A recent study reveals that race-specific lung function assessments may be underdiagnosing asthma in Black children, potentially exacerbating existing health disparities. Researchers, led by Dr. Gurjit Khurana Hershey of Cincinnati Children’s Hospital Medical Center, found that the 2012 Global Lung Initiative (GLI) race-specific equation failed to detect reduced lung function in a significant proportion of Black children across three large cohorts.
The study, published in JAMA Network Open, compared the performance of the race-specific equation to the 2022 GLI race-neutral equation. Results showed that the race-specific formula missed reduced lung function in 39% of Black children participating in the study. More alarmingly, it failed to indicate reduced percent predicted forced expiratory volume in 1 second (FEV1) in 41-55% of Black children with asthma or asthma symptoms in two of the cohorts.
In contrast, the race-neutral equation identified two to four times more Black children with asthma or related symptoms as having reduced lung function. This increased detection rate could lead to more accurate diagnoses and timely interventions for a population already disproportionately affected by asthma.
The implications of these findings are significant, considering that Black children experience higher rates of asthma prevalence and morbidity compared to their white counterparts. The researchers argue that the race-specific equation, which applies a 10-15% adjustment for Black individuals, is based on flawed studies suggesting inherently higher lung capacity in white people.
Dr. Khurana Hershey’s team emphasizes that switching to the race-neutral equation could improve asthma detection, reduce the risk of mislabeling uncontrolled asthma as controlled, and contribute to addressing asthma-related health disparities. This shift aligns with the American Thoracic Society’s 2023 recommendation for pulmonary function testing laboratories to adopt race-neutral result interpretation.
While the race-neutral approach shows promise in earlier detection and treatment for children with uncontrolled asthma, the researchers acknowledge the potential for overtreatment in well-controlled cases. They also note that the study’s focus on Black and white children limits its generalizability to other racial and ethnic groups.
As the medical community continues to reevaluate long-standing practices, this research underscores the importance of moving away from race-based assessments in pulmonary function testing. The goal is clear: to promote health equality and ensure that all children, regardless of race, receive accurate diagnoses and appropriate care for asthma management.
See: “Race-specific and race-neutral equations for lung function and asthma diagnosis in Black children” (February 28, 2025)
