Position Statement on race-neutral spirometry reference equations. June 2025

26 June 2025

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The Global Lung Function Initiative (GLI) Network is a European Respiratory Society Clinical Research Collaboration that aims to improve how lung function tests are interpreted. The network published GLI multi-ethnic spirometry reference equations in 2012, and those equations were subsequently endorsed by all the major respiratory societies including the ARTP. At the time it was the most comprehensive set of lung function reference data and aimed to present a unified and global approach for the interpretation of spirometry measurements. Over this past decade, the GLI network has continued to work on improving lung function interpretation.

In the 2012 GLI publication, the limitations of self-reported race/ethnicity were acknowledged, as were the limitation of the categories. At the time, these were considered better than using an all-White reference population. More recent evidence has shown that the role of social and environmental determinants of lung function differences between ethnic groups had been previously underestimated, such that applying reference equations for different ethnic groups may, in fact, negatively impact assessment of disease severity. A new “GLI Global” reference equation, which eliminates the use of ethnicity as a factor in interpreting lung function, has now been published. The use of this race-neutral approach is a first step towards mitigating health inequalities in lung function between ethnic groups.

The GLI Global equations have already been endorsed by the European Respiratory Society and the American Thoracic Society but are not yet widely established in the UK. The ARTP have given careful consideration and recognise this is a contrast to years of a race specific approach. The re-evaluation is not unique to respiratory medicine; other societies and professional bodies are recognising that race used elsewhere in clinical algorithms may have perpetuated health inequalities and are revising guidance where possible. With this in mind, and after careful deliberation, the ARTP are endorsing the use of the 2022 GLI Global reference equations.

A switch to GLI Global requires more thoughtful consideration of the inherent uncertainty and limitations to any reference equation. The use of GLI Global to interpret spirometry requires consideration of an individual’s symptoms and clinical history, and it should be remembered that spirometry is not the only part of a diagnosis or clinical decision making. Further information on the considerations when switching to these equations and some of the frequently asked questions are discussed further within the statement, which can be accessed below.

Click here to download the position statement 

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