The fixed-ratio spirometric criteria for COPD underdiagnoses potential COPD in African American patients, according to a study published in the Journal of General Internal Medicine. Elizabeth A. Regan, MD, PhD, and colleagues compared COPD diagnosis by fixed-ratio with findings and outcomes by race. The analysis included current or former smokers with 10 or more pack-year smoking history. Using the fixed ratio, 70% of African Americans were classified as non-COPD versus 49% of non-Hispanic White patients. Twelve-year mortality was similar for African American smokers despite being younger (55 vs 62), more often currently smoking (80% vs 39%), and having fewer pack-years. For FEV₁ and FVC raw spirometry values, density distribution plots showed disproportionate reductions in FVC relative to FEV₁ among African Americans that systematically led to higher ratios. African Americans with GOLD 0 stage had greater symptoms, worse diffusing capacity for carbon monoxide, spirometry, and BODE index scores, and greater deprivation than White participants in a matched analysis.

Journal of General Internal Medicine, August 18, 2023.