Applying race-neutral pulmonary function reference equations reduced eligibility for bronchoscopic lung volume reduction compared to race-based equations (71.1% vs 78.9%, p<0.001).
Observational (n=536)
No
Does the use of race-neutral pulmonary function reference equations alter eligibility for bronchoscopic lung volume reduction in patients with advanced COPD?
Transitioning from race-based to race-neutral pulmonary function reference equations significantly reduced the overall pool of candidates eligible for bronchoscopic lung volume reduction.
Absolute Event Rate: 71.1% vs 78.9%
p-value: p=<0.001
Abstract Rationale Recent ATS/ERS guidelines recommend race-neutral equations for pulmonary function test (PFT) interpretation to promote equitable care. Prior studies indicate that adopting race-neutral reference equations can alter the perceived severity of lung disease across diverse ethnic populations, potentially influencing diagnostic classifications and access to advanced therapies. This study examined how implementing race-neutral equations affected eligibility for bronchoscopic lung volume reduction (BLVR) among patients with advanced chronic obstructive pulmonary disease (COPD) at Henry Ford Health in Detroit, Michigan. Methods A retrospective study included patients evaluated for BLVR in the interventional pulmonology clinic at Henry Ford Hospital between January 1, 2019, and June 30, 2024. Patients were initially evaluated for BLVR using race-based equations. PFTs were reinterpreted using the Global Lung Function Initiative race-neutral equations to classify patients as eligible under race-based equations only, race-neutral equations only, both, or neither equation set. Group characteristics were compared using either a chi-square test for independence or Kruskal-Wallis test. BLVR eligibility criteria included FEV1 15-45% predicted, TLC ≥100% predicted, and RV ≥ 150% predicted. Results Among 536 patients, 423 (78.9%) met eligibility criteria using race-based equations, versus 381 (71.1%) using race-neutral equations (p 0.001). Reclassification analysis showed 59 patients (11.0%) would lose eligibility under race-neutral equations (RB+RN-), while 17 (3.2%) would gain eligibility (RB-RN+), yielding a net 7.8% reduction in eligible patients. The majority (67.9%) remained eligible under both equations sets. Age and sex differed significantly among groups (p 0.05), whereas race and BMI 35 did not. Mean FEV1%, DLCO%, TLC%, and RV% predicted all differed significantly between groups. Among patients ineligible under race-neutral equations, FEV1 criteria accounted for 58% of exclusions, followed by TLC (27%), RV (20%), and DLCO (12%). No racial difference in BLVR eligibility was observed, likely reflecting the small proportion of Black patients evaluated in the interventional pulmonary clinic (48 patients; 9%). Conclusions Transitioning from race-based to race-neutral pulmonary function reference equations altered BLVR eligibility, leading to a reduction in the overall pool of candidates. Most reclassifications were driven by changes in FEV1 percent predicted derived from race-neutral equations. These findings highlight the need to assess how race-neutral interpretation of pulmonary function may influence access to advanced therapies for COPD. Although racial differences in BLVR eligibility were not statistically significant in this single-center analysis, the relatively small proportion of Black patients likely limited the statistical power to detect such effects. This abstract is funded by: None
Cherabuddi et al. (Fri,) conducted a observational in Advanced chronic obstructive pulmonary disease (COPD) (n=536). Race-neutral pulmonary function reference equations vs. Race-based pulmonary function reference equations was evaluated on Eligibility for bronchoscopic lung volume reduction (BLVR) (p=<0.001). Applying race-neutral pulmonary function reference equations reduced eligibility for bronchoscopic lung volume reduction compared to race-based equations (71.1% vs 78.9%, p<0.001).