According to research published at the ATS 2022 international conference, a significant percentage of black men were found to have normal lung function after race-based adjustments to spirometry were found to have emphysema on their computed tomography (CT) scans.
Black adults in the US are more likely to have unrecognized emphysema than white adults. This is in part due to the normalization of lower lung function in people of color through breed-specific interpretations of spirometry. We found in this observational sample of middle-aged adults in the United States that 14.6 percent of black men (versus 1.7 percent of white men) with “above normal” spirometry were found to have emphysema on race-specific comparisons. imaging CT. Our traditional measures of lung health based on breed-specific spirometry can significantly identify impaired respiratory health in black individuals.”
Gabrielle Liu, MD, study author, pulmonary and critical care fellow, Northwestern University Feinberg School of Medicine, Chicago
It is standard practice to interpret spirometry results using breed-specific standards, leading to a reduction in the predicted lower bound of “normal” for FEV1 and FVC for black patients. FEV1 is the maximum amount of air a person can forcefully exhale in one second and FVC is the forced vital capacity; maximum amount that can be exhaled forcefully after taking a deep breath. The practice of race correction has no biological basis and is based on the erroneous belief, first proposed during colonial times, that black people have smaller lungs.
Spirometry is a commonly used lung function test in which a patient exhales forcefully into a mouthpiece connected to a spirometry machine. The machine measures how much air the person can exhale and inhale and helps determine if he or she has lung disease. Emphysema, which involves the gradual destruction of lung tissue, is often associated with COPD and can lead to extremely poor health outcomes.
dr. Liu and colleagues evaluated the association between self-identified race and visually identified emphysema on CT scans in participants with normal spirometry who participated in the multicenter Coronary Artery Risk Development in Young Adults (CARDIA) study, which followed black and white participants entering in 1985. This study examined the CT scans of 2,674 participants when they were average age 50, and spirometry results when they were average age 55 years.
“We found that significant racial differences in the prevalence of emphysema mainly occur in people with FEV1 between 80 and 120 percent of those predicted,” said Dr. Liu. “This suggests that the greatest potential for misclassification using race-specific comparisons occurs in black adults who are at risk for disease and who may benefit from risk factor modification. .”
The research team also wanted to see whether individual socioeconomic status (SES) and smoking might contribute to higher rates of emphysema in black participants, and whether the association between race and emphysema in people with similar lung function would be reduced or eliminated when adjusted for smoking and SES. They found that there was still a racial disparity in emphysema in people with a similar predicted race-specific FEV1 † However, after adjusting for SES and smoking, the difference in emphysema prevalence between black and white men was reduced.
“We believe that these findings support the rethinking of the use of race-specific spirometry reference comparisons in favor of race-neutral reference comparisons and support further research into the utility and implications of including CT imaging in the evaluation of people with suspected impaired respiratory health and normal spirometry,” said Dr. Liu.
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