Race-neutral versus race-specific GLI reference equations on spirometry interpretation in the general population

Area of Science:

• Pulmonary Medicine
• Respiratory Physiology
• Clinical Epidemiology

Background:

• Pulmonary function interpretation is crucial for diagnosing and managing respiratory diseases.
• The Global Lung Function Initiative (GLI) has evolved its spirometry reference equations from race-specific (2012) to race-neutral (2022).

Purpose of the Study:

• To evaluate the impact of transitioning from the 2012 race-specific GLI to the 2022 race-neutral GLI reference equations on spirometry interpretation in Northeast Asians.
• To assess changes in lung function impairment, medical disability classification, and longitudinal lung function trajectories.

Main Methods:

• Utilized spirometric data from 10,030 adults in the KoGES cohort.
• Derived percent-predicted values using both 2012 race-specific and 2022 race-neutral GLI reference equations.
• Analyzed prevalence of lung function impairment, medical disability, associations with respiratory symptoms, and lung function decline rates.

Main Results:

• Moderate to almost perfect agreement was observed between the two GLI equation sets for impairment and disability classification.
• The 2022 race-neutral equations reclassified 48.9% and 39.9% of patients to normal lung physiology or less severe disability.
• While symptom associations remained consistent, the 2022 equations indicated more rapid longitudinal decline in FEV1 and FVC (p < 0.001).

Conclusions:

• The shift to race-neutral 2022 GLI equations decreases lung function impairment and medical disability classifications in Northeast Asians.
• Different rates of lung function decline are observed with the new equations, despite consistent symptom associations.
• Careful consideration is needed when adopting new pulmonary function interpretation approaches due to differential effects across populations.