Race and Ethnicity in Pulmonary Function Test Interpretation: An Official American Thoracic Society Statement.

Current American Thoracic Society (ATS) standards promote the use of racial/ethnic-specific reference equations for pulmonary function test (PFT) interpretation. There is rising concern that the use of race/ethnicity in PFT interpretation contributes to a false view of fixed differences between races and may mask the effects of differential exposures. This use of race/ethnicity may contribute to health disparities by norming differences in pulmonary function. In the United States, race serves as a social construct that is based on appearance and reflects social values, structures, and practices. Classification of people into racial/ethnic groups differs geographically and temporally. These considerations challenge the notion that racial/ethnic categories have biological meaning and question the use of race in PFT interpretation. The ATS convened a diverse group of clinicians and investigators for a workshop to evaluate the use of race/ethnicity in PFT interpretation. Review of evidence published since then that challenges current practice and continued discussion concluded with a recommendation to replace race/ethnicity-specific equations with race-neutral average reference equations, which must be accompanied with broader re-evaluation of how PFTs are used to make clinical/employment/insurance decisions. There was also a call to engage key stakeholders not represented in this workshop and a statement of caution regarding the uncertain effects and potential harms of this change. Other recommendations include continued research and education to understand the impact of the change, to improve the evidence for the use of PFTs in general, and to identify modifiable risk factors for reduced pulmonary function.