ArticleChest2024
Changes in Spirometry Interpretative Strategies: Implications for Classifying COPD and Predicting Exacerbations.
Article in Chest, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers.
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Who cites it
17 citing papers in PubMed.
- Race-neutral spirometry reclassification in self-identified Black and White patients.ERJ open research · 2026Article
- Current Practices and Preferences Regarding Race and Spirometry Interpretation: A National Survey.CHEST pulmonary · 2026Article
- The allure and pitfalls of physiological quotients in lung function interpretation.Respiratory research · 2026Article
- Joint statement from GOLD/GLI regarding the use of spirometry to define airflow obstruction and diagnose COPD.The European respiratory journal · 2026Article
- Author Reply: 'Is lung function in a race against time?'Experimental physiology · 2026Article
- Defining obstruction in COPD: do fixed ratio and lower limit of normal criteria reflect different clinical characteristics? findings from a Greek cross-sectional study (EMENO).BMC pulmonary medicine · 2026Article
- The need to adopt the z-score in the interpretation of spirometry in Brazil.Respiratory research & clinical practice · 2026Article
- Development of an opportunistic chest CT-based nomogram for identifying low muscle mass in hospitalized patients with COPD.Frontiers in medicine · 2026Article
- GLI Global equations for interstitial lung disease patients: shall we keep the baby, the bathwater or both?ERJ open research · 2025Article
- Challenges and Opportunities for the Management of COPD: A Narrative Review of Patient and Health Care Professional Perspectives.Chronic obstructive pulmonary diseases (Miami, Fla.) · 2025Article
- Examining discordance in spirometry reference equations: A retrospective study.Physiological reports · 2025Article
- Demographic and Clinical Characteristics of Mild, Young and Early COPD: A Cross-Sectional Analysis of 5468 Patients.Journal of clinical medicine · 2024Article
- Race-NeutralAmerican journal of respiratory and critical care medicine · 2024Article
- Mexican Hispanics show significant improvement in lung function approximately 1 year after having severe COVID-19.Experimental physiology · 2024Observational
- Reply to Miller: Race-Specific Interpretation of Spirometry.Annals of the American Thoracic Society · 2024Article
- Testing the Limits: Alternative Definitions of Spirometry Thresholds.Annals of the American Thoracic Society · 2024Article
- Pulmonary Function Tests: Easy Interpretation in Three Steps.Journal of clinical medicine · 2024Review
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Authors and funding
8 authors.
Funding
Abstract
backgroundRecent guidelines for spirometry interpretation recommend both race-neutral reference equations and use of z score thresholds to define severity of airflow obstruction. RESEARCH QUESTION: How does the transition from race-specific to race-neutral equations impact severity classifications for patients with COPD when using % predicted vs z score thresholds, and do changes in severity correspond to clinical risk? STUDY DESIGN AND
methodsThis retrospective cohort study included Black and White patients with COPD and available spirometry from the Johns Hopkins Health System. Global Lung Function Initiative (GLI) 2012 (race-specific) equations and GLI Global (race-neutral) equations were used to determine FEV
resultsThis cohort included 13,324 patients, of whom 9,232 patients (69.3%) were White (mean age, 65.7 years) and 4,092 patients (30.7%) were Black (mean age, 61.1 years). More Black than White patients showed a change in severity classification between approaches when using % predicted thresholds (20.2% vs 6.1%; P < .001), but not with z score thresholds (12.6% vs 12.3%; P = .68). An increased severity classification with a race-neutral approach was associated with increased risk of exacerbation when using z score thresholds (OR, 2.34; 95% CI, 1.51-3.63), but not when using % predicted thresholds (OR, 1.08; 95% CI, 0.61-1.93). A decreased severity classification with a race-neutral approach was associated with lower risk of exacerbation with both % predicted (OR, 0.49; 95% CI, 0.28-0.87) and z score (OR 0.67; 95% CI, 0.50-0.90) thresholds.
interpretationThe proportions of Black and White individuals reclassified were similar with z score thresholds, and changes in severity corresponded to clinical risk with z scores. These results support recent recommendations for use of race-neutral equations and z score thresholds for spirometry interpretation.
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