- The 2012 GLI race-specific equation failed to detect reduced lung function in 39% of Black children participating in three large cohorts.
- The 2022 GLI race-neutral equation identified two- to four-fold more Black children with asthma or asthma symptoms as having reduced lung function.
- The findings suggest that the race-neutral equation, which is recommended by the American Thoracic Society, would result in fewer missed asthma diagnoses.
Lung function assessment factoring in race performed poorly in flagging asthma among Black children, a study showed.
The 2012 Global Lung Initiative (GLI) race-specific equation failed to detect reduced lung function in 39% of Black children participating in three large cohorts, reported Gurjit Khurana Hershey, MD, PhD, of Cincinnati Children’s Hospital Medical Center, and colleagues.
It also failed to indicate reduced percent predicted forced expiratory volume in 1 second (FEV1) in 41-55% of the small number of Black children with asthma or asthma symptoms across two cohorts (12 of 22 and five of 15).
By contrast, the 2022 GLI race-neutral equation identified two- to four-fold more Black children with asthma or symptoms thereof as having reduced lung function, “increasing the likelihood of further testing and asthma detection,” the researchers wrote in JAMA Network Open.
The findings suggest that the race-specific equation “results in missed asthma diagnoses in our most vulnerable populations,” the group added, noting the higher rates of asthma prevalence and morbidity among Black children compared with white children.
The equations used to determine percent predicted FEV1 and forced vital capacity (FVC) adjust for age, sex, height, and race (white, Black, North East Asian, South East Asian, or other).
“[B]ased upon flawed studies suggesting that white people have ‘naturally higher’ lung capacity compared with other races,” these equations have been built into U.S. spirometers and apply a 10-15% adjustment for Black persons.
In 2023, however, the American Thoracic Society recommended that all pulmonary function testing laboratories shift to race-neutral interpretation of results, such as with the GLI 2022 neutral or global equation.
“A shift to universal use of the race-neutral equation will likely improve the detection of asthma, decrease the risk of labeling uncontrolled asthma as controlled, and keep moving science away from outdated racist practices and toward alleviating asthma-related health disparities, promoting health equality,” Khurana Hershey’s group wrote.
The researchers analyzed three cohorts: 849 children ages 5-12 years with mild to moderate asthma in the Childhood Asthma Management Program (CAMP, 1991-2012), 578 infants of atopic parents in the Cincinnati Childhood Allergy and Air Pollution Study (CCAAPS, 2001-2010), and 106 children ages 0-2 years with atopic dermatitis in the Mechanisms of Progression of Atopic Dermatitis to Asthma (MPAACH, 2016-2024).
CAMP followed children for 5 to 6 years, CCAAPS followed participants until age 7 years, and MPAACH followed them for 5 years. The proportion of Black children in the three cohorts was 16%, 20%, and 58%, respectively.
Across all three, switching from the race-specific equation to the race-neutral equation significantly decreased percent predicted FEV1 and FVC in Black children (by 11.9-13.5 percentage points and 13.4-15.4 percentage points, respectively) using the race-neutral equation and increased it to a lesser degree in white children.
Overall, 39% of the Black children (111 of 281) changed from normal (≥90% predicted) to reduced (<90% predicted) FEV1 with the race-neutral versus race-inclusive equation. Only up to 6% of white children changed from reduced to normal with the race-neutral equation.
The race-specific equation led to 44% (16 of 36) of Black children in CCAAPS and 38% (six of 16) of those in MPAACH not being sent for further testing to determine if they had an asthma diagnosis.
“Collectively, these findings suggest that the race-specific equation overestimates lung function in Black children, which may lead to underdiagnosis of asthma in this susceptible group,” Khurana Hershey and colleagues concluded.
Conversely, “the race-neutral equation may lead to earlier detection and treatment for children with uncontrolled asthma, [but] it could potentially lead to overtreatment in well-controlled children with asthma,” they acknowledged.
They noted that the study only analyzed Black and white children’s results, which limits generalizability to other races and ethnicities.
Disclosures
The study was funded by the National Institute of Allergy and Infectious Diseases and the National Institute of Environmental Health Sciences.
Hershey had no disclosures. Co-authors disclosed relationships with the National Institutes of Health, GSK, Sanofi, Regeneron, Amgen, AstraZeneca, Om Pharma, Genentech, Polarean, AiCME, PlatformQ Health, Advent, and UpToDate.
Primary Source
JAMA Network Open
Source Reference: Chi Chang W, et al “Race-specific and race-neutral equations for lung function and asthma diagnosis in Black children” JAMA Netw Open 2025; DOI: 10.1001/jamanetworkopen.2024.62176.
Please enable JavaScript to view the