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Peer-reviewedCC BYThe open respiratory medicine journal

Adopting Global Lung Function Initiative Reference Equations Alters Pulmonary Function Testing Interpretation in a Safety-Net Cohort.

  • Stephen T Russell1,2
  • Jenny E Han1,2
  • Jordan A Kempker1,2
  • Eric Honig1,2
  • Abiodun T Kukoyi1,2
  1. 1Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Emory University School of Medicine, Atlanta, GA, USA.
  2. 2Grady Health System, Atlanta, GA, USA.
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Abstract

Introduction/objective

Current American Thoracic Society/European Respiratory Society (ATS/ERS) guidelines recommend Global Lung Initiative (GLI) reference equations for spirometry, lung volumes, and diffusing capacity (DLCO). The impact of adopting these reference equations remains unclear and may differ by race.Methods

We conducted a cross-sectional study of Pulmonary Function Tests (PFT) performed at Grady Memorial Hospital in Atlanta, GA, from 2017 to 2024. PFT components and interpretive patterns were analyzed using current Grady reference equations, then compared with GLI, including race-neutral spirometry, and stratified by race.Results

There were 7877 eligible patients; 7034 (89%) were Black, 529 (7%) were White, and 314 (4%) were Hispanic. Black patients had increased frequency of abnormal FEV1 (37.4% to 52.1%, p < 0.001), FVC (32.4% to 48.4%, p < 0.001), Total Lung Capacity (TLC) (6.7% to 40.8%, p < 0.001), and DLCO (30.3% to 45.3%, p < 0.001). White and Hispanic patients had decreases in abnormal FEV1 (48.0% to 38.0%, p < 0.001, and 29.0% to 20.7%, p < 0.001, respectively), decreases in abnormal FVC (38.0% to 26.1%, p< 0.001, and 26.1% to 18.2%, p < 0.001), increases in abnormal TLC (12.7% to 17.8%, p < 0.001, and 12.4% to 16.8%, p < 0.001) and no change in DLCO. 44.3% of Black, 16.8% of White, and 14.5% of Hispanic patients had a new interpretive pattern.Discussion

In this health system with a predominantly Black patient population, transitioning our PFT reference equations to GLI increased detection of abnormalities and changed interpretive patterns, with greater effects in Black patients.Conclusion

The health-system impact of implementing GLI reference equations is highly context-dependent, influenced by demographics and prior reference equations.

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Cite

BibTeXRIS
BibTeX
@article{russell2026adopting,
  title = {{Adopting Global Lung Function Initiative Reference Equations Alters Pulmonary Function Testing Interpretation in a Safety-Net Cohort.}},
  author = {Stephen T Russell and Jenny E Han and Jordan A Kempker and Eric Honig and Abiodun T Kukoyi},
  journal = {The open respiratory medicine journal},
  year = {2026},
  month = aug,
  doi = {10.2174/0118743064497297260820041654},
  url = {https://europepmc.org/article/MED/42899075},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Adopting Global Lung Function Initiative Reference Equations Alters Pulmonary Function Testing Interpretation in a Safety-Net Cohort.
AU  - Stephen T Russell
AU  - Jenny E Han
AU  - Jordan A Kempker
AU  - Eric Honig
AU  - Abiodun T Kukoyi
PY  - 2026
DA  - 2026/08/24
JO  - The open respiratory medicine journal
DO  - 10.2174/0118743064497297260820041654
UR  - https://europepmc.org/article/MED/42899075
AB  - Introduction/objective  Current American Thoracic Society/European Respiratory Society (ATS/ERS) guidelines recommend Global Lung Initiative (GLI) reference equations for spirometry, lung volumes, and diffusing capacity (DLCO). The impact of adopting these reference equations remains unclear and may differ by race.Methods  We conducted a cross-sectional study of Pulmonary Function Tests (PFT) performed at Grady Memorial Hospital in Atlanta, GA, from 2017 to 2024. PFT components and interpretive patterns were analyzed using current Grady reference equations, then compared with GLI, including race-neutral spirometry, and stratified by race.Results  There were 7877 eligible patients; 7034 (89%) were Black, 529 (7%) were White, and 314 (4%) were Hispanic. Black patients had increased frequency of abnormal FEV1 (37.4% to 52.1%, p < 0.001), FVC (32.4% to 48.4%, p < 0.001), Total Lung Capacity (TLC) (6.7% to 40.8%, p < 0.001), and DLCO (30.3% to 45.3%, p < 0.001). White and Hispanic patients had decreases in abnormal FEV1 (48.0% to 38.0%, p < 0.001, and 29.0% to 20.7%, p < 0.001, respectively), decreases in abnormal FVC (38.0% to 26.1%, p< 0.001, and 26.1% to 18.2%, p < 0.001), increases in abnormal TLC (12.7% to 17.8%, p < 0.001, and 12.4% to 16.8%, p < 0.001) and no change in DLCO. 44.3% of Black, 16.8% of White, and 14.5% of Hispanic patients had a new interpretive pattern.Discussion  In this health system with a predominantly Black patient population, transitioning our PFT reference equations to GLI increased detection of abnormalities and changed interpretive patterns, with greater effects in Black patients.Conclusion  The health-system impact of implementing GLI reference equations is highly context-dependent, influenced by demographics and prior reference equations.
SN  - 1874-3064
ER  -