CHEST Guidelines-Effect-of-Race-and-Ethnicity-on-Pulmonary-Function

Effect-of-Race-and-Ethnicity-on-Pulmonary-Function

Pdf Summary

The document is an evidence review and research statement from leading thoracic and respiratory societies evaluating the use of race and ethnicity in interpreting pulmonary function test (PFT) results. Historically, medicine, including respiratory practices, used race and ethnicity as biological variables in clinical assessments, guided by a belief in inherent biological differences among races. However, this approach is increasingly questioned due to concerns about perpetuating health disparities and inaccuracies in medical care.<br /><br />The expert panel addressed three key questions: (1) the validity of race- and ethnicity-specific reference equations for PFTs, (2) clinical implications of using or not using these factors in PFT interpretations, and (3) research gaps in understanding the racial and ethnic effects on PFTs.<br /><br />Current findings reveal statistically significant differences in lung function, such as FEV1 and FVC values, among racial and ethnic groups. While White European ancestry generally associates with larger lung values, the reasons remain only partially explained by socioeconomic and anthropometric factors. This complicates the use of traditional race-based reference equations, with evidence suggesting that they may not accurately reflect lung health outcomes such as mortality and morbidity.<br /><br />The document highlights the need for universally applicable, evidence-based solutions that avoid using race as a biological determinant in spirometry, advocating for improved methods of assessment that integrate social determinants of health and other life-course factors impacting respiratory outcomes. Research priorities include developing standardized definitions and protocols for race and ethnicity and designing studies that emphasize precise biological measurements and clinical relevance.<br /><br />The report underscores that there is no current clinical guidance provided, urging for more research to support future recommendations and the possibility of adopting a race-neutral approach in clinical practice to better address lung health disparities.

Keywords

pulmonary function tests

race and ethnicity

respiratory societies

health disparities

lung function

spirometry

social determinants of health

clinical assessments

reference equations

race-neutral approach