By América Torres
The ATS removes race and ethnicity when interpreting patients' spirometry. This organization issued its official statement just weeks after the Global Initiative for Chronic Obstructive Lung Disease published its GOLD Report 2023, which still considers such factors.
The American Thoracic Society's panel of authors remarked that the change was necessary. They believe that taking race and ethnicity into account when interpreting spirometry and other pulmonary function tests (PFTs) can contribute to an inaccurate view of racial differences. In addition, it can mask the effects of differential exposures.
A social construct, rather than a biological one
A social construct, rather than a biological one
In its document, the ATS mentions that racism in PFPs dates back to U.S. President Thomas Jefferson. In 1785, he pointed out that there were differences and deficiencies in the "pulmonary apparatus" of , compared to that of "whites."
Many years later, as spirometry became widespread, explanations of the differences began to expand beyond "a racial factor" to include a wider range of factors such as lung infections, tobacco smoke, pollution, climate, and nutrition. In many clinical and occupational settings, race adjustment was seen as a way to avoid disparity and discrimination.
In contrast, during the 80's (in full apartheid), the work of epidemiologist Jonny Myers and pulmonologist Neil White opposed notions of innate racial differences. These South African researchers had dedicated themselves to studying the health of workers working in mines and in the manufacturing industry. Four decades before the ATS statement, they already argued that the differences were not biological, but merely social and called for the use of a universal standard. Something that was not considered until now.
Race and ethnicity are not relevant in pulmonary function tests
Race and ethnicity are not relevant in pulmonary function tests
The ATS believes that considering race and ethnicity can accentuate health disparities. Classifying patients in this way challenges the notion that racial and ethnic categories have biological significance and questions the use of race in the interpretation of PFT.
In 2021, this organization convened a diverse group of doctors and researchers to participate in a workshop with the objective of evaluating these factors in the interpretation of pulmonary function tests. In that meeting, the evidence available so far was analyzed, as well as the challenges of the practice of specialists. After the discussions of the participating group, they concluded what we have already talked about at the beginning of this article. The following aspects were also mentioned:
- It is recommended to replace race- and ethnicity-specific equations in the interpretation of PFPs and replace them with race-neutral average inference equations.
- A broader reassessment of the use ofPFTs to make clinical, employment, and insurance decisions is suggested.
- There was also a call to involve key stakeholders not represented at this workshop and a precautionary statement regarding the uncertain effects and potential harms of this change.
- Other recommendations include ongoing research and education to understand the impact of change, improve evidence for PFT use in general, and identify modifiable risk factors for reduced lung function.
SCHILLER's mission has always been to offer physicians and researchers pulmonary function testing devices, with the greatest technological advances. This kind of tools, added to the tenacity and meticulousness of men of science, are what allows knowledge to advance to reaffirm, or overturn, the available data. Paradigm shifts are what save lives and improve patients' lives. That's why we're so proud to offer ultrasonic technology in our SpiroScout spirometer, our DLCO system PowerCube Diffusion+, and PowerCube Body+ plethysmograph.
To read the full statement from the ATS, click here.
