A COMPREHENSIVE OVERVIEW OF PRISm: FROM SPIROMETRIC PATTERN TO CLINICAL OUTCOMES AND PSYCHOSOCIAL IMPACT

Preserved Ratio Impaired Spirometry (PRISm) is a spirometric phenotype characterized by reduced forced expiratory volume in the presence of a preserved FEV₁/FVC ratio. It is increasingly recognized as a clinically meaningful condition rather than a benign or transitional state. Individuals with PRISm frequently experience respiratory symptoms, impaired functional capacity, and reduced quality of life, and are at increased risk of cardiovascular disease and mortality compared with those with normal lung function. Objective. This narrative review synthesizes current evidence on the epidemiology, pathophysiology, and clinical consequences of PRISm, with particular emphasis on its association with cardiometabolic diseases and mental health outcomes. Methods. A comprehensive search of PubMed, Web of Science, and Scopus was conducted to identify publications related to PRISm and its association with mental health outcomes up to December 2025, using predefined keywords and Boolean combinations. Eligible cohort, cross-sectional, case–control studies, systematic reviews, and meta analyses were screened, and a total of 68 full-text articles meeting the inclusion criteria were analyzed. Results. Current evidence indicates that the pathophysiology of PRISm is multifactorial, involving small-airway dysfunction, reduced lung volumes, systemic inflammation, skeletal muscle impairment, and metabolic abnormalities such as obesity and insulin resistance. Environmental and occupational exposures further contribute to the risk and progression of PRISm. An expanding body of research links PRISm with depression and anxiety, which increase symptom burden, healthcare utilization, and may independently worsen prognosis. Conclusion. PRISm is a clinically significant and heterogeneous phenotype associated with adverse respiratory, cardiometabolic, and psychosocial outcomes. Despite its growing recognition, it remains underdiagnosed and insufficiently addressed in current clinical frameworks. A multidimensional approach integrating respiratory, metabolic, and mental health assessment is essential, and further research is needed to develop standardized diagnostic criteria and targeted interventions.