Black adults with normal lung function were found to have emphysema after race-based adjustments in spirometry.

Black adults with normal lung function were found to have emphysema after race-based adjustments in spirometry.

A significant proportion of black men with normal lung function after race-based adjustments in spirometry were, in fact, found to have emphysema on computerized tomography (CT) scans, according to research published at the ATS 2022 International Conference.

Black adults in the United States are more likely to have unknown emphysema than white adults. This is due in part to the normalization of lower lung function in people of color by race-specific interpretations of spirometry. In this observational sample of middle-aged adults in the United States, we found that 14.6 percent of black men (versus 1.7 percent of white men) who had “above normal” spirometry based on race-specific equations were found to have emphysema on computed tomography. Photography. Our traditional measures of lung health based on race-specific spirometry may be far under-recognizing respiratory health in black individuals.”

Gabrielle Liu, MD, study presenting author, and pulmonary and critical care fellow, Northwestern University Feinberg School of Medicine, Chicago

It is standard practice to interpret results from spirometry using race-specific criteria, resulting in a reduction in the lower expected ‘normal’ FEV1 and FVC for black patients. FEV1 It is the maximum amount of air a person can forcefully exhale in one second and FVC is the forced vital capacity – the maximum amount of force a person can exhale after a deep breath. The practice of race correction has no biological basis and is based on the misconception, first proposed during the colonial era, that black individuals have smaller lungs.

Spirometry is a commonly used test of lung function in which the patient exhales forcefully into a mouthpiece attached to a spirometer. The device measures the amount of air a person can exhale and inhale and helps determine if they have lung disease. Emphysema, which involves the progressive destruction of lung tissue, is often associated with COPD and can lead to very poor health outcomes.

Dr. Liu and colleagues evaluated the association between self-identified race and visually-identified emphysema on computed tomography (CT) scans in participants with normal spirometry who participated in the Multicenter Coronary Risk Development in Adults (CARDIA) study, which followed black participants and eggs starting in 1985. This study examined 2,674 participants with CT scans when their average age was 50, and spirometry results when their average age was 55.

“We found that large racial differences in the prevalence of emphysema occur mostly among people with hepatitis C1 Dr. Liu said between 80 and 120 percent of that was expected. “This suggests that the greatest potential for misclassification using race-specific equations occurs among black adults at risk for disease who would benefit from a risk factor adjustment.”

The research team also wanted to know whether individual socioeconomic status and smoking might contribute to higher rates of emphysema in black participants, and whether the association between race and emphysema among those with similar lung function would be reduced or eliminated when adjusted for smoking and SES. They found that there was still racial disparity in emphysema among those with a similar race-specific expected FEV.1 . However, after adjusting to SES and smoking, the disparity in the prevalence of emphysema was reduced between black and white men.

“We feel that these findings support a reconsideration of the use of race-specific spirometry reference equations in favor of race-neutral reference equations, and support further research into the utility and effects of incorporating CT in the assessment and measurement of those with suspected impaired respiratory health. Normal breathing Dr. Liu said.


American Thoracic Society

2022-05-16 03:48:00

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