From the authors

We read with great interest the article by Wijnant et al. [1] in a recent issue of European Respiratory Journal investigating the longitudinal outcomes of patients with preserved ratio impaired spirometry (PRISm) in the Rotterdam cohort. PRISm is a subject of increased investigation as it is associated with respiratory symptoms, cardiovascular disease, metabolic syndrome and, quite clearly in the recent study, increased mortality [1–3]. While there have been numerous studies examining outcomes related to PRISm in high-income countries (HICs), few studies have assessed the clinical significance of this spirometric finding in low- and middle-income countries (LMICs).

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