Journal Article

Race-specific spirometry equations may overestimate asthma control in Black children and adolescents

Mills, Katherine, Espaillat, Andre E., Schworer, Stephen A., Loughlin, Ceila E., Rooney, Jennifer, Hernandez, Michelle L., Burbank, Allison J., Phipatanakul, Wanda, Atkinson, Claire E.

2023

Overview

Background A growing body of evidence suggests that use of race terms in spirometry reference equations underestimates disease burden in Black populations, which may lead to disparities in pulmonary disease outcomes. Data on asthma-specific health consequences of using race-adjusted spirometry are lacking. Methods We performed a secondary analysis of 163 children from two observational asthma studies to determine the frequencies of participants with ppFEV1 < 80% (consistent with uncontrolled asthma) or ppFEV1 ≥ 80% using race-specific (GLI-African American or Caucasian) vs. race-neutral (GLI-Global) spirometry and their alignment with indicators of asthma control (Asthma Control Test™, ACT). Comparisons of mean ppFEV1 values were conducted using Wilcoxon matched-pairs signed-rank tests. Two group comparisons were conducted using Wilcoxon rank-sum tests. Results Data from 163 children (100 Black, 63 White) were analyzed. Mean ppFEV 1 was 95.4% (SD 15.8) using race-specific spirometry and 90.4% (16.3) using race-neutral spirometry (p < 0.0001). Among 54 Black children with uncontrolled asthma (ACT ≤ 19), 20% had ppFEV1 < 80% using race-specific spirometry compared to 40% using race-neutral spirometry. In Black children with controlled asthma (ACT > 19), 87% had ppFEV1 ≥ 80% using race-specific compared to 67% using race-neutral spirometry. Children whose ppFEV1 changed to ≤ 80% with race-neutral spirometry had lower FEV1/FVC compared to those whose ppFEV1 remained ≥ 80% [0.83 (0.07) vs. 0.77 (0.05), respectively; p = 0.04], suggesting greater airway obstruction. Minimal changes in alignment of ppFEV1 with ACT score were observed for White children. Conclusions Use of race-specific reference equations in Black children may increase the risk of inappropriately labeling asthma as controlled.

• Publisher: BioMed Central,BioMed Central Ltd,Nature Publishing Group,BMC
• Subject: Adolescent / African American children / African Americans / Airway management / Airway Obstruction - diagnosis / Airway Obstruction - epidemiology / Airway Obstruction - ethnology / Alignment / Asthma / Asthma - diagnosis / Asthma - epidemiology / Asthma - ethnology / Asthma - therapy / Asthma Control Test / Asthma in children / Black or African American / Child / Children / Children & youth / Clinical significance / Consent / Correspondence / Cost of Illness / Demographic aspects / Diagnosis / Diagnostic errors / Ethnicity / Health aspects / Health disparities / Humans / Lung diseases / Mathematical analysis / Medicine / Medicine & Public Health / Methods / Mortality / Observational Studies as Topic / Pediatric research / Pneumology/Respiratory System / Population / Race / Racial differences / Rank tests / Review boards / Risk factors / Secondary analysis / Socioeconomic factors / Spirometry / Spirometry - standards / White