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Application of the ERS/ATS Spirometry Standards and Race-Neutral Equations in the COPDGene Study
Journal article   Peer reviewed

Application of the ERS/ATS Spirometry Standards and Race-Neutral Equations in the COPDGene Study

Enrico Schiavi, Min Hyung Ryu, Leonardo Martini, Aparna Balasubramanian, Meredith C McCormack, Spyridon Fortis, Elizabeth A Regan, Matteo Bonini and Craig P Hersh
American journal of respiratory and critical care medicine, Vol.210(11), pp.1317-1328
12/01/2024
DOI: 10.1164/rccm.202311-2145OC
PMCID: PMC11622435
PMID: 38607551
url
https://pmc.ncbi.nlm.nih.gov/articles/PMC11622435/pdf/rccm.202311-2145OC.pdfView
Open Access

Abstract

The European Respiratory Society (ERS) and the American Thoracic Society (ATS) recommend using z-scores, and the ATS has recommended using Global Lung Initiative (GLI)- "Global" race-neutral reference equations for spirometry interpretation. However, these recommendations have been variably implemented and the impact has not been widely assessed, both in clinical and research settings. We evaluated the ERS/ATS airflow obstruction severity classification. In the COPDGene Study (n = 10,108), airflow obstruction has been defined as a forced expiratory volume in one second to forced vital capacity (FEV1/FVC) ratio <0.70, with spirometry severity graded from class 1 to 4 based on race-specific percent predicted (pp) FEV1 cut-points as recommended by the Global Initiative for Chronic Obstructive Lung Disease (GOLD). We compared the GOLD approach, using NHANES III race-specific equations, to the application of GLI-Global equations using the ERS/ATS definition of airflow obstruction as FEV1/FVC ratio < lower limit of normal (LLN) and z-FEV1 cut-points of -1.645, -2.5, and -4 ("zGLI Global"). We tested the four-tier severity scheme for association with COPD outcomes. The lowest agreement between ERS/ATS with zGLI Global and the GOLD classification was observed in individuals with milder disease (56.9% and 42.5% in GOLD 1 and 2) and race was a major determinant of redistribution. After adjustment for relevant covariates, zGLI Global distinguished all-cause mortality risk between normal spirometry and the first grade of COPD (Hazard Ratio 1.23, 95% CI 1.04-1.44, p=0.014), and showed a linear increase in exacerbation rates with increasing disease severity, in comparison to GOLD. The zGLI Global severity classification outperformed GOLD in the discrimination of survival, exacerbations, and imaging characteristics.
 Ethnicity Pulmonary Function Tests Survival Analysis Chronic Obstructive Pulmonary Disease

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