Implications of removing race from spirometry reference equations in children with asthma

Area of Science:

• Pediatric Pulmonology
• Respiratory Medicine
• Health Disparities Research

Background:

• The Global Lung Initiative (GLI) introduced a race-neutral reference equation (GLI-2022) in 2022.
• The impact of GLI-2022 on asthma assessments in diverse pediatric populations, particularly Latino children, remains understudied.

Purpose of the Study:

• To evaluate changes in spirometry results, asthma severity, and airway obstruction classifications in African American (AA), Latino, and White children with asthma following GLI-2022 implementation.
• Compare GLI-2022 findings with previous race-adjusted GLI-2012 equations.

Main Methods:

• Retrospective cross-sectional analysis of spirometry data from children aged 5-17 with asthma (2018-2023).
• Calculated z-scores and percent-predicted values for FVC, FEV1, and FEV1/FVC using both GLI-2022 and GLI-2012 equations.
• Included 7138 children: 3543 AA, 2795 White, and 800 Latino.

Main Results:

• GLI-2022 implementation showed significant differences in FEV1 z-scores: -0.872 for AA, -0.360 for Latino, and +0.267 for White children (P < .0001).
• Asthma severity and airway obstruction classifications worsened for AA children and improved for White children.
• Latino children's classifications remained largely unaffected, but FVC and FEV1 values were lower compared to White children.

Conclusions:

• GLI-2022 adoption alters asthma severity and obstruction classifications across racial groups.
• The new equation may lead to the identification of more underdiagnosed asthma cases in AA and Latino children.
• This could be a crucial step toward addressing and mitigating disparities in asthma outcomes.