Pulmonary Function Testing

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Health Equity and Pulmonary Function Testing

Measurements of lung function are essential components of the diagnosis and clinical care of individuals with pulmonary disease. Lung function is used beyond the care of those with chronic lung disease to inform clinical care decisions, such as eligibility for certain medications, surgeries and transplant.  Pulmonary function tests (PFTs) are also used to assess eligibility for certain occupations and have been used to assess eligibility for disability and insurance benefits.

Historically, differences in lung function observed between populations have been attributed to the combination of genetic and environmental influences on the growth and development of the lungs. Consequently, the ATS and ERS have recommended population-specific reference equations, often summarized as race/ethnicity specific reference equations. However, this approach likely underestimates the impact that social determinants have on lung health, and the use of race/ethnic specific equations may obscure true disparities in lung health.

The reasons for observed differences in lung function between people around the world are multifactorial and not fully understood. There are ongoing efforts to elucidate the geographical, environmental, genetic, and social determinants of health that play a role in explaining these observed differences. The ATS is committed to providing the community with clear guidance on interpretation of lung function with approaches that are free from bias. Although we do not have specific guidance currently, the ATS recognizes that race/ethnicity are social constructs and not biological determinants of lung size. The ATS PFT committee together with the Equity, Diversity, and Inclusivity (EDI) committee have convened a workshop to review and discuss the literature and evidence and a workshop report is forthcoming.  The ATS is also part of a larger multi-organization working group which includes CHEST, American Association of Respiratory Care, and Canadian Thoracic Society which is evaluating the evidence and guidance.

New approaches will be considered with a prioritized goal of ensuring health equity and with emphasis on considering lung function in the context of an individual’s medical history and clinical presentation.