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Clinical Characteristics and Medical Utilization of Smokers with Preserved Ratio Impaired Spirometry [Letter]
Authors Hammad
Received 12 October 2023
Accepted for publication 30 October 2023
Published 2 November 2023 Volume 2023:18 Pages 2391—2392
DOI https://doi.org/10.2147/COPD.S444499
Checked for plagiarism Yes
Editor who approved publication: Dr Richard Russell
Hammad1,2
1Health Department, Poltekkes Kemenkes, Banjarmasin, Indonesia; 2Department Health, Poltekkes Kemenkes Surabaya, Surabaya, Jawa Timur, Indonesia
Correspondence: Hammad, Department of Health, Poltekkes Kemenkes, Jl. H. Mistar Cokrokusumo No. 1A Kelurahan Sei Besar Banjarbaru, Banjarmasin, Kalimantan Selatan, Indonesia, Email [email protected]
View the original paper by Dr Shin and colleagues
A Response to Letter has been published for this article.
Dear editor
We have read the study conducted by the article “Clinical Characteristics and Medical Utilization of Smokers with Preserved Ratio Impaired Spirometry” with a keen interest. While the study by Shin et al1 provides useful real-world data on this understudied population, I believe there are some limitations that should be highlighted for proper interpretation of the results.
The lack of post-bronchodilator spirometry is a significant limitation, as pre-bronchodilator testing is known to overestimate both obstructive and restrictive lung function patterns.2 Without bronchodilator response, definitive classification and phenotyping of the preserved ratio impairment is difficult. Potential comorbid conditions such as heart failure and interstitial lung diseases that could contribute to a restrictive spirometry pattern were not accounted for in the analysis.3 This is an important confounder when attributing outcomes specifically to the spirometric restriction.
The cross-sectional nature of the study means causal inferences cannot be made between PRISm and the outcomes analyzed. Longitudinal follow-up is needed to elucidate the natural history and prognostic significance of PRISm.4
Medication compliance was not considered in the analysis of exacerbations and healthcare utilization. Lack of compliance could significantly confound the results attributed specifically to PRISm.5
Finally, never smokers were excluded from the study population. Analyzing never smokers could provide useful information on risk factors like secondhand smoke exposure and other environmental exposures in PRISm.5
In summary, while this study provides real-world data on PRISm patients, the limitations preclude definitive conclusions. As the authors continue this important research, I hope they will address the limitations highlighted above. This will lead to further elucidation of PRISm as a distinct clinical entity and its optimal management.
Disclosure
The author reports no conflicts of interest in this communication.
References
1. Shin Y, Park S, Lee JH. Clinical characteristics and medical utilization of smokers with preserved ratio impaired spirometry. J Chron Obstruc Pulmona Dis. 2023;2023:2187–2194. doi:10.2147/COPD.S425934
2. Lavorini F. Commentary: quantifying bronchodilator responses in chronic obstructive pulmonary disease trials. Br J Clin Pharmacol. 2005;59(4):385–386. doi:10.1111/j.1365-2125.2005.02400.x
3. Ozoh O, Eze J, Adeyeye O, et al. Unrecognized respiratory morbidity among adolescents and young adults in Nigeria: implications for future health outcomes. Niger Med J. 2020;61:210. doi:10.4103/nmj.NMJ_36_20
4. Woodruff PG, Van Den Berge M, Boucher R, et al. American thoracic society_national heart, lung, and blood institute asthma-chronic obstructive pulmonary disease overlap workshop report. Am J Respir Crit Care Med. 2017;196(3):375–381. doi:10.1164/rccm.201705-0973WS
5. Lamprecht B, Soriano JB, Studnicka M, et al. Determinants of underdiagnosis of COPD in national and international surveys. Chest. 2015;148:971–985. doi:10.1378/chest.14-2535
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