Expanding the concept of chronic obstructive pulmonary disease: The concept of Preserved Ratio Impaired Spirometry (PRISm)

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. 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. 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. 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. 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.

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