Transitions Among Four Spirometric States and Subsequent Pre-Bronchodilator Airflow Obstruction: A Community Cohort Study.
6 affiliations
- 1Department of Pulmonary and Critical Care Medicine, West China Hospital, State Key Laboratory of Respiratory Health and Multimorbidity, Sichuan University, Chengdu, Sichuan, People's Republic of China.
- 2Institute of Respiratory Health, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
- 3Precision Medicine Center, Precision Medicine Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
- 4The Research Units of West China, Chinese Academy of Medical Sciences, West China Hospital, Chengdu, Sichuan, People's Republic of China.
- 5Institute of Respiratory Health and Multimorbidity, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
- 6General Office, Cohort Study Center, Institute of Respiratory Health and Multimorbidity, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
Abstract
Purpose
To compare short-term transitions among four pre-bronchodilator spirometric states, assess subsequent airflow obstruction risk by baseline state and the distribution of these states among observed events, and examine the association between repeated isolated spirometry-defined small-airway dysfunction (sSAD) and subsequent airflow obstruction.Patients and methods
We analyzed spirometry data from three Chinese community cohorts (2019-2023). Modified Poisson regression assessed subsequent pre-bronchodilator airflow obstruction (AFO) by baseline state. Logistic models additionally adjusted for baseline FEV₁/FVC. Repeated isolated sSAD was examined using bias-reduced logistic models before and after adjustment for prior FEV₁/FVC values.Results
Among 13,220 participants, 74.1% retained their baseline state. Among 11,551 without baseline AFO, follow-up AFO proportions were 0.61%, 8.11% and 18.60% for preserved spirometry, isolated sSAD and preserved ratio impaired spirometry (PRISm), respectively. In logistic models, additional baseline FEV₁/FVC adjustment reduced standardized risk ratios from 12.44 to 2.33 (95% CI 1.58-3.44) for isolated sSAD and from 26.75 to 4.32 (2.69-6.92) for PRISm. Baseline isolated sSAD accounted for 392 of 492 AFO events (79.7%). Among 3947 participants with preserved spirometry or isolated sSAD at both initial examinations, the OR for two versus no isolated-sSAD detections decreased from 34.49 (12.02-99.00) to 1.99 (0.63-6.31; P=0.242) after adjustment for both prior FEV₁/FVC values.Conclusion
PRISm was associated with the highest subsequent pre-bronchodilator AFO risk, whereas most events occurred in participants with baseline isolated sSAD. Associations were attenuated but persisted after baseline FEV₁/FVC adjustment. The repeated-sSAD association was attenuated and no longer statistically significant after adjustment for both prior ratios.
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BibTeX
@article{he2026transitions,
title = {{Transitions Among Four Spirometric States and Subsequent Pre-Bronchodilator Airflow Obstruction: A Community Cohort Study.}},
author = {Dongyu He and Jiaxuan Wu and Junyi Ke and Lan Yang and Rui Zhang and Weimin Li},
journal = {International journal of chronic obstructive pulmonary disease},
year = {2026},
month = oct,
doi = {10.2147/copd.s655213},
url = {https://europepmc.org/article/MED/42921268},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Transitions Among Four Spirometric States and Subsequent Pre-Bronchodilator Airflow Obstruction: A Community Cohort Study.
AU - Dongyu He
AU - Jiaxuan Wu
AU - Junyi Ke
AU - Lan Yang
AU - Rui Zhang
AU - Weimin Li
PY - 2026
DA - 2026/10/19
JO - International journal of chronic obstructive pulmonary disease
DO - 10.2147/copd.s655213
UR - https://europepmc.org/article/MED/42921268
AB - Purpose To compare short-term transitions among four pre-bronchodilator spirometric states, assess subsequent airflow obstruction risk by baseline state and the distribution of these states among observed events, and examine the association between repeated isolated spirometry-defined small-airway dysfunction (sSAD) and subsequent airflow obstruction.Patients and methods We analyzed spirometry data from three Chinese community cohorts (2019-2023). Modified Poisson regression assessed subsequent pre-bronchodilator airflow obstruction (AFO) by baseline state. Logistic models additionally adjusted for baseline FEV₁/FVC. Repeated isolated sSAD was examined using bias-reduced logistic models before and after adjustment for prior FEV₁/FVC values.Results Among 13,220 participants, 74.1% retained their baseline state. Among 11,551 without baseline AFO, follow-up AFO proportions were 0.61%, 8.11% and 18.60% for preserved spirometry, isolated sSAD and preserved ratio impaired spirometry (PRISm), respectively. In logistic models, additional baseline FEV₁/FVC adjustment reduced standardized risk ratios from 12.44 to 2.33 (95% CI 1.58-3.44) for isolated sSAD and from 26.75 to 4.32 (2.69-6.92) for PRISm. Baseline isolated sSAD accounted for 392 of 492 AFO events (79.7%). Among 3947 participants with preserved spirometry or isolated sSAD at both initial examinations, the OR for two versus no isolated-sSAD detections decreased from 34.49 (12.02-99.00) to 1.99 (0.63-6.31; P=0.242) after adjustment for both prior FEV₁/FVC values.Conclusion PRISm was associated with the highest subsequent pre-bronchodilator AFO risk, whereas most events occurred in participants with baseline isolated sSAD. Associations were attenuated but persisted after baseline FEV₁/FVC adjustment. The repeated-sSAD association was attenuated and no longer statistically significant after adjustment for both prior ratios.
SN - 1176-9106
SN - 1178-2005
ER -