ORIGINAL RESEARCH article
Front. Med.
Sec. Pulmonary Medicine
Clinical characteristics and outcomes associated with preserved ratio impaired spirometry (PRISm) in Saudi Arabia
Abdullah A. Alqarni 1
Abdulelah Aldhahir 2
Hassan Alwafi 3
Rayan A. Siraj 4
Jaber S Alqahtani 5
Hanan F. Nassier 6
Maria M. Kutbi 6
Joud S. Sager 6
Hanadi A. Balfas 6
Ahmed H. Alasimi 7
Yousef Aldabayan 4
John R Hurst 8
1. Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
2. Respiratory Therapy Program, Department of nursing, College of Nursing and Health Sciences, Jazan University, Jazan, Saudi Arabia, Jazan, Saudi Arabia
3. Umm Al-Qura University College of Medicine, Mecca, Saudi Arabia
4. Department of Respiratory Care, College of Applied Medical Sciences, King Faisal University, Al-Ahsa, Saudi Arabia, Al-Ahsa, Saudi Arabia
5. Prince Sultan Military College of Health Sciences, Dhahran, Saudi Arabia
6. King Abdulaziz University, Jeddah, Saudi Arabia
7. Imperial College London, London, United Kingdom
8. University College London, London, United Kingdom
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Abstract
Background: 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. Methods: 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). Results: 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%) demonstrated impacts in association with PRISm on their health status, 37 (36.6%) had increased levels of breathlessness, and 67 (66.3%) had impaired quality of life. PRISm subjects 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 subjects 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. Conclusions: Our study demonstrates 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 quality of life for PRISm patients
Summary
Keywords
Dyspnea, Lung function, Preserved Ratio Impaired Spirometry, PRISM, Quality of Life, respiratory symptoms, Spirometry
Received
22 October 2025
Accepted
23 January 2026
Copyright
© 2026 Alqarni, Aldhahir, Alwafi, Siraj, Alqahtani, Nassier, Kutbi, Sager, Balfas, Alasimi, Aldabayan and Hurst. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Abdullah A. Alqarni
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