Addressing Race in Pulmonary Function Testing by Aligning Intent and Evidence With Practice and Perception

Nirav R. Bhakta, David A. Kaminsky, Christian Bime, Neeta Thakur, Graham L. Hall, Meredith C. McCormack, Sanja Stanojevic

Research output: Contribution to journalReview articlepeer-review


The practice of using race or ethnicity in medicine to explain differences between individuals is being called into question because it may contribute to biased medical care and research that perpetuates health disparities and structural racism. A commonly cited example is the use of race or ethnicity in the interpretation of pulmonary function test (PFT) results, yet the perspectives of practicing pulmonologists and physiologists are missing from this discussion. This discussion has global relevance for increasingly multicultural communities in which the range of values that represent normal lung function is uncertain. We review the underlying sources of differences in lung function, including those that may be captured by race or ethnicity, and demonstrate how the current practice of PFT measurement and interpretation is imperfect in its ability to describe accurately the relationship between function and health outcomes. We summarize the arguments against using race-specific equations as well as address concerns about removing race from the interpretation of PFT results. Further, we outline knowledge gaps and critical questions that need to be answered to change the current approach of including race or ethnicity in PFT results interpretation thoughtfully. Finally, we propose changes in interpretation strategies and future research to reduce health disparities.

Original languageEnglish (US)
Pages (from-to)288-297
Number of pages10
Issue number1
StatePublished - Jan 2022


  • pulmonary function test
  • race or ethnicity
  • racial disparities
  • reference equations

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine


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