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Pott, H.* ; Martin, R.* ; Bertrams, W.* ; Abdo, M.* ; Heier, M. ; Peters, A. ; Stubbe, B.* ; Kutzinski, M.* ; Obst, A.* ; Ewert, R.* ; Heider, D.* ; Völzke, H.* ; Rohde, G.* ; Vogelmeier, C.F.* ; Schmeck, B.* ; Karrasch, S.

Three spirometry-based at-risk phenotypes predict incident airflow limitation: A population-based study.

Respirology, DOI: 10.1002/resp.70296 (2026)
Publ. Version/Full Text Research data DOI PMC
Open Access Hybrid
Creative Commons Lizenzvertrag
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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
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Publication type Article: Journal article
Document type Scientific Article
Keywords Copd ; Kora ; Ship ; Airflow Limitation ; Lung Function ; Small Airway Dysfunction; Lung-function; Fef25-75-percent; Equations; Values; Adults; Health
ISSN (print) / ISBN 1323-7799
e-ISSN 1440-1843
Journal Respirology
Publisher Wiley
Publishing Place 111 River St, Hoboken 07030-5774, Nj Usa
Reviewing status Peer reviewed
Institute(s) Institute of Epidemiology (EPI)
Grants Deutsches Zentrum fr Lungenforschung
Bundesministerium fr Bildung und Forschung