Comparison of GLI-Global and PLATINO spirometry equations for disease identification and staging in a Mexican-Hispanic population.

BACKGROUND: The Global Lung Function Initiative updated spirometry reference equations (GLI-Global) to be race-neutral. However, concerns remain that GLI-Global may shift predicted values in underrepresented populations. We assessed whether GLI-Global and regional PLATINO reference equations yield comparable disease classification and severity staging in Mexican-Hispanic adults.

METHODS: This study included 1236 Mexican-Hispanics ≥40 years who underwent spirometry in México. Predicted values, percent predicted, lower limit of normal (LLN), and z-scores were calculated using both equations. Ventilatory patterns (obstruction, possible restriction, preserved ratio impaired spirometry [PRISm]) and GOLD severity stages were compared.

RESULTS: PLATINO generated higher predicted volumes, resulting in lower percent predicted values for FEV1 (79 ± 23 vs. 83 ± 24%) and FVC (82 ± 19 vs. 90 ± 21%), higher LLN thresholds for FEV1 and FVC, lower LLN for FEV1/FVC, and more negative z-scores (all p < 0.001). GLI-Global identified more obstruction (16 vs. 12%, p < 0.001), whereas PLATINO identified more possible restriction (13 vs. 10%, p < 0.001) and PRISm (24 vs. 18%, p < 0.001). PLATINO shifted GOLD staging toward greater severity. Reclassification of impairment and severity was 12-35% by approach.

CONCLUSIONS: GLI-Global and PLATINO equations are not interchangeable in this population. Equation choice affected ventilatory pattern identification and severity staging, with implications for diagnosis, risk stratification, and management.