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P20. GLI SPIROMETRIC NORMS IN A TUNISIAN

PAEDIATRIC POPULATION: RACE-SPECIFIC VS. RACE-
NEUTRAL NORMS

WIEME BEN HMID1, BALSAM BARKOUS1,2, CHAIMA BRIKI1, SABA BOUBAKRI1,
SONIA ROUATBI1,2, HELMI BEN SAAD1,2

1 DEPARTMENT OF PHYSIOLOGY AND FUNCTIONAL EXPLORATIONS, UNIVERSITY HOSPITAL OF
FARHAT HACHED SOUSSE, TUNISIA 2 RESEARCH LABORATORY OF HEART FAILURE, LR12SP09,
UNIVERSITY HOSPITAL OF FARHAT HACHED SOUSSE, TUNISIA

INTRODUCTION. In Tunisia, spirometry traditionally relies on 2012-global lung
initiative (GLI)- race-specific norms (ie; Caucasian), which may not fully capture the
respiratory physiology of children having a North African descent. This raises
concerns about the appropriateness of applying GLI-2012 Caucasian norms to
interpret spirometry results in Tunisian paediatric patients.
AIM. To compare the spirometric data and profiles of a Tunisian paediatric
population using the GLI-2012 race-specific norms (ie; Caucasian) vs. GLI-2023
race-neutral norms

METHODS. This retrospective comparative study analysed spirometric parameters
of a paediatric Tunisian population. Spirometry was conducted and interpreted
following the most updated ERS-ATS 2019 technical standards and 2022
interpretative guide. The study focused on five ventilatory impairments (VI):
Obstructive VI (OVI), probable restrictive VI (RVI), probable mixed VI (MVI),
preserved ratio impaired spirometry (PRIsm), and dysanapsis. Comparative
analyses involved the frequency of each VI and z-scores spirometric data using the
GLI-2012 Caucasian norms and GLI-2023 race-neutral norms.

RESULTS. The study included 773 children (55.2% boys, 8.4% active smokers,
means±standard-deviations of age and body mass index: 10.85±3.43 years and
18.2±3.7 kg/m2, respectively). i) Using the GLI-20192 Caucasian norms vs. GLI-2023
race-neutral norms induced significantly higher frequencies of OVI (12.4 vs. 12.0%,
respectively) and dysanapsis (7.9 vs. 5.4%, respectively), and significantly lower
frequencies of probable RVI (4.4 vs. 9.6%, respectively), probable MVI (1.0 vs. 1.9%,
respectively), and PRIsm (4.3 vs. 8.4%, respectively); ii) Compared to race-neutral
norms, the Caucasians norms gave significantly lower z-scores for FEV1 (-0.45±1.31
vs. -0.14±1.25, respectively) and FVC (-0.35±1.19 vs. -0.02±1.11, respectively), and
significantly higher z-scores for FEV1/FVC (-0.21±1.09 vs. -0.24±1.09).

CONCLUSION. Using GLI Caucasian norms for spirometry interpretation in a
Tunisian paediatric population may lead to misclassification of some VIs and
spirometric data.

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