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ATS is On a Mission to Take Race Out of Lung Function Testing; Encourages Use of GLI Global Reference Equations
2023 statement for clinicians concluded that the new race-neutral reference equation more accurately captures lung function and is more likely to ensure more accurate diagnosis and treatment.
Nov. 12, 2026 – Race should not be used in the interpretation of pulmonary function test (PFT) results – a key measure of how an individual’s lungs are functioning – concluded the American Thoracic Society in a 2023 official statement for clinicians. In the statement, published in the American Journal of Respiratory and Critical Care Medicine, ATS’s panel of experts recommended the use of recently-developed GLI Global reference equations instead of race/ethnicity-specific equations in PFT laboratories and clinical practice.
Despite this recommendation, health systems have been slow to adopt GLI Global. ATS is hoping to change that with an Encoding Equity Grant from The Counsel for Medical Specialty Societies funded by the Doris Duke Foundation.
In a new video to help drive awareness and improve implementation, pulmonologists Lauren Kearney, MD, of Boston Medical Center and Sean Levy, MD, of Beth Israel Deaconess Medical Center, make a compelling argument for why race is not an appropriate proxy for genetics or ancestry that might contribute to lung function differences. They encourage institutional decisionmakers, including hospital and health system personnel, to transition to GLI Global.
Their reasoning is based on evidence collected when the ATS convened a diverse workshop panel of clinicians and investigators to evaluate the use of race/ethnicity in PFT interpretation, make recommendations and provide clinical guidance. The evidence led ATS to publish the statement and put health systems on notice that the way patients’ lung function was tested and the way the severity of respiratory diseases like asthma and COPD was determined needed to change.
Once the report was published, panel co-chair Nirav R. Bhakta, MD, PhD, critical care specialist and pulmonologist, University of California, San Francisco School of Medicine, noted “Reviews of clinical algorithms throughout medicine in the past decade have spawned concerns about bias and harm when race is used as a variable and has led to revisions of these algorithms.”
He added: “In many areas of the world, the categorization of people by race is associated with structural racism and its negative effects. Globally, race/ethnicity is a social construct that changes across geography and time, making it difficult to envision it as a fixed characteristic of people; this is true now more than ever before with increased movement of people and mixing of cultures.”
In recent years, the scientific community has increasingly recognized that race is a social construct based on superficial appearance and does not encompass biological characteristics.
For more resources on race-neutral lung function testing, watch the ATS Breathe Easy podcast with Dr. Bhakta and this NEJM interview with Dr. Levy.
About the American Thoracic Society
About the American Thoracic Society: Founded in 1905, the American Thoracic Society is the world's leading medical society dedicated to accelerating the advancement of global respiratory health through multidisciplinary collaboration, education, and advocacy. Core activities of the Society’s more than 16,000 members are focused on leading scientific discoveries, advancing professional development, impacting global health, and transforming patient care. Key areas of member focus include developing clinical practice guidelines, hosting the annual International Conference, publishing four peer-reviewed journals, advocating for improved respiratory health globally, and developing an array of patient education and career development resources. Please visit our website to learn more.