Race-neutral lung function equations alter FEV1, FVC in pediatric patients with asthma
Key takeaways:
- African American and Latino pediatric patients had lower FEV1 and FVC z scores after race-neutral equation use.
- African American patients also had poorer asthma severity following equation use.
SAN DIEGO — Following use of race-neutral lung function equations, African American and Latino pediatric patients with asthma had reductions in FEV1 and FVC while white patients with asthma had increases, according to a presentation here.
This retrospective cross-sectional study was presented at the 2025 American Academy of Allergy, Asthma and Immunology/World Allergy Organization Joint Congress.
“Based on our findings that add on to previous studies by evaluating Latino children as well as African American and white children, the everyday clinician should firstly recognize that race-adjusted spirometry is not based on inherent physiological differences between different races and ethnicities; rather, race-adjusted spirometry has repeatedly been shown to overestimate asthma control for African American children and adults, which likely led to under-treatment of asthma in this population,” Lina Mahmood, MD, allergy and immunology fellow physician at University of Arkansas for Medical Sciences/Arkansas Children’s Hospital, told Healio.
“Implementing race-neutral spirometry reference equations offers the opportunity to identify more African American and Latino patients with asthma to provide early and appropriate therapies based on their asthma severity and control; young children should be a special focus of these interventions to avoid irreversible structural lung changes,” Mahmood continued.
Using data from January 2018 to December 2023, Mahmood and colleagues evaluated 7,138 pediatric patients aged 5 to 17 years with asthma and spirometry tests to determine how various lung function measures captured for three racial groups differ after use of Global Lung Function Initiative race-neutral reference equations.
This study population included 3,543 African American pediatric patients, 2,795 white pediatric patients and 800 Latino pediatric patients, according to the abstract.
When analyzing median changes in FEV1 z scores, researchers found reductions in this measure among African American (–0.872) and Latino (–0.36) patients, whereas white patients had a rise in this z score (+0.267).
Similarly, African American and Latino pediatric patients experienced drops in FVC z scores with use of race-neutral spirometry equations (median change, –0.966 and –0.548), whereas this measure went up among white pediatric patients (median change, +0.268), according to the abstract.
Researchers noted comparable patterns to those above when evaluating change in percent-predicted FEV1 and FVC values after applying race-neutral spirometry.
The direction of FEV1/FVC z scores following use of race-neutral equations also differed by racial group, as African American and Latino patients saw rises in this measure, and white patients saw a decline.
To uncover if asthma severity improved or worsened in the groups after race-neutral spirometry use, researchers looked at percent-predicted FEV1. For changes in airway obstruction classification, FEV1 z score was used.
“Our study showed that after switching to race-neutral spirometry, we saw worsened asthma severity and airway obstruction for African American children, improved outcomes for white children and no changes for Latino children,” Mahmood told Healio. “These findings were mostly in line with several prior studies that assessed the implications of race-neutral spirometry in adults and children, but with the addition of Latino children as a unique group for evaluation.”
Looking ahead, Mahmood said more research is needed on this topic.
“Future research is essential to further assess the implications of using race-neutral spirometry, particularly in pediatric populations, where studies remain limited,” Mahmood told Healio.
“Additionally, it is important for future studies to incorporate greater racial and ethnic diversity, as well as include children with other respiratory conditions, to ensure comprehensive comparisons and findings,” Mahmood said.
For more information:
Please reach out to study author Ariel Berlinski, MD, at berlinskiariel@uams.edu.