The Evolving Role of Pulmonary Function Interpretation: Clinical Implications of the New ERS/ATS Standards in Asthma Care

Abstract

Asthma remains a significant public health challenge, requiring precise diagnostic and management strategies. Pulmonary function tests (PFTs) are essential in assessing disease severity, guiding treatment decisions, and monitoring disease progression. The 2022 ERS/ATS technical standards introduced critical updates to enhance the accuracy and standardization of interpretation of pulmonary function findings. These modifications include the adoption of Global Lung Initiative reference values, the transition from race-based to raceneutral equations, the replacement of percent-predicted values with z-scores, and a redefinition of bronchodilator responsiveness criteria. Additionally, new spirometric patterns such as dysanapsis and preserved ratio impaired spirometry have been recognized, improving the detection and characterization of airflow limitation. These updates significantly impact asthma management by refining disease phenotyping, improving diagnostic precision, and tailoring treatment strategies. Furthermore, advancements in artificial intelligence are expected to enhance predictive analytics and early intervention strategies in assessment of pulmonary function. However, challenges remain with respect to the adoption of these modifications in clinical practice, particularly regarding the classification of disease severity and the impact of race-neutral equations on diagnostic thresholds. Future research is necessary to validate the long-term implications of these changes on asthma outcomes. Clinicians must familiarize themselves with evolving standards to optimize patient care and reduce health disparities. The 2022 ERS/ATS guidelines represent a substantial advancement in PFT, with the potential to improve both clinical decision-making and patient prognosis in asthma management.

Keywords: Asthma; Guidelines; Lung function; Reference equations; Spirometry.