Lost in Equity-Impact of reference equation change and ERS/ATS 2022 guidelines on lung function test interpretationin Pakistani population

<bold>Objective:</bold> To compare spirometry interpretations based on race-neutral and race-specific equations in Pakistani patient population To determine differences in the percentage of obstructive function impairments identified using the two sets of reference equations <bold>Methods:</bold> Calculators based on race-neutral Global Lung Function Initiative 2020 (GLI) and GLI 2012 were developed using self-generated API keys. The interpretations were compared with those produced using two race and ethnicity–specific reference equations. Data from spirometry from January 2012-2022 was taken. Data analysis was done in R software. <bold>Results:</bold> Total 16915 cases were included; incase of patients with more than one spirometry only first was include in the data. This resulted in exclusion of 4316 studies.12599 were included in final analysis. 10,153(80.6%) males and 2446 (19.4%) were females. Median age was 42 (IQR 33-53). 2384 (18.9%) were smokers and 830 ex-smokers. Differences in Mean FEV1 and FVC using race-neutral GLI vs using race-specific equation were statistically significant. <fig><object-id>erj;64/suppl_68/PA1447/F1</object-id><object-id>F1</object-id><object-id>F1</object-id><graphic></graphic></fig> <bold>Conclusion:</bold> Use of race neutral GLI equation resulted in signifacnt changes in interperteation and impariments in Pakistani population when compares with race-specific equation.