Race-Based Pulmonary Function Testing Correction in COPD Inhaler Therapy Trials: A Systematic Review.

Area of Science:

• Pulmonary Medicine
• Clinical Trial Methodology
• Health Disparities

Background:

• Race-based correction is a common practice in clinical settings for pulmonary function testing (PFT).
• Concerns exist that this practice may lead to underdiagnosis and exclusion of minority populations from research.
• This systematic review investigates the use and impact of race-based correction in chronic obstructive lung disease (COPD) research.

Approach:

• A systematic search of Medline (2010-2022) identified randomized controlled trials (RCTs) on COPD inhaler therapy.
• Data on study design, inclusion criteria, demographics, and race-based correction were extracted and synthesized.
• 21 RCTs involving 70,696 participants were included in the review.

Key Points:

• Racial minorities were underrepresented in the included COPD trials, with Black participants comprising <1% to 4.7%.
• Race-based correction was explicitly mentioned in only 4 studies, but estimated to be used in 15 of the 21 trials.
• Inconsistent reporting of race-based correction practices was noted.

Conclusions:

• Race-based correction is likely prevalent in major COPD RCTs, yet reporting is inconsistent.
• This lack of transparency may exacerbate the underrepresentation of racialized populations in clinical research.
• Further investigation into the implications of race-based correction on health equity in COPD is warranted.