Race-Based Pulmonary Function Testing Correction in COPD Inhaler Therapy Trials: A Systematic Review

Jean Z Wang,1,2 Ryan Chow,1 Sheojung Shin,1,2 Sarah Yang,1 Preshit Ambade,3 Sadia Jama,4 Razan Frances,2 Smita Pakhale1,2,4 1Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; 2Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada; 3Department of Health Management, Economics and Policy, Augusta University, Augusta, Georgia, USA; 4Ottawa Hospital Research Institute, Ottawa, Ontario, CanadaCorrespondence: Smita Pakhale, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada, Tel +1-613-737-8899 ext. 79428, Email [email protected]: Race-based correction is widely utilized in clinical practice, but may contribute to overestimation of lung function, underdiagnoses in minority groups, and exclusion of minority groups from research trials. The aim of this systematic review is to examine the usage of race-based correction in pulmonary function testing (PFT) within chronic obstructive lung disease (COPD) research and its impact on the exclusion of minority groups from research trials.Methods: We systematically searched Medline from 2010 to 2022 to identify randomized controlled trials (RCTs) that examine inhaler therapy for COPD. Article screening, critical appraisal, and data extraction were completed in duplicate by independent reviewers. Data regarding study design, inclusion criteria, demographics, and race-based correction were extracted and synthesized narratively.Results: Of the 774 screened articles, we included 21 RCTs in the review, which were multinational trials involving 70696 study participants. All studies had an inclusion criteria of an FEV1 cutoff of 50% to 80%. Racial minorities remained underrepresented in the trials, with the proportion of black participants ranging from < 1% to 4.7%. Four studies directly mentioned race-based correction, while the remainder of the studies did not provide any explicit details. After obtaining additional information by contacting authors and reviewing the citations, 15 were estimated to utilize race-based correction.Conclusion: Race-based correction may be frequently utilized in major COPD RCTs, but there remains inconsistent reporting regarding the usage of race-based correction. This may contribute to the exclusion of racialized populations from research trials as there remains significant underrepresentation of racialized populations from research.Keywords: chronic obstructive lung disease, pulmonary function testing, race-based correction, racial disparities, ethnic representation in research