What question did this study set out to answer?

This research aims to examine how race-neutral pulmonary function test equations affect diagnosis and treatment of progressive pulmonary fibrosis.

May 20, 2026

A95-09 Impact on Adaptation of Race-Neutral Pulmonary Function Tests on Diagnosis and Treatment of Progressive Pulmonary Fibrosis

Key Points

This research aims to examine how race-neutral pulmonary function test equations affect diagnosis and treatment of progressive pulmonary fibrosis.
Retrospective cohort analysis of 605 patients with non-idiopathic pulmonary fibrosis at MUSC and UTSW clinics.
Validation using a secondary dataset and evaluation of PPF incidence defined by reductions in FVC or DLCO.
Statistical analyses conducted using Cochran’s Q test and McNemar’s test.
In the UTSW cohort, GLI Race-Based equations showed a significant difference in diagnosis compared to NHANES (p < 0.05).
Greater proportions of PPF diagnoses were met using GLI equations compared to Crapo & Morris equations in both cohorts.
Limited racial distribution may affect the ability to detect differences between race-based and race-neutral equations.

Abstract

Abstract Rationale Progressive pulmonary fibrosis (PPF) utilizes physiologic criteria with pulmonary function testing (PFT) to define its classification and inform initiation of anti-fibrotic medications. In PPF, there is a paucity of research examining how the transition to race-neutral equations have affected both classification of PPF and treatment for this group of patients. Methods This was a retrospective cohort analysis of patients seen at the Medical University of South Carolina’s (MUSC) interstitial lung disease (ILD) clinics and diagnosed with non-idiopathic pulmonary fibrosis (IPF) ILD. A secondary prospectively collected dataset from the University of Texas Southwestern (UTSW) was used for validation. Incidence of PPF was determined by a 10% reduction in forced vital capacity (FVC) or diffusion capacity of lungs for carbon monoxide (DLCO) within 1 or 2 years calculated using PFT reference equations for FVC (NHANES, GLI Race-Neutral, and GLI Race-Based) and DLCO (Crapo 0.05) was observed in the reference equations for the UTSW cohort, with the GLI Race-Based equation showing a significant unadjusted difference compared to NHANES; however, no such difference was observed in the MUSC cohort. Evaluation of the incidence of PPF determined by decreases in DLCO found a greater proportion of diagnoses met using the GLI equation relative to Crapo & Morris in both cohorts. Conclusions A difference in rates of diagnosis of PPF between the reference equations used for PFTs could potentially exist. Specifically, this data demonstrated that diagnostic rates were greater with GLI Race-Neutral reference equations. However, the study was limited by the distribution of observations across the race categories, which may have reduced the ability to detect differences between race-based and race-neutral equations, suggesting that larger or more evenly distributed samples are necessary to better evaluate the diagnostic differences between the equations. This abstract is funded by: None

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