• Posted March 4, 2025

Race-Neutral Formulas Improve Asthma Detection in Black Children

Race plays a role in whether a child is quickly and accurately diagnosed with asthma, a new study suggests.

Outdated and flawed studies previously led to the belief that white children had “naturally higher” lung function compared to other races, researchers said.

Diagnostic procedures based on that assumption have caused asthma to be dramatically underdiagnosed among Black children, researchers reported Feb. 28 in JAMA Open Network.

About 2.5 to 4 times more Black children with asthma symptoms are diagnosed with reduced lung function when doctors use updated formulas, or equations, that exclude race, researchers found.

“These findings have significant clinical implications and further support the universal use of race-neutral equations to increase the likelihood of identifying reduced lung function and improving the detection of asthma, particularly in Black children, promoting health equity," the research team led by Dr. Gurjit Khurana Hershey, director of asthma research at Cincinnati Children’s Hospital, concluded.

Diagnosis of asthma requires lung function testing using a calculation built into U.S. spirometers, researchers said in background notes. This calculation follows a standard formula using age, sex, body size and race.

Because of those earlier studies, the racial component of the formula adjusted lung function by 10% to 15% for Black people and 4% to 6% for Asian people, researchers said.

In 2022, the Global Lung Initiative Network updated lung function reference equations to exclude race from the calculation. 

But doctors, hospitals and health networks have not universally adopted the new race-neutral one, researchers said.

For this study, researchers analyzed data on 1,500 children from three prior studies that tested their lung function

The use of the race-neutral formula changed 39% of all Black children from normal to reduced lung function when compared to the race-specific equation, researchers found.

Further, between 38% to 44% of children not initially eligible for further testing under the old formula became eligible for further asthma testing using the race-neutral equation, results show.

Importantly, using the race-neutral equation had no impact on lung function testing among white children, researchers said.

“The use of a race-neutral equation promotes the identification of deficits in lung function that the race-specific equation fails to detect, particularly in Black children,” researchers concluded in their report.

“A shift to universal use of the race-neutral equation will likely improve the detection of asthma, decrease the risk of labeling uncontrolled asthma as controlled, and keep moving science away from outdated racist practices and toward alleviating asthma-related health disparities, promoting health equality,” researchers concluded.

More information

The Asthma and Allergy Foundation of America has more about childhood asthma.

SOURCES: Cincinnati Children’s Hospital, news release, Feb. 28, 2025; JAMA Network Open, Feb. 28, 2025