Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology · 2025
Implications of removing race from spirometry reference equations in children with asthma.
СтатьяПоддержка NIH: внешняя программаНазвание и аннотация: Перевод пока не подготовлен
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Mahmood Lina Z, Perry Tamara T, Jefferson Akilah A, Berlinski Ariel
Аннотация
BACKGROUND: The Global Lung Initiative (GLI) recently developed a race-neutral reference equation in 2022 (GLI-2022); however, the implications of its use in children with asthma, especially Latino children, have not been extensively studied.
OBJECTIVE: To assess the difference in spirometry results, asthma severity, and airway obstruction classification for African American (AA), Latino, and White children with asthma after implementing GLI-2022.
METHODS: This retrospective cross-sectional study evaluated the first spirometry performed by children with asthma aged 5 to 17 years between January 1, 2018, and December 31, 2023. z-Scores and percent-predicted (pp) values for forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and FEV1/FVC were calculated using GLI-2022 and race-adjusted GLI-2012 equations.
RESULTS: A total of 7138 children (3543 AA, 2795 White, and 800 Latino) were included (median age = 10.3 years). FEV1 z-score median difference was -0.872, -0.360, and +0.267 in AA, Latino, and White children, respectively (P < .0001) after implementing GLI-2022. FVC z-scores, ppFEV1, and ppFVC values demonstrated similar patterns. Adopting GLI-2022 worsened asthma severity (based on ppFEV1) and degree of airway obstruction (based on FEV1 z-score) classifications in AA children, improved them in White children, and did not affect Latino children.
CONCLUSION: Implementing GLI-2022 affected asthma severity and airway obstruction classifications and resulted in a lower FVC and FEV1 in AA and Latino children and greater values in White children. Using GLI-2022 may uncover more cases of underdiagnosed asthma in AA and Latino children, which may contribute to alleviating disparate asthma outcomes.
OBJECTIVE: To assess the difference in spirometry results, asthma severity, and airway obstruction classification for African American (AA), Latino, and White children with asthma after implementing GLI-2022.
METHODS: This retrospective cross-sectional study evaluated the first spirometry performed by children with asthma aged 5 to 17 years between January 1, 2018, and December 31, 2023. z-Scores and percent-predicted (pp) values for forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and FEV1/FVC were calculated using GLI-2022 and race-adjusted GLI-2012 equations.
RESULTS: A total of 7138 children (3543 AA, 2795 White, and 800 Latino) were included (median age = 10.3 years). FEV1 z-score median difference was -0.872, -0.360, and +0.267 in AA, Latino, and White children, respectively (P < .0001) after implementing GLI-2022. FVC z-scores, ppFEV1, and ppFVC values demonstrated similar patterns. Adopting GLI-2022 worsened asthma severity (based on ppFEV1) and degree of airway obstruction (based on FEV1 z-score) classifications in AA children, improved them in White children, and did not affect Latino children.
CONCLUSION: Implementing GLI-2022 affected asthma severity and airway obstruction classifications and resulted in a lower FVC and FEV1 in AA and Latino children and greater values in White children. Using GLI-2022 may uncover more cases of underdiagnosed asthma in AA and Latino children, which may contribute to alleviating disparate asthma outcomes.