Impact of race-based spirometry equations on guideline-based asthma management in clinical trials.

Background: The American Thoracic Society recently recommended that race- and ethnicity-specific predicted equations for spirometry be replaced with race-neutral equations. This change could have implications for asthma management.

Objective: Our aim was to examine the effect of race-specific versus race-neutral spirometry reference equations on the resultant guideline-directed asthma therapy in a study population with a high proportion of Black children.

Methods: We pooled and harmonized data on 2076 children and adolescents across 4 Inner-City Asthma Consortium studies that had all used a computer-asssisted algorithm for management of asthma medication. The asthma control level was recalculated, first by using the percent predicted FEV values derived from the 2012 race-specific equations and then by using those derived from the Global Lung Initiative GLI Global race-neutral equations. The calculated control level was then used to determine the recommendation for treatment step changes.

Results: Among urban Black children not already at the highest recommended inhaled corticosteroid doses, 18% would have been assigned a higher medication step at study entry when using the race-neutral rather than race-specific reference equations to assess asthma control. A very small number of children in other race or ethnicity groups had a recommendation for a higher medication step.

Conclusion: The transition to use of race-neutral values for measures of lung function has the potential to reduce racial bias in diagnosing and treating asthma.