Study Examines How Updated Pulmonary Function Testing Standards Influence Lung Function Score Calculation
August 19, 2026
A research team from the Division of Pediatric Pulmonary Medicine at UPMC Children's Hospital of Pittsburgh published a new study examining how changes in pulmonary function testing standards affect calculation of the lung function score, which is an established measure used to assess pulmonary status in children undergoing stem cell transplantation.
The study, “Impact of Reference Equations and Lower Limit of Normal Definitions on Lung Function Score Calculation,” was published in Annals of the American Thoracic Society. Coauthors include Kristina Gaietto, MD, MPH; Daniel Atwood, MD; Christian Rosas-Salazar, MD, MPH (former fellow); and Daniel J. Weiner, MD, professor of pediatrics and medical director, Pulmonary Function Laboratory at UPMC Children’s.
Background
The Lung Function Score combines measurements of forced expiratory volume in one second (FEV₁) and diffusing capacity of the lung for carbon monoxide to evaluate pulmonary function before stem cell transplantation.
Recent updates to pulmonary function testing guidelines adopted new reference equations and eliminated the use of race as a covariate in pulmonary function test equations.
Because the updated pulmonary function testing guidelines introduced race-neutral reference equations, this study examined whether changing the reference standard also changes the performance of the lung function score, which was originally developed using earlier equations.
Findings from the Research
The study examined data from 278 children between 6 and 21 years of age who underwent hematopoietic stem cell transplantation. They recalculated lung function scores using the original approach and current pulmonary function testing recommendations.
The analysis showed that the updated reference equations, including the newer race-neutral equations, changed the number of children classified as having abnormal lung function and the relationship between the lung function score and post-transplant survival.
While an abnormal lung function score calculated using the original approach remained associated with an increased risk of mortality following transplantation, that association was not observed when the score was calculated using current pulmonary function testing recommendations.
The findings indicate that updates to pulmonary function testing standards can influence interpretation of the lung function score and should be considered when applying this established assessment tool in pediatric stem cell transplant populations.
Reference
Gaietto K, Atwood D, Rosas-Salazar C, Weiner DJ. Impact of Reference Equations and Lower Limit of Normal Definitions on Lung Function Score Calculation. Ann Am Thorac Soc. Published online June 10, 2026.
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