CHEST pulmonary · 2026
Current Practices and Preferences Regarding Race and Spirometry Interpretation: A National Survey.
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Brems J Henry, Balasubramanian Aparna, Ferryman Kadija, Wharton Robert, Eakin Michelle N, McCormack Meredith C
Аннотация
BACKGROUND: The American Thoracic Society recently recommended the use of race-neutral rather than race-specific equations for spirometry interpretation. The uptake of and clinicians' opinions about these practices remain unclear.
RESEARCH QUESTION: What are clinicians' current practices and opinions around race-specific vs race-neutral reference equations?
STUDY DESIGN AND METHODS: We conducted a national survey of pulmonologists identified through the American Lung Association and Pulmonary Fibrosis Foundation. Participants completed an electronic survey about their opinions and practices related to race in spirometry reference equations. Descriptive and thematic analyses were conducted.
RESULTS: We received and analyzed 66 responses (29% response rate). Respondents had a median age of 48 years (interquartile range, 41-55), and 63 (95%) worked in an academic setting. A total of 34 respondents (54%) reported that their pulmonary function testing laboratory is already using a race-neutral equation. Most (n = 42, 64%) recommended that race-neutral equations should be used for spirometry interpretation, and 6 (9%) recommended race-specific equations alone should be used. When considering alternatives to race-specific equations, the use of Global Lung Function Initiative (GLI)-Global or GLI-Other as a single race-neutral equation was the most preferred alternative (n = 47, 71%). The most cited advantages of race-neutral equations were (1) improving equity, fairness, and bias (48%); and (2) improving accuracy and classification of disease (40%). The most cited disadvantages were (1) misclassification of respiratory disease (25%) and (2) loss of precision of lung function estimates (13%).
INTERPRETATION: Our results show that most academic pulmonologists would prefer to use a race-neutral rather than race-specific equation for spirometry interpretation. Although most have already transitioned to a race-neutral approach, significant gaps in implementing GLI-Global remain and indicate needs for ongoing research and education.
RESEARCH QUESTION: What are clinicians' current practices and opinions around race-specific vs race-neutral reference equations?
STUDY DESIGN AND METHODS: We conducted a national survey of pulmonologists identified through the American Lung Association and Pulmonary Fibrosis Foundation. Participants completed an electronic survey about their opinions and practices related to race in spirometry reference equations. Descriptive and thematic analyses were conducted.
RESULTS: We received and analyzed 66 responses (29% response rate). Respondents had a median age of 48 years (interquartile range, 41-55), and 63 (95%) worked in an academic setting. A total of 34 respondents (54%) reported that their pulmonary function testing laboratory is already using a race-neutral equation. Most (n = 42, 64%) recommended that race-neutral equations should be used for spirometry interpretation, and 6 (9%) recommended race-specific equations alone should be used. When considering alternatives to race-specific equations, the use of Global Lung Function Initiative (GLI)-Global or GLI-Other as a single race-neutral equation was the most preferred alternative (n = 47, 71%). The most cited advantages of race-neutral equations were (1) improving equity, fairness, and bias (48%); and (2) improving accuracy and classification of disease (40%). The most cited disadvantages were (1) misclassification of respiratory disease (25%) and (2) loss of precision of lung function estimates (13%).
INTERPRETATION: Our results show that most academic pulmonologists would prefer to use a race-neutral rather than race-specific equation for spirometry interpretation. Although most have already transitioned to a race-neutral approach, significant gaps in implementing GLI-Global remain and indicate needs for ongoing research and education.