, Volume 196, Issue 6, pp 649–658 | Cite as

Imaging Features of Chronic Bronchitis with Preserved Ratio and Impaired Spirometry (PRISm)

  • Xia WeiEmail author
  • Qi Ding
  • Nan Yu
  • Jiuyun Mi
  • Jingting Ren
  • Jie Li
  • Shudi Xu
  • Yanzhong Gao
  • Youmin Guo



The purpose of the study was to investigate the quantitative chest tomographic features of chronic bronchitis with preserved ratio and impaired spirometry (PRISm), including airway wall area, emphysema index, and lung capacity.


An observational, cross-sectional study of 343 patients at the Ninth Hospital of Xi’an Affiliated Hospital of Xi’an Jiaotong University between October 2014 and September 2017. The patients were divided into three groups: 77 cases of chronic bronchitis with normal lung function (forced expiratory volume in one second/forced vital capacity) (FEV1/FVC > 70%, FEV1%pred > 80%), 80 cases of chronic bronchitis with PRISm (FEV1/FVC > 70%, FEV1%pred < 80%), and 186 cases of the early chronic obstructive pulmonary disease (COPD) (FEV1/FVC < 70%, FEV1%pred > 50%, that is, Global Initiative for Chronic Obstructive Lung Disease (GOLD) grade 1 + 2). We compared and analyzed the differences in imaging between the chronic bronchitis with PRISm and the other two groups.


Compared with the early COPD group, the PRISm group revealed significant differences in airway wall area, emphysema index, and lung capacity (P < 0.05). Compared with the chronic bronchitis with normal lung function group, the PRISm group showed increased WA%LUL5, decreased lung capacity, and higher mean lung density.


In terms of airway wall area and emphysema index, patients with chronic bronchitis with PRISm were essentially no different than those with chronic bronchitis without abnormal spirometry, whereas for symptoms, they are more like GOLD 1 and 2 patients. Our findings show that it is not yet clear whether it constitutes an intermediate stage of chronic bronchitis with normal lung function that progression to early COPD.


Chronic obstructive pulmonary disease Chronic bronchitis Preserved ratio and impaired spirometry Computed tomography Early diagnosis 



This study was funded by the following grants: “Digital Lung” disease assessment system and diagnostic criteria (201402013) approved by the Chinese Society for Clinical Research; Award Number: ChiCTR-OCH-14004904 | Recipient: Youmin Guo, Clinical trial registration number: ChiCTR-OCH-14004904. The Social Development Science Research Project of Shaanxi Province; Award Number: No. 2016SF-151 | Recipient: Xia Wei. Xi’an Science and Technology Project; Award Number: 2016045SF / YX01 | Recipient: Xia Wei.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Yin P, Wang H, Vos T, Li Y, Liu S, Liu Y, Liu J, Wang L, Naghavi M, Murray CJ, Zhou M (2016) A subnational analysis of mortality and prevalence of COPD in China from 1990 to 2013. Chest 150:1269–1280CrossRefGoogle Scholar
  2. 2.
    Liu S, Zhou Y, Liu S, Chen X, Zou W, Zhao D, Li X, Pu J, Huang L, Chen J, Li B, Liu S, Ran P (2016) Association between exposure to ambient particulate matter and chronic obstructive pulmonary disease: results from a cross-sectional study in China. Thorax 72:788–795CrossRefGoogle Scholar
  3. 3.
    Tiffeneau R, Pinelli A (1947) Air circulant et air captif dans l’exploration de la fonction ventilatrice pulmonaire. Paris Med 37:624–628PubMedGoogle Scholar
  4. 4.
    Vestbo J, Edwards LD, Scanlon PD, Yates JC, Agusti A, Bakke P, Calverley PM, Celli B, Coxson HO, Crim C, Lomas DA, MacNee W, Miller BE, Silverman EK, Tal-Singer R, Wouters E, Rennard SI, ECLIPSE Investigators (2011) Changes in forced expiratory volume in 1 second over time in COPD. N Engl J Med 365:1184–1192CrossRefGoogle Scholar
  5. 5.
    Iyer VN, Schroeder DR, Parker KO, Hyatt RE, Scanlon PD (2011) The nonspecific pulmonary function test: longitudinal follow-up and outcomes. Chest 139:878–886CrossRefGoogle Scholar
  6. 6.
    Wan ES, Castaldi PJ, Cho MH, Hokanson JE, Regan EA, Make BJ, Beaty TH, Han MK, Curtis JL, Curran-Everett D, Lynch DA, DeMeo DL, Crapo JD, Silverman EK, COPDGene Investigators (2014) Epidemiology, genetics, and subtyping of preserved ratio impaired spirometry (PRISm) in COPDGene. Respir Res 15:89CrossRefGoogle Scholar
  7. 7.
    Guerra S, Sherrill DL, Venker C, Ceccato CM, Halonen M, Martinez FD (2010) Morbidity and mortality associated with the restrictive spirometric pattern: a longitudinal study. Thorax 65:499–504CrossRefGoogle Scholar
  8. 8.
    Mannino DM, Holguin F, Pavlin BI, Ferdinands JM (2005) Risk factors for prevalence of and mortality related to restriction on spirometry: findings from the First National Health and Nutrition Examination Survey and follow-up. Int J Tuberc Lung Dis 9:613–621PubMedGoogle Scholar
  9. 9.
    Vaz Fragoso CA, Gill TM, McAvay G, Yaggi HK, Van Ness PH, Concato J (2011) Respiratory impairment and mortality in older persons: a novel spirometric approach. J Investig Med 59:1089–1095CrossRefGoogle Scholar
  10. 10.
    Mannino DM, Ford ES, Redd SC (2003) Obstructive and restrictive lung disease and markers of inflammation: data from the Third National Health and Nutrition Examination. Am J Med 114:758–762CrossRefGoogle Scholar
  11. 11.
    Diaz AA, Strand M, Coxson HO, Ross JC, San Jose Estepar R, Lynch D, van Rikxoort EM, Rosas IO, Hunninghake GM, Putman RK, Hatabu H, Yen A, Kinney GL, Hokanson JE, Silverman EK, Crapo J, Washko GR (2017) Disease severity dependence of the longitudinal association between CT lung density and lung function in smokers. Chest 153:638–645CrossRefGoogle Scholar
  12. 12.
    Hogg JC (2012) A pathologist’s view of airway obstruction in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 186:5–7CrossRefGoogle Scholar
  13. 13.
    Coxson HO, Leipsic J, Parraga G, Sin DD (2014) Using pulmonary imaging to move chronic obstructive pulmonary disease beyond FEV1. Am J Respir Crit Care Med 190:135–144CrossRefGoogle Scholar
  14. 14.
    Barr RG, Berkowitz EA, Bigazzi F et al (2012) A combined pulmonary-radiology workshop for visual evaluation of COPD: study design, chest CT findings and concordance with quantitative evaluation. COPD 9:151–159CrossRefGoogle Scholar
  15. 15.
    Thomsen LH, Shaker SB, Dirksen A, Pedersen JH, Tal-Singer R, Bakke P, Vestbo J (2015) Correlation between emphysema and lung function in healthy smokers and smokers with COPD. Chronic Obstr Pulm Dis 2:204–213PubMedPubMedCentralGoogle Scholar
  16. 16.
    Haruna A, Muro S, Nakano Y, Ohara T, Hoshino Y, Ogawa E, Hirai T, Niimi A, Nishimura K, Chin K, Mishima M (2010) CT Scan findings of emphysema predict mortality in COPD. Chest 138:635–640CrossRefGoogle Scholar
  17. 17.
    Wei X, Ma Z, Yu N, Ren J, Jin C, Mi J, Shi M, Tian L, Gao Y, Guo Y (2018) Risk factors predict frequent hospitalization in patients with acute exacerbation of COPD. Int J Chronic Obstr Pulm Dis 13:121–129CrossRefGoogle Scholar
  18. 18.
    Pu J, Fuhrman C, Good WF, Sciurba FC, Gur D (2011) A differential geometric approach to automated segmentation of human airway tree. IEEE Trans Med Imaging 30:266–278CrossRefGoogle Scholar
  19. 19.
    Yu N, Xin X-M, Li Y, Ma JC, Gao J, Jin CW, Guo YM (2015) Effect of computed tomography dose on quantitative measurement and automated segmentation of airway tree. J Med Imaging Health Inform 5:1519–1523CrossRefGoogle Scholar
  20. 20.
    Pu J, Leader JK, Zheng B, Knollmann F, Fuhrman C, Sciurba FC, Gur D (2009) A computational geometry approach to automated pulmonary fissure segmentation in CT examinations. IEEE Trans Med Imaging 28:710–719CrossRefGoogle Scholar
  21. 21.
    Pu J, Zheng B, Leader JK, Fuhrman C, Knollmann F, Klym A, Gur D (2009) Pulmonary lobe segmentation in CT examinations using implicit surface fitting. IEEE Trans Med Imaging 28:1986–1996CrossRefGoogle Scholar
  22. 22.
    Burgel PR (2011) The role of small airways in obstructive airway diseases. Eur Respir Rev 20:23–33CrossRefGoogle Scholar
  23. 23.
    McDonough JE, Yuan R, Suzuki M, Seyednejad N, Elliott WM, Sanchez PG, Wright AC, Gefter WB, Litzky L, Coxson HO, Paré PD, Sin DD, Pierce RA, Woods JC, McWilliams AM, Mayo JR, Lam SC, Cooper JD, Hogg JC (2011) Small-airway obstruction and emphysema in chronic obstructive pulmonary disease. N Engl J Med 365:1567–1575CrossRefGoogle Scholar

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Authors and Affiliations

  1. 1.Department of Respiratory MedicineThe Ninth Hospital of Xi’an Affiliated Hospital of Xi’an Jiaotong UniversityXi’anChina
  2. 2.Department of RadiologyThe First Affiliated Hospital of Xi’an Jiaotong UniversityXi’anChina
  3. 3.Department of RadiologyThe Affiliated Hospital of Shaanxi University of Traditional Chinese MedicineXianyangChina
  4. 4.Department of RadiologyThe Ninth Hospital of Xi’an Affiliated Hospital of Xi’an Jiaotong UniversityXi’anChina

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