Impact of race-neutral global reference equations on spirometry interpretation in healthy children in The Gambia

Impact of race-neutral global reference equations on spirometry interpretation in healthy children in The GambiaDear Editor, Accurate interpretation of spirometry results is crucial for diagnosing and managing respiratory diseases, particularly in children.This interpretation relies on reference equations that predict lung function based on factors like age, sex, height, and, historically, race. 1 In 2012, the Global Lung Function Initiative (GLI) introduced race-specific reference equations (GLI 2012 ), aiming for standardised spirometry interpretation across populations. 2However, these equations were primarily developed using data from healthy individuals in North America, Europe and Asia and lacked representation from sub-Saharan Africa.This raises concerns about the accuracy of these equations in interpreting lung function for all populations.The inclusion of race in spirometry equations is a topic of debate due to its potential for bias.Using race-adjusted equations in underrepresented populations can lead to incorrect diagnosis and treatment of lung diseases. 3elying on race-adjusted equations could also worsen already existing racial disparities in healthcare access and outcomes. 4To address this, the GLI released new race-neutral GLI 2022 equations, which rely only on age, sex, and height. 5However, the impact of these revised race-neutral equations on lung function interpretation in children and adolescents from sub-Saharan Africa is yet to be described.Our objective was to evaluate the impact of the GLI 2022 race-neutral equations on the interpretation of lung function in healthy Gambian children compared to the racespecific GLI 2012 equations.Through this evaluation, we aimed to contribute to a more comprehensive understanding of their accuracy and their potential impact on clinical practice.We performed a secondary analysis of spirometry data from 91 children and adolescents who participated as a healthy comparison group in a comparative study that assessed the prevalence of residual respiratory impairment in children after completion of TB treatment. 6The participants were aged 5-18 years and resided in the Western Region of The Gambia.They had no recent respiratory tract infections, no history of smoking and no known chronic respiratory conditions.Spirometry was conducted in accordance with the ERS/ATS (European Respiratory Society/ American Thoracic Society) guidelines using a calibrated portable Easy on-PC spirometer (ndd, Zurich, Switzerland). 2 We derived z-scores for forced expiratory volume in one second (zFEV 1 ), forced vital capacity (zFVC), and the ratio of FEV 1 to forced vital capacity (FVC) using the GLI 2012 and GLI 2022