What Does Race-Neutral Spirometry Mean for Primary Care?

The way we interpret lung function is changing. In a move that reflects wider efforts to reduce health inequality in healthcare, the Association for Respiratory Technology & Physiology (ARTP) has endorsed the adoption of race-neutral spirometry reference equations for use in the UK. These new standards are expected to replace race-based algorithms in spirometry interpretation, raising new questions for primary care professionals and equipment providers alike.

Why Are Spirometry Reference Equations Changing?

Until now, spirometry measurements often included race or ethnicity as a factor. While this approach was based on statistical differences between populations, it’s now recognised that race is not a biological determinant and should not be used in clinical decisions. Environmental and social factors, rather than genetics alone, influence lung function across different groups. Continuing to apply ethnic-specific equations may unintentionally mask disease or contribute to unequal treatment.

That’s why the Global Lung Function Initiative (GLI), supported by the European Respiratory Society and now the ARTP, has introduced Global GLI, a race-neutral reference equation that removes ethnicity from the equation altogether.

What Are GLI Global Equations?

Global GLI equations are the updated standard for interpreting spirometry. They replace the 2012 GLI multi-ethnic equations and are designed to:

Remove the need to record self-identified race or ethnicity
Provide a unified, equitable approach to lung function interpretation
Reflect the diversity of lung function across all populations

These equations are already endorsed by global respiratory societies and are seen as a necessary step forward to address disparities in respiratory care.

Key Benefits for Primary Care

Simplified data entry– No need to ask patients about ethnicity
Greater accuracy– Reduces the risk of misclassifying disease severity based on race
Improved equity– Supports more inclusive care for diverse communities
Streamlined practice– Easier standardisation of spirometry interpretation across different sites and systems

How Will This Affect Your Devices?

Here’s how the major spirometry manufacturers currently stand:

NDD

Neutral ethnicity support: Yes
Software version: Available in EasyOne Connect (EOC) version V03.09.05.19
Recalculation: Older tests can be recalculated using neutral ethnicity
Limitations: Ethnicity must be entered at the time of testing; cannot be added later

Cosmed

Neutral ethnicity support: Yes
Recalculation: Existing tests can be recalculated

MIR

Neutral ethnicity support: Not yet available
Current function: ‘Other’ category applies to anything outside the four main listed ethnicities but is not the same as GLI Global
Development status: MIR has confirmed they are working on integrating race-neutral spirometry, but no timeline has been announced
Platforms affected:
- MIR Spiro
- Spirobank Smart apps (iOS and Android)
- Spirobank II firmware

We will keep you informed as updates become available.

What Should Primary Care Services Do Now?

Review current software– Check whether your current devices support the new GLI Global equations.
Prepare your teams– Inform clinical staff that ethnicity is no longer needed for spirometry interpretation.
Communicate with patients– If spirometry results change due to the new equation, provide clear and supportive explanations.
Recalculate retrospective data– For longitudinal monitoring, tests may need to be reanalysed under the new standards.

Can You Use the GLI 2012 ‘Other’ Category for Now?

Yes, but with caution. While the GLI 2012 ‘Other’ category is similar to Global GLI, it’s not identical. It may be a valid temporary option if software updates are pending. The ARTP recommends discussing this locally and pushing manufacturers to adopt the race-neutral standard as quickly as possible.

A Step Forward for Respiratory Equality

The shift to race-neutral spirometry is more than a technical update—it’s a step towards more inclusive and accurate respiratory care. While some patients may find their classification changes slightly (e.g., from ‘normal’ to ‘restrictive’), the core method of interpretation, based on FEV1/FVC ratios, remains unchanged.

For clinicians and practice managers, the focus should be on ensuring accurate implementation, training staff, and using a whole-person approach to diagnosis that considers symptoms and history alongside test results.

Need Help Adapting Your Spirometry Equipment?

We’re here to support you as the industry transitions to Global GLI. Whether you use MIR, Cosmed, or NDD devices, our team can advise on software compatibility, updates, and recalculating past results.

Browse our full range of spirometry solutions or contact us directly for guidance.