{
  "abstract": "Background and Objective: Incident airflow limitation is frequently diagnosed at advanced stages. Identifying individuals at risk through primary care spirometry may enable earlier intervention, yet validated, pragmatic frameworks remain lacking.\n\nMethods: We applied a framework of three mutually exclusive spirometric at‐risk phenotypes, termed Three‐Phenotype Spirometry‐Based Identification (hereafter TriSpi), to 6123 participants from two population‐based cohorts: KORA (n = 1973, 3‐year Follow‐up, derivation) and SHIP (n = 4150, 5‐year Follow‐up, validation). TriSpi+ individuals were defined as meeting criteria for one of the three phenotypes: Early airflow limitation (EAL, FEV1/FVC > 0.7 and < 10th percentile or < 0.7 and > 5th percentile), small airway dysfunction (SAD) defined using FEF50‐ or FEF75‐based thresholds; and preserved‐ratio impaired‐spirometry (PRISm). Associations with incident airflow limitation were tested using Firth's regression.\n\nResults: EAL, PRISm, and SAD (defined using either FEF50 or FEF75‐based thresholds) were significantly associated with incident airflow limitation across cohorts and follow‐ups. TriSpi+ individuals accounted for 26%–36% of the population, identifying 74%–93% of future cases, while TriSpi+ was associated with a 10–25‐fold increase in risk. Negative predictive values exceeded 95% across definitions, and the number needed to screen among TriSpi+ individuals ranged from 7 to 13. EAL showed the strongest individual association (OR up to 53.2), while SAD was more common in younger adults.\n\nConclusion: Combining definitions for EAL, PRISm, and SAD enables robust prediction of incident airflow limitation. TriSpi may serve as a scalable, pragmatic approach for early risk stratification in primary care, in absence of post‐BD spirometry.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Medicine, Pulmonary and Critical Care Medicine Clinic for Airway Infections, University Medical Centre Marburg, Philipps‐University Marburg Marburg Germany",
    "Institute for Lung Research, Universities of Giessen and Marburg Lung Centre, Philipps‐University Marburg Marburg Germany",
    "Institute of Medical Informatics, University of Münster Münster Germany",
    "LungenClinic Grosshansdorf and Airway Research Center North Grosshansdorf Germany",
    "Institute of Epidemiology, Helmholtz Zentrum München ‐ German Research Center for Environmental Health (GmbH) Neuherberg Germany",
    "KORA Study Centre, University Hospital Augsburg Augsburg Germany",
    "Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, LMU Munich Munich Germany",
    "German Centre for Cardiovascular Research (DZHK), Partner Site: Munich Heart Alliance Munich Germany",
    "Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, LMU Munich Munich Germany",
    "Comprehensive Pneumology Center Munich (CPC‐M), Member of the German Center for Lung Research (DZL) Munich Germany",
    "Chair of Epidemiology, Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig‐Maximilians‐Universität München Munich Germany",
    "Department of Internal Medicine B University Medicine Greifswald Greifswald Germany",
    "Institute for Community Medicine, University Medicine Greifswald Greifswald Germany",
    "Department of Medicine, Pulmonary and Critical Care Medicine University Medical Centre Marburg, Philipps‐University Marburg Marburg Germany",
    "German Centre for Lung Research (DZL) Marburg Germany",
    "Institute for Lung Health Giessen Germany",
    "German Centre for Infectious Disease Research (DZIF) Germany"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 17,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Hendrik Pott",
      "orcid": "0000-0002-6842-143X"
    },
    {
      "affs": [
        2
      ],
      "name": "Roman Martin",
      "orcid": "0000-0001-7678-7856"
    },
    {
      "affs": [
        1
      ],
      "name": "Wilhelm Bertrams"
    },
    {
      "affs": [
        3
      ],
      "name": "Mustafa Abdo"
    },
    {
      "affs": [
        4,
        5
      ],
      "name": "Margit Heier"
    },
    {
      "affs": [
        4,
        6,
        7,
        8,
        9,
        10
      ],
      "name": "Annette Peters"
    },
    {
      "affs": [
        11
      ],
      "name": "Beate Stubbe"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Max Kutzinski",
      "orcid": "0009-0008-8751-603X"
    },
    {
      "affs": [
        11
      ],
      "name": "Anne Obst"
    },
    {
      "affs": [
        11
      ],
      "name": "Ralf Ewert",
      "orcid": "0000-0002-6746-9925"
    },
    {
      "affs": [
        2
      ],
      "name": "Dominik Heider",
      "orcid": "0000-0002-3108-8311"
    },
    {
      "affs": [
        12
      ],
      "name": "Henry Völzke"
    },
    {
      "affs": [
        13,
        14
      ],
      "name": "Gernot Rohde",
      "orcid": "0000-0002-5193-7755"
    },
    {
      "affs": [
        13,
        14
      ],
      "name": "Claus F. Vogelmeier"
    },
    {
      "affs": [
        0,
        1,
        13,
        14,
        15,
        16
      ],
      "name": "Bernd Schmeck"
    },
    {
      "affs": [
        4,
        8,
        9
      ],
      "name": "Stefan Karrasch",
      "orcid": "0000-0001-9807-2915"
    },
    {
      "name": "the KORA‐study group"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/01118hndjc8jt.bib",
  "cited_by": 1,
  "doi": "10.1002/resp.70296",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13728517/",
  "id": "01118hndjc8jt",
  "issns": [
    "1323-7799",
    "1440-1843"
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  "landing_url": "https://doi.org/10.1002/resp.70296",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "COPD"
    ],
    [
      "heading",
      "Original Article"
    ],
    [
      "openalex",
      "2740|Chronic Obstructive Pulmonary Disease (COPD) Research"
    ]
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  "openalex": "W7202216613",
  "pdf_url": "https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/resp.70296",
  "pmcid": "PMC13728517",
  "pmid": "42578378",
  "published": "2026-08-11",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/01118hndjc8jt.ris",
  "sources": [
    {
      "first_seen": "2026-11-07T12:21:29Z",
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      "url": "https://doi.org/10.1002/resp.70296"
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  "subjects": [
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      "field": "medicine",
      "origin": "openalex:2740|Chronic Obstructive Pulmonary Disease (COPD) Research",
      "subfield": "general"
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  ],
  "title": "Three Spirometry‐Based At‐Risk Phenotypes Predict Incident Airflow Limitation: A Population‐Based Study",
  "title_text": "Three Spirometry‐Based At‐Risk Phenotypes Predict Incident Airflow Limitation: A Population‐Based Study",
  "type": "peer-reviewed",
  "updated_at": "2026-11-07T12:21:29Z",
  "url": "https://research.draconitic.com/paper/01118hndjc8jt",
  "venue": "Respirology (Carlton, Vic.)",
  "versions": []
}