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Spirometry Interpretation After Implementation of Race-Neutral Reference Equations in Children.

Erick Forno1,2, Daniel J Weiner2, Christian Rosas-Salazar3

  • 1Division of Pediatric Pulmonology, Allergy, and Sleep Medicine, Department of Pediatrics, Indiana University, Indianapolis.

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|May 28, 2024
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Switching to race-neutral spirometry equations (GLIN) significantly alters lung function results in children, particularly for Black children. This change may impact the diagnosis and treatment of chronic lung diseases in minority populations.

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Area of Science:

  • Pediatric Pulmonology
  • Respiratory Medicine
  • Clinical Interpretation of Spirometry

Background:

  • Spirometry interpretation in children traditionally used race-specific reference equations.
  • The Global Lung Function Initiative (GLI) has introduced race-neutral reference equations (GLIN, 2023), replacing older race-specific ones (GLIR, 2012).
  • The impact of this transition on pediatric spirometry results and diagnostic patterns is not well understood.

Purpose of the Study:

  • To evaluate changes in spirometry results and interpretation patterns in children when shifting from GLI race-specific (GLIR) to GLI race-neutral (GLIN) reference equations.
  • To assess the differential impact of this transition across racial groups.
  • To understand potential clinical implications for diagnosing pediatric lung diseases.

Main Methods:

  • A cross-sectional study analyzed spirometry data from 24,630 children (aged 6-21) at two US pediatric institutions.
  • Spirometry parameters (FEV1, FVC, FEV1/FVC) were calculated using both GLIR and GLIN equations.
  • Test results were categorized into normal, obstructive, restrictive, and other patterns based on z-scores from both equation sets.

Main Results:

  • Transitioning to GLIN significantly decreased FEV1 and FVC z-scores in Black children, altering normal patterns to restrictive or uncategorized.
  • White children showed smaller, opposite changes in spirometry results.
  • Black children had a threefold higher odds of experiencing a spirometry pattern change after GLIN implementation compared to White children.

Conclusions:

  • Adopting GLI race-neutral reference equations leads to pronounced differences in spirometry results and patterns, varying significantly by race.
  • These changes may affect the clinical management of chronic lung diseases, especially in underrepresented minority children where conditions like asthma are more prevalent.
  • Further research is needed to guide clinical practice and ensure equitable care during this transition.