People come in different shapes and sizes, and so do their lungs. This seemingly trivial observation raises significant problems when it comes to defining the presence and severity of lung function impairment using spirometry – a fundamental test in respiratory physiology. A common approach is to make a lung function measurement such as forced expiratory volume in 1 s (FEV₁), and to compare that measurement to a so-called healthy normal population by making adjustments for age, sex at birth, height and, controversially, race. Many populations, often those systemically disadvantaged for diverse reasons and those in the Global South where chronic lung disease is highly prevalent, do not have relevant reference populations for comparison, and it is not clear how what is said to be "normal" should take account, or not, of systemic disadvantages. In part to address this, the American Thoracic Society has made a clear recommendation to replace race-specific spirometry reference equations with race-neutral approaches [1], based on race being a social construct without biological basis and that the inclusion of race is perpetuating structural racism [2].

人们的形状和大小各不相同，肺部也是如此。当使用肺活量测定法（呼吸生理学的基本测试）来确定肺功能损伤的存在和严重程度时，这种看似微不足道的观察结果引发了重大问题。一种常见的方法是进行肺功能测量，例如 1 秒用力呼气量 (FEV ₁ )，并通过调整年龄、出生时性别、身高以及有争议的因素，将该测量值与所谓的健康正常人群进行比较， 种族。许多人群，通常是那些因各种原因而处于系统性弱势的人群，以及慢性肺病高度流行的南半球国家的人群，没有相关的参考人群进行比较，并且不清楚如何考虑所谓的“正常”人群或不存在系统性缺陷。为了解决这个问题，美国胸科学会明确建议用种族中立的方法取代种族特定的肺活量测定参考方程[1]，因为种族是一种没有生物学基础的社会结构，并且种族的包容性是永久性的结构性种族主义[2]。