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Changes in Spirometry Interpretative Strategies: Implications for Classifying COPD and Predicting Exacerbations.

J Henry Brems1, Aparna Balasubramanian2, Sarath Raju2

  • 1Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD; Berman Institute of Bioethics (J. H. B.), Johns Hopkins University, Baltimore, MD.

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|March 27, 2024
PubMed
Summary
This summary is machine-generated.

The transition to race-neutral spirometry equations and z score thresholds for classifying COPD severity showed similar reclassification rates for Black and White patients. Changes in severity using z scores corresponded to clinical risk, supporting updated guidelines.

Keywords:
% predictedCOPDracereference equationsspirometryz score

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Area of Science:

  • Pulmonary Medicine
  • Respiratory Physiology
  • Clinical Diagnostics

Background:

  • Current spirometry interpretation guidelines advocate for race-neutral reference equations and z score thresholds to determine airflow obstruction severity.
  • The shift from race-specific to race-neutral equations aims to standardize COPD severity classification.

Purpose of the Study:

  • To evaluate how the change from race-specific to race-neutral spirometry equations affects COPD severity classifications.
  • To compare the impact of using percent predicted versus z score thresholds on severity reclassification.
  • To determine if changes in severity classification correlate with clinical outcomes like COPD exacerbations.

Main Methods:

  • A retrospective cohort study analyzed spirometry data from Black and White patients with COPD.
  • Global Lung Function Initiative (GLI) 2012 (race-specific) and GLI Global (race-neutral) equations were applied.
  • Patients' forced expiratory volume in 1 second (FEV1) percent predicted and z scores were calculated to classify disease severity (mild, moderate, severe).
  • Logistic regression assessed the association between changes in severity classification and COPD exacerbations or hospitalizations.

Main Results:

  • Among 13,324 patients (30.7% Black, 69.3% White), race-neutral equations with percent predicted thresholds led to significant reclassification differences between racial groups (20.2% Black vs. 6.1% White).
  • However, z score thresholds showed similar reclassification rates for Black and White patients (12.6% vs. 12.3%).
  • Increased severity classification with race-neutral z scores correlated with higher exacerbation risk (OR, 2.34), while decreased severity correlated with lower risk for both percent predicted and z scores.

Conclusions:

  • Z score thresholds provide consistent COPD severity reclassification across racial groups when transitioning to race-neutral spirometry equations.
  • Changes in severity classification based on z scores align with clinical risk, supporting their use in updated spirometry interpretation guidelines.