.025.Li G, Jankowich MD, Lu Y, Wu L, Shao L, Ke C. Preserved Ratio Impaired Spirometry, Metabolomics, and the Risk of Type 2 Diabetes. J Clin Endocrinol Metab. 2023;108(9):e769–e778. https://doi.org/10.1210/clinem/dgad140.Li G, Jankowich MD, Lu Y, Wu L, Shao L, Ke C. Preserved Ratio Impaired Spirometry, Metabolomics, and the Risk of Type 2 Diabetes. J Clin Endocrinol Metab. 2023;108(9):e769–e778. https://doi.org/10.1210/clinem/dgad140.Thomas PS, Cowen ER, Hulands G, Milledge JS. Respiratory function in the morbidly obese before and after weight loss. Thorax. 1989;44(5):382–386. https://doi.org/10.1136/thx.44.5.382.Thomas PS, Cowen ER, Hulands G, Milledge JS. Respiratory function in the morbidly obese before and after weight loss. Thorax. 1989;44(5):382–386. https://doi.org/10.1136/thx.44.5.382.Talaminos Barroso A, Marquez Martin E, Roa Romero LM, Ortega Ruiz F. Factors affecting lung function: a review of the literature. Arch Bronconeumol. 2018;54(6):327–332. https://doi.org/10.1016/j.arbres.2018.01.030.Talaminos Barroso A, Marquez Martin E, Roa Romero LM, Ortega Ruiz F. Factors affecting lung function: a review of the literature. Arch Bronconeumol. 2018;54(6):327–332. https://doi.org/10.1016/j.arbres.2018.01.030.Collins LC, Hoberty PD, Walker JF, Fletcher EC, Peiris AN. The effect of body fat distribution on pulmonary function tests. Chest. 1995;107(5):1298–1302. https://doi.org/10.1378/chest.107.5.1298.Collins LC, Hoberty PD, Walker JF, Fletcher EC, Peiris AN. The effect of body fat distribution on pulmonary function tests. Chest. 1995;107(5):1298–1302. https://doi.org/10.1378/chest.107.5.1298.Heo IR, Kim HC, Kim TH. Health-Related Quality of Life and Related Factors in Persons with Preserved Ratio Impaired Spirometry: Data from the Korea National Health and Nutrition Examination Survey. Medicina. 2020;57(1):4. https://doi.org/10.3390/medicina57010004.Heo IR, Kim HC, Kim TH. Health-Related Quality of Life and Related Factors in Persons with Preserved Ratio Impaired Spirometry: Data from the Korea National Health and Nutrition Examination Survey. Medicina. 2020;57(1):4. https://doi.org/10.3390/medicina57010004.Klein OL, Krishnan JA, Glick S, Smith LJ. Systematic review of the association between lung function and Type 2 diabetes mellitus. Diabet Med. 2010;27(9):977–987. https://doi.org/10.1111/j.1464-5491.2010.03073.x.Klein OL, Krishnan JA, Glick S, Smith LJ. Systematic review of the association between lung function and Type 2 diabetes mellitus. Diabet Med. 2010;27(9):977–987. https://doi.org/10.1111/j.1464-5491.2010.03073.x.Zhu J, Zhao H, Chen D, Tse LA, Kinra S, Li Y. Genetic correlation and bidirectional causal association between Type 2 diabetes and pulmonary function. Front Endocrinol. 2021;12:777487. https://doi.org/10.3389/fendo.2021.777487.Zhu J, Zhao H, Chen D, Tse LA, Kinra S, Li Y. Genetic correlation and bidirectional causal association between Type 2 diabetes and pulmonary function. Front Endocrinol. 2021;12:777487. https://doi.org/10.3389/fendo.2021.777487.Shin J, Toyoda S, Nishitani S, Onodera T, Fukuda S, Kita S et al. SARS-CoV-2 infection impairs the insulin/IGF signaling pathway in the lung, liver, adipose tissue, and pancreatic cells via IRF1. Metabolism. 2022;133:155236. https://doi.org/10.1016/j.metabol.2022.155236.Shin J, Toyoda S, Nishitani S, Onodera T, Fukuda S, Kita S et al. SARS-CoV-2 infection impairs the insulin/IGF signaling pathway in the lung, liver, adipose tissue, and pancreatic cells via IRF1. Metabolism. 2022;133:155236. https://doi.org/10.1016/j.metabol.2022.155236.Washko GR, Hunninghake GM, Fernandez IE, Nishino M, Okajima Y, Yamashiro T et al. Lung volumes and emphysema in smokers with interstitial lung abnormalities. N Engl J Med. 2011;364(10):897–906. https://doi.org/10.1056/NEJMoa1007285.Washko GR, Hunninghake GM, Fernandez IE, Nishino M, Okajima Y, Yamashiro T et al. Lung volumes and emphysema in smokers with interstitial lung abnormalities. N Engl J Med. 2011;364(10):897–906. https://doi.org/10.1056/NEJMoa1007285.Paterniti MO, Bi Y, Rekić D, Wang Y, Karimi-Shah BA, Chowdhury BA. Acute Exacerbation and Decline in Forced Vital Capacity Are Associated with Increased Mortality in Idiopathic Pulmonary Fibrosis. Ann Am Thorac Soc. 2017;14(9):1395–1402. https://doi.org/10.1513/AnnalsATS.201606-458OC.Paterniti MO, Bi Y, Rekić D, Wang Y, Karimi-Shah BA, Chowdhury BA. Acute Exacerbation and Decline in Forced Vital Capacity Are Associated with Increased Mortality in Idiopathic Pulmonary Fibrosis. Ann Am Thorac Soc. 2017;14(9):1395–1402. https://doi.org/10.1513/AnnalsATS.201606-458OC.Ogata H, Nakano H, Yanagihara T, Moriuchi Y, Enokizu-Ogawa A, Ishimatsu A et al. Preserved ratio impaired spirometry and severity of obstructive sleep apnea: An observational cross-sectional study. Respir Med. 2024;234:107806. https://doi.org/10.1016/j.rmed.2024.107806.Ogata H, Nakano H, Yanagihara T, Moriuchi Y, Enokizu-Ogawa A, Ishimatsu A et al. Preserved ratio impaired spirometry and severity of obstructive sleep apnea: An observational cross-sectional study. Respir Med. 2024;234:107806. https://doi.org/10.1016/j.rmed.2024.107806.Patel I, Zhang JY, Chai YH, Qiao YS, Gong HJ, Xu H, Zhou J. Preserved ratio impaired spirometry, airflow obstruction, and their trajectories in relationship to chronic kidney disease: a prospective cohort study. Sci Rep. 2025;15(1):3439. https://doi.org/10.1038/s41598-025-86952-6.Patel I, Zhang JY, Chai YH, Qiao YS, Gong HJ, Xu H, Zhou J. Preserved ratio impaired spirometry, airflow obstruction, and their trajectories in relationship to chronic kidney disease: a prospective cohort study. Sci Rep. 2025;15(1):3439. https://doi.org/10.1038/s41598-025-86952-6.Sumida K, Kwak L, Grams ME, Yamagata K, Punjabi NM, Kovesdy CP et al. Lung function and incident kidney disease: the atherosclerosis risk in communities (ARIC) study. Am J Kidney Dis. 2017;70(5):675–685. https://doi.org/10.1053/j.ajkd.2017.05.021.Sumida K, Kwak L, Grams ME, Yamagata K, Punjabi NM, Kovesdy CP et al. Lung function and incident kidney disease: the atherosclerosis risk in communities (ARIC) study. Am J Kidney Dis. 2017;70(5):675–685. https://doi.org/10.1053/j.ajkd.2017.05.021.Yang K, Wang L, Shen J, Chen S, Liu Y, Chen R. The association between preserved ratio impaired spirometry and adverse outcomes of depression and anxiety: evidence from the UK Biobank. Psychol Med. 2024;54(12): 3530–3538. https://doi.org/10.1017/S0033291724002162.Yang K, Wang L, Shen J, Chen S, Liu Y, Chen R. The association between preserved ratio impaired spirometry and adverse outcomes of depression and anxiety: evidence from the UK Biobank. Psychol Med. 2024;54(12): 3530–3538. https://doi.org/10.1017/S0033291724002162.

The authors declare that there are no conflicts of interest present.