Ethnicity corrections in pulmonary function test reports: what to do?

TL;DR

This paper discusses the debate on whether to apply ethnic corrections in pulmonary function test predictions and suggests that if used, they should be clearly stated.

Contribution

The paper recommends transparency in the use of ethnic corrections in pulmonary function reports.

Findings

Ethnic corrections for lung volumes are inconsistently applied in pulmonary function tests.

There is ongoing debate about the necessity of these corrections for non-European ancestry individuals.

The paper advocates for clear documentation of any ethnic corrections used in reports.

Abstract

The 2023 American Thoracic Society (ATS) document on race and ethnicity in pulmonary function test interpretation advocating “race-neutral prediction equations” [1], and the subsequent editorial on the same subject, in a recent issue of the European Respiratory Journal [2], are timely, in spite of some disagreement. For many years, pulmonary function laboratories have (alternatively, they may have chosen not to) reduced the predictions (based on age, height and sex) for lung volumes and capacities (but not for the transfer factor, TLCO) by 10–15% for patients of African or Asian ancestry. In my book on pulmonary function, published 13 years ago [3], I said (p. 262) “… a practical solution would be to ‘note’ the ethnic origin in the pulmonary function report, rather than correct the lung volumes by an arbitrary figure”.

Current opinions diverge about the need for corrections to lung volume prediction equations for people of non-European ancestry. This letter favours neither position at the present time, but recommends that “ethnic” corrections, if applied, must be stated.
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