FEV1Q: what (even) is normal lung function?

Extract People come in different shapes and sizes, and so do their lungs. This seemingly trivial observation raises significant problems when it comes to defining the presence and severity of lung function impairment using spirometry – a fundamental test in respiratory physiology. A common approach is to make a lung function measurement such as forced expiratory volume in 1 s (FEV1), and to compare that measurement to a so-called healthy normal population by making adjustments for age, sex at birth, height and, controversially, race. Many populations, often those systemically disadvantaged for diverse reasons and those in the Global South where chronic lung disease is highly prevalent, do not have relevant reference populations for comparison, and it is not clear how what is said to be "normal" should take account, or not, of systemic disadvantages. In part to address this, the American Thoracic Society has made a clear recommendation to replace race-specific spirometry reference equations with race-neutral approaches [1], based on race being a social construct without biological basis and that the inclusion of race is perpetuating structural racism [2].
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Editorials Source Type: research