Prevalence, Associated Factors and Quality of Life in PRISm: Findings from a Cross-Sectional Study in a Low- to Middle-Income Country
- 1Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
- 2INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
- 3Department of Pulmonology, Lebanese American University Medical Center, Rizk Hospital, Beirut, Lebanon
Abstract
Background: Preserved Ratio Impaired Spirometry (PRISm) is increasingly recognized as a potential precursor to chronic obstructive pulmonary disease (COPD); however, evidence on its relevance in Lebanon and neighboring countries remains limited. This study aimed to estimate PRISm prevalence, identify associated factors, and assess its relationship with quality of life (QoL) among adults.
Methods: A cross-sectional study using multistage cluster sampling was conducted in two major governorates (Beirut and Mount Lebanon) in 2025. Participants were classified as having normal pulmonary function tests (PFTs) with FEV1 (forced expiratory volume in 1 sec)/FVC (forced vital capacity) ≥ 0.7 and FEV1 ≥ 80%, PRISm with FEV1/FVC ≥ 0.7 and FEV1 < 80% post-bronchodilator, COPD as FEV1/FVC < 70% post-bronchodilator, or other patterns. Data included sociodemographic, clinical, lifestyle, and QoL using the St. George’s Respiratory Questionnaire (SGRQ). A multinomial regression analysis was conducted to identify factors associated with each spirometry pattern, mainly PRISm, while a multiple linear regression was used to examine factors associated with the QoL. An alpha of 0.05 was considered statistically significant.
Results: The mean age of the 760 participants was 60 years (51.3% females, 53.4% current smokers). PRISm prevalence was 10.1% (95% CI: 8.1–12.5). PRISm were older (adjusted OR (95% CI) = 1.03 (1.01–1.05); p=0.042), had greater cumulative cigarette smoking (1.007 (1.001–1.01; p=0.028), and were more likely to report wheeze (2.64 (1.34–5.20); p=0.005) versus normal PFT. PRISm was not significantly associated with worse QoL, whereas COPD was associated with poorer QoL.
Conclusion: PRISm may represent an important respiratory phenotype in this LMIC, associated with older age, cumulative smoking, and wheeze, supporting the role of spirometry-based early detection and smoking cessation in at-risk populations. PRISm was not significantly associated with QoL impairment, in contrast to COPD, highlighting the substantial patient-reported burden of the latter. Further longitudinal studies are needed to clarify the natural history of PRISm and guide prevention and management strategies.
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BibTeX
@article{akiki2026prevalence,
title = {{Prevalence, Associated Factors and Quality of Life in PRISm: Findings from a Cross-Sectional Study in a Low- to Middle-Income Country}},
author = {Zeina Akiki and Heba Mohsen and Hala AlJawhary and Pascale Salameh and Dany Gaspard},
journal = {International Journal of Chronic Obstructive Pulmonary Disease},
year = {2026},
month = oct,
doi = {10.2147/copd.s627414},
url = {https://doi.org/10.2147/copd.s627414},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Prevalence, Associated Factors and Quality of Life in PRISm: Findings from a Cross-Sectional Study in a Low- to Middle-Income Country
AU - Zeina Akiki
AU - Heba Mohsen
AU - Hala AlJawhary
AU - Pascale Salameh
AU - Dany Gaspard
PY - 2026
DA - 2026/10/30
JO - International Journal of Chronic Obstructive Pulmonary Disease
DO - 10.2147/copd.s627414
UR - https://doi.org/10.2147/copd.s627414
AB - Background: Preserved Ratio Impaired Spirometry (PRISm) is increasingly recognized as a potential precursor to chronic obstructive pulmonary disease (COPD); however, evidence on its relevance in Lebanon and neighboring countries remains limited. This study aimed to estimate PRISm prevalence, identify associated factors, and assess its relationship with quality of life (QoL) among adults. Methods: A cross-sectional study using multistage cluster sampling was conducted in two major governorates (Beirut and Mount Lebanon) in 2025. Participants were classified as having normal pulmonary function tests (PFTs) with FEV1 (forced expiratory volume in 1 sec)/FVC (forced vital capacity) ≥ 0.7 and FEV1 ≥ 80%, PRISm with FEV1/FVC ≥ 0.7 and FEV1 < 80% post-bronchodilator, COPD as FEV1/FVC < 70% post-bronchodilator, or other patterns. Data included sociodemographic, clinical, lifestyle, and QoL using the St. George’s Respiratory Questionnaire (SGRQ). A multinomial regression analysis was conducted to identify factors associated with each spirometry pattern, mainly PRISm, while a multiple linear regression was used to examine factors associated with the QoL. An alpha of 0.05 was considered statistically significant. Results: The mean age of the 760 participants was 60 years (51.3% females, 53.4% current smokers). PRISm prevalence was 10.1% (95% CI: 8.1–12.5). PRISm were older (adjusted OR (95% CI) = 1.03 (1.01–1.05); p=0.042), had greater cumulative cigarette smoking (1.007 (1.001–1.01; p=0.028), and were more likely to report wheeze (2.64 (1.34–5.20); p=0.005) versus normal PFT. PRISm was not significantly associated with worse QoL, whereas COPD was associated with poorer QoL. Conclusion: PRISm may represent an important respiratory phenotype in this LMIC, associated with older age, cumulative smoking, and wheeze, supporting the role of spirometry-based early detection and smoking cessation in at-risk populations. PRISm was not significantly associated with QoL impairment, in contrast to COPD, highlighting the substantial patient-reported burden of the latter. Further longitudinal studies are needed to clarify the natural history of PRISm and guide prevention and management strategies.
SN - 1176-9106
SN - 1178-2005
ER -