Clinical characteristics and outcomes associated with preserved ratio impaired spirometry (PRISm) in Saudi Arabia

Preserved ratio impaired spirometry (PRISm) is an abnormal spirometric pattern associated with increased morbidity and mortality. However, its psychological and symptomatic burden remains poorly characterized. This study aimed to: (1) assess the prevalence of anxiety, depression, breathlessness, impaired health status, and reduced quality of life; (2) evaluate the impact of psychological and respiratory symptoms on clinical outcomes; and (3) explore the associations of psychological and respiratory symptoms with clinical outcomes among patients with PRISm in Saudi Arabia.

Breathlessness was assessed using the modified Medical Research Council (mMRC) Dyspnea Scale. Symptoms of anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale (HADS). Quality of life was measured using the St. George's Respiratory Questionnaire (SGRQ). Overall health status and the impact of respiratory symptoms on daily activities were assessed using the Chronic Airways Assessment Test (CAAT).

A total of 101 patients with PRISm met our inclusion criteria and were included in the analysis. Of these patients, 38 (37.6%) exhibited symptoms of anxiety, and 27 (26.7%) exhibited symptoms of depression. Furthermore, 45 (44.5%) patients exhibited impacts on their health status in association with PRISm, 37 (36.6%) had increased levels of breathlessness, and 67 (66.3%) had impaired quality of life. PRISm patients with uncontrolled respiratory symptoms have reduced health status and increased levels of psychological symptoms compared with those with controlled symptoms. In addition, quality of life, health status, and respiratory symptoms were significantly impaired in patients with depressive or anxious symptoms compared with those without depression or anxiety. Although no associations were observed with hospital-based outcomes, depression was associated with a higher number of comorbidities.

Our study has shown that individuals with PRISm face substantial respiratory and psychological difficulties, including elevated anxiety and depression levels, as well as frequent hospitalizations. Given that PRISm is underdiagnosed and underappreciated with no clear guidelines on treatment plans, these findings underscore the critical need for routine assessments and comprehensive management strategies to enhance the quality of life for PRISm patients.