Spirometry Results Based on Race-Neutral Questions - EMJ

Spirometry Results Differ Based on Race-Neutral Questions

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STUDY reveals that transitioning to race-neutral spirometry reference equations, changes lung function interpretations, potentially impacting treatment for children with chronic lung .

The cross-sectional study of 24,630 children aged 6-21 years between 2012 and 2022 at two large academic paediatric institutions in the United States, found significant differences when switching to the Global Lung Function Initiative race-neutral reference equations (GLIN) on spirometry interpretation in children, particularly those from underrepresented minorities.

The study analysed and compared spirometry results, using the Global Lung Function Initiative (GLI) race-specific reference equations (GLIR) and the newly implemented race-neutral reference equations (GLIN).

Results showed that following the switch to GLIN, forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) scores significantly decreased in Back children. The man difference was -0.814; 95% Cl −0.823 to −0.806; P <.001 for FEV1 and -0.911; 95% CI, −0.921 to −0.902; P <.001 for FVC, resulting in fewer tests categorized as having a normal lung functional pattern (decreasing from 68.7% to 61.9%). The results also identified changes in spirometry patterns, where the reduction in normal pattern tests among Black children was primarily due to reclassification into suspected restrictive or uncategorised patterns. This suggests a substantial shift in the interpretation of lung function and potential changes in clinical management. In contrast, White children showed slight increases in FEV1 and FVCz scores with GLIN, leading to a smaller, yet opposite, effect on spirometry patterns compared to black children. Adjusted models indicated that Black children has approximately three times higher odds than White children of having their spirometry pattern change with the implementation of GLIN (adjusted odds ratio, 3.15; 95% CI, 2.86 to 3.48; P <.001).

This study brings to attention the profound effects of switching to race-neutral reference equations, adopting this change will alter the clinical management of chronic lung diseases, such as asthma, which disproportionately affect minorities. The researchers emphasise that this transition could lead to changes in treatment strategies and ensure more accurate treatment for all paediatric patients.


Forno E et al. Spirometry Interpretation After Implementation of Race-Neutral Reference Equations in Children. JAMA Pediatr.2024 [Epub ahead of print].


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