Overview

• The New England Journal of Medicine paper traces how flawed race-adjusted spirometry equations arose from studies that ignored social and environmental determinants of lung health.
• Mass General Brigham and UCSF have replaced race-based calculations with the Global Lung Function Initiative’s race-neutral reference equations.
• The upcoming AMA Guides update will remove race-based reference equations for evaluating occupational pulmonary impairment.
• Health systems and regulators face complex implementation hurdles, including overhauling clinical workflows and securing state and federal approvals.
• Researchers call for retrospective reviews of disability ratings and compensation to remedy harms for patients whose lung impairment was previously underestimated.