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P25. SPIROMETRIC INTERPRETATION DISCREPANCIES:

GLI CAUCASIAN VS. RACE-NEUTRAL NORMS

BALSAM BARKOUS1,2, WIÈME BEN HMID1, CHAIMA BRIKI1, SABA BOUBAKRI1,
SONIA ROUATBI1,2, HELMI BEN SAAD1,2,3

1DEPARTMENT OF PHYSIOLOGY AND FUNCTIONAL EXPLORATIONS, FARHAT HACHED
HOSPITAL, SOUSSE, TUNISIA. 2RESEARCH LABORATORY OF HEART FAILURE (LR12SP09),
FARHAT HACHED HOSPITAL, SOUSSE, TUNISIA. 3INTERNATIONAL CENTER OF FUNCTIONAL
EXPLORATIONS, SOUSSE, TUNISIA.

INTRODUCTION. The Global Lung Function Initiative (GLI) has underscored the
importance of considering race/ethnicity in establishing spirometric norms.
However, there have been concerns regarding the implementation of race-specific
norms. As a result, the European Respiratory Society and American Thoracic
Society (ERS-ATS) have advocated for a race-neutral approach in interpreting
spirometry results.

AIM. To compare spirometric parameter values obtained from GLI Caucasian
norms with those derived from race-neutral norms, evaluating the differences in
lung function interpretation.

METHODS. A retrospective comparative analysis was conducted, involving
spirometric data from a Tunisian population. Spirometry was conducted in
accordance with the 2019 ERS-ATS technical standards and interpreted based on
the 2022 ERS-ATS recommendations. Five ventilatory impairments (VIs) were
considered: Obstructive VI (OVI), probable restrictive VI (RVI), probable mixed VI
(MVI), preserved ratio impaired spirometry (PRIsm), and dysanapsis. Frequencies of
each VI and spirometric data were compared between GLI Caucasian and race-
neutral norms.

RESULTS. The study comprised 6426 Tunisian patients, with a male predominance
(70.7%), and mean age and height of 45.3±14.9 years and 168.5± 9.5 cm, respectively.
Compared to race-neutral norms, Caucasian norms yielded lower z-scores for
FEV1 (-0.84±1.58 vs. -0.39±1.59, p=0.001) and FVC (-0.77±1.39 vs. -0.22±1.39, p=0.001).
Significant differences were observed in the frequencies of VIs assessed in our
sample using Caucasian vs. race-neutral norms: OVI (14.2 vs. 15.4%, p=0.001),
probable RVI (16.5 vs. 7.4%, p=0.001), probable MVI (7.9 vs. 6.2%, p=0.001), PRIsm (15.3
vs. 8.0%, p=0.001), and dysanapsis (2.1 vs. 4.1%, p=0.001).
CONCLUSION. Substantial disparities exist between spirometric parameter values
derived from GLI Caucasian and race-neutral norms, suggesting potential
variations in diagnostic outcomes.

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