This population-based study evaluated whether three spirometric at-risk phenotypes — Early Airflow Limitation (EAL), Small Airway Dysfunction (SAD), and PRISm — combined into the TriSpi framework, could predict incident airflow limitation in two cohorts: KORA (n=1,973, 3-year follow-up) and SHIP (n=4,150, 5-year follow-up).
TriSpi+ individuals (26%–36% of the population) identified 74%–93% of future airflow limitation cases, with a 10–25-fold increase in risk. Negative predictive values exceeded 95%, and the number needed to screen among TriSpi+ ranged from 7 to 13. EAL had the strongest individual association (OR up to 53.2); SAD was more prevalent in younger adults.
- No post-bronchodilator spirometry was available, limiting specificity for fixed airflow obstruction. - Derivation and validation cohorts are both European, limiting generalizability to other populations. - Follow-up durations differed between cohorts (3 vs. 5 years), complicating direct comparison.
In primary care settings without post-bronchodilator spirometry, applying the TriSpi framework to routine spirometry can flag 1 in 4–3 in 10 patients as high-risk, capturing the vast majority of those who will develop airflow limitation. A negative TriSpi result (NPV >95%) offers strong reassurance that airflow limitation is unlikely in the near term.
