Race-Specific and Race-Neutral Equations for Lung Function and Asthma Diagnosis in Black Children.

Summary

Across three pediatric cohorts (n=1533), applying race-neutral GLI equations lowered percent-predicted FEV1 in Black children by ~12–13 percentage points versus race-specific equations, revealing previously missed airflow limitation. Consequently, many Black children became eligible for bronchodilator reversibility testing, improving objective asthma detection.

Key Findings

• Race-neutral GLI equations reduced percent-predicted FEV1 by 11.9–13.5 pp in Black children across three cohorts.
• Race-specific equations missed reduced FEV1 in 55% (CCAAPS) and 41% (MPAACH) of symptomatic/asthmatic Black children.
• Switching to race-neutral equations increased eligibility for bronchodilator reversibility testing by 38–44% in Black children.

Clinical Implications

Adopting race-neutral GLI equations in pediatric spirometry will increase identification of airflow limitation and eligibility for reversibility testing among Black children, leading to earlier, more equitable asthma diagnosis and management.

Limitations

• Observational design; not a randomized diagnostic intervention
• Generalizability beyond included cohorts and age ranges may be limited

Future Directions

Prospective implementation studies assessing clinical outcomes and healthcare utilization after adopting race-neutral equations in pediatric and adult practices; guideline integration and EHR decision support.