For decades, if you walked into a doctor’s office for a lung function test—also called spirometry—your results might have been automatically “adjusted” based on one thing: your race. Black patients’ lung capacity scores were often reduced by as much as 10–15% before the doctor even interpreted the results. Why? Because of outdated, pseudoscientific assumptions that Black bodies naturally have lower lung capacity than white bodies.
That “adjustment” didn’t just live in dusty medical textbooks. It’s been built into the software of modern pulmonary testing devices, subtly reinforcing health disparities that stretch back to slavery-era “science.” Enslavers and early white physicians used lung capacity as so-called proof that African-descended people were biologically inferior—conveniently ignoring how systemic oppression, pollution, and poor access to healthcare impact respiratory health. Those racist foundations lingered in medical practice for over a century.
Now, a growing movement of doctors, researchers, and racial justice organizations is dismantling those assumptions.
The Reckoning in Respiratory Medicine
In 2023, several major health institutions—including the American Thoracic Society—officially called for the elimination of race-based adjustments in lung function tests. Hospitals such as Mass General Brigham and UCSF have begun rewriting protocols so Black and brown patients’ lung health is measured without baked-in racial bias.
The shift is part of a broader movement to “decolonize” medical algorithms—removing factors that encode structural racism into supposedly objective science. Similar campaigns have pushed to end race-based calculations in kidney function (eGFR) and heart health risk scores.
Dr. Aisha Morris, a pulmonologist and advocate for health equity, says,
“When you lower a patient’s lung score based on their race, you risk missing a diagnosis, delaying treatment, or dismissing symptoms. That’s not medicine. That’s discrimination with a stethoscope.”
Why It Matters
The consequences of race-based spirometry have been far-reaching:
-Missed diagnoses: Black patients with early lung disease were told they were “normal” because their baseline was set artificially lower.
–Occupational harm: Workers seeking compensation for lung damage (like from asbestos or chemical exposure) often faced denials because the adjusted scores didn’t meet legal thresholds.
-Delayed care: By the time a condition like COPD or asthma was detected, the disease had progressed further, leading to worse outcomes.
Given that Black communities already face higher exposure to air pollution, smoking-related illnesses, and asthma-triggering environments—often tied to housing segregation and environmental racism—the harm from biased lung testing has been compounded.
Organizing for Change
Advocacy groups like White Coats for Black Lives and the Center for Anti-Racist Research have been vocal in pushing hospitals, insurers, and device manufacturers to overhaul lung testing software. Some tech developers are now rewriting the code to remove the race variable entirely.
Community health organizations are also stepping in, ensuring Black patients understand their right to ask for non-adjusted spirometry readings and to challenge medical results that seem questionable.
The Bigger Picture
Removing race corrections from lung testing isn’t just about numbers on a screen—it’s about breaking the silent chain that connects 19th-century racist science to 21st-century healthcare. As we’ve seen in other areas of medicine, race is too often treated as a biological truth instead of what it really is: a social construct that reflects lived experience, inequality, and exposure to systemic harm.
The fight to breathe freely—without bias baked into the machine—is part of the larger struggle for health equity. It’s a reminder that even in the most sterile of hospital rooms, racism can hide in the code, the calculations, and the quiet “standard practices.”
And as more patients, doctors, and advocates push back, the medical establishment is being forced to take a long-overdue deep breath—and finally exhale the myths.
