Clinical Characteristics and Medical Utilization of Smokers with Preserved Ratio Impaired Spirometry

Int J Chron Obstruct Pulmon Dis. 2023 Oct 6:18:2187-2194. doi: 10.2147/COPD.S425934. eCollection 2023.

Abstract

Purpose: To investigate the clinical characteristics and medical utilization of smokers with preserved ratio impaired spirometry (PRISm).

Patients and methods: We used data from the Korean National Health and Nutrition Examination Survey between 2007 and 2012, linked to the Health Insurance Review and Assessment Service. Clinical characteristics and medical utilization, including inpatient admission, emergency department visit, prescribed medication, and medical cost, were retrospectively compared among three groups: normal spirometry, PRISm, and chronic obstructive pulmonary disease (COPD).

Results: A total of 7115 smokers were included (4743 normal spirometry, 689 PRISm, and 1683 COPD subjects). The mean age was the highest in the COPD group, followed by the PRISm and normal groups, and the proportion of women was the highest in the PRISm group. The tobacco exposure, socioeconomic status (SES), and schooling level of the PRISm group were at levels between those of the normal and COPD groups. However, the PRISm group had the highest proportion of current smokers, highest body mass index (BMI), and lowest mean FEV1 and FVC % predicted. During the study period, the medical utilization of 92 smokers (13.4%) in the PRISm group and 436 smokers (25.9%) in the COPD group was related to respiratory diseases. Emergency department visit or hospitalization and overall medical cost of the PRISm group were comparable to those of the COPD group, except for outpatient clinic visit. Old age, women, low BMI, low SES, low schooling level, high amount of tobacco exposure, wheezing, and decreased FEV1 and FVC % predicted were factors associated with medical utilization in PRISm.

Conclusion: Medical utilization was comparable between the PRISm and COPD groups. Smokers with PRISm who were older, women, or heavy smokers with low BMI, low SES and schooling level, wheezing, or low FEV1 and FVC might need close observation and early treatment.

Keywords: emergency department; hospitalization; lung function; restrictive lung disease; wheezing.

MeSH terms

  • Female
  • Forced Expiratory Volume
  • Humans
  • Lung
  • Nutrition Surveys
  • Pulmonary Disease, Chronic Obstructive* / diagnosis
  • Pulmonary Disease, Chronic Obstructive* / therapy
  • Respiratory Sounds
  • Retrospective Studies
  • Smokers
  • Spirometry
  • Vital Capacity

Grants and funding

This work was supported by the Research Program funded Korea National Institute of Health (Fund CODE 2016ER670100, 2016ER670101, 2016ER670102, 2018ER67100, 2018ER67101, 2018ER67102, 2021ER120500 and 2021ER120501), grants from the Korean Environment Industry and Technology Institute through the Core Technology Development Project for Environmental Disease Prevention and Management, funded by the Korea Ministry of Environment (Grant number 2022003310008), and the National Research Foundation of Korea (NRF-2020R1A5A2019210).