The American Thoracic Society (ATS) removed race and ethnicity from spirometry interpretation. They announced this official change just weeks after the Global Initiative for Chronic Obstructive Lung Disease (GOLD) released its 2023 Report, which still includes these demographic factors in its evaluation criteria.
The ATS‘s panel of authors remarked that the change was necessary. They believe that taking race and ethnicity into account when interpreting spirometry and other pulmonary function tests (PFTs) can contribute to an inaccurate view of racial differences. Moreover, it can mask the effects of differential exposures. Therefore, this move supports the adoption of race-neutral spirometry interpretation.
By América Torres
A social construct, rather than a biological one
In its document, the ATS mentions that racism in pulmonary diagnostics dates back to U.S. President Thomas Jefferson. In 1785, he pointed out that there were differences and deficiencies in the “pulmonary apparatus” of African slaves, compared to that of “whites.”
Many years later, as clinicians and researchers adopted spirometry more widely, they expanded their explanations for the differences beyond “a racial factor” to include a broader range of influences such as lung infections, tobacco smoke, pollution, climate, and nutrition. In many clinical and occupational settings, professionals applied race adjustments in spirometry in an effort to avoid disparity and discrimination.
In contrast, during the 80s (in full apartheid), the work of epidemiologist Jonny Myers and pulmonologist Neil White opposed notions of innate racial differences. These South African researchers dedicated themselves to studying the health of workers working in mines and in the manufacturing industry. Notably, four decades before the ATS statement, they already argued that the differences were not biological, but merely social and called for the use of a universal standard for pulmonary function testing. Something that was not considered until now.
Race and ethnicity are not relevant in pulmonary function tests
The ATS believes that considering race and ethnicity can accentuate health disparities. Classifying patients in this way challenges the notion that racial and ethnic categories have biological significance and questions the use of race in the interpretation of PFT. This underlines the importance of removing race from pulmonary function tests.
In 2021, this organization convened a diverse group of doctors and researchers to participate in a workshop with the objective of evaluating these factors in the interpretation of pulmonary function tests. During that meeting, participants analyzed the available evidence and examined the challenges specialists face in practice. After their discussions, the group concluded what we discussed at the beginning of this article. They also highlighted the following aspects:
- It is recommended to replace race- and ethnicity-specific equations in the interpretation of PFTs ((Pulmonary Function Tests) and replace them with race-neutral average inference equations.
- A broader reassessment of the use of PFTs to make clinical, employment, and insurance decisions is suggested.
- There was also a call to involve key stakeholders not represented at this workshop and a precautionary statement regarding the uncertain effects and potential harms of this change.
- Other recommendations include ongoing research and education to understand the impact of change, improve evidence for PFTs use in general, and identify modifiable risk factors for reduced lung function.
This marks a pivotal shift toward equity in respiratory diagnostics. By eliminating race and ethnicity from pulmonary function test interpretation, the American Thoracic Society aims to foster more accurate, unbiased, and inclusive assessments of lung health.
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REFERENCE
Bhakta, N. R., Bime, et al. Race and ethnicity in pulmonary function test interpretation: An official American Thoracic Society statement. American Journal of Respiratory and Critical Care Medicine, 207(8), 978–995. https://doi.org/10.1164/rccm.202302-0310ST
FAQ
What is race-neutral spirometry interpretation?
Race-neutral spirometry interpretation refers to evaluating lung function test results without adjusting values based on a patient’s race or ethnicity. This approach helps reduce bias and health disparities in respiratory diagnosis.
Why did the ATS remove race and ethnicity from pulmonary function tests?
The ATS determined that including race and ethnicity in PFTs can lead to inaccurate interpretations and reinforce health inequities. They now recommend using race-neutral equations to improve fairness and diagnostic accuracy.
What are the implications of removing race-based adjustments in spirometry?
Removing race-based equations may lead to earlier detection of lung diseases in minority populations, reduce systemic bias, and encourage more equitable treatment standards in respiratory care.