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Lung development starts in utero and continues during childhood through to adolescence, reaching its peak in early adulthood. This growth is followed by gradual decline due to physiological lung ageing. Lung-function development can be altered by several host and environmental factors during the life course. As a result, a range of lung-function trajectories exist in the population. Below average trajectories are associated with respiratory, cardiovascular, metabolic, and mental health comorbidities, as well as with premature death. This Review presents progressive research into lung-function trajectories and assists the implementation of this knowledge in clinical practice as an innovative approach to detect poor lung health early, monitor respiratory disease progression, and promote lung health. Specifically, we propose that, similar to paediatric height and weight charts used globally to monitor children's growth, lung-function charts could be used for both children and adults to monitor lung health status across the life course. To achieve this proposal, we introduce our free online Lung Function Tracker tool. Finally, we discuss challenges and opportunities for effective implementation of the trajectory concept at population level and outline an agenda for crucial research needed to support such implementation., Competing Interests: Declaration of interests LL has given lectures sponsored by Chiesi, a non-profit organisation facilitating lifelong learning for health-care providers, and received consulting fees from AstraZeneca, all paid to Ghent University. EM has received lecture fees from Airsonett, ALK, AstraZeneca, Chiesi, and Sanofi. AA has received lecture fees from AstraZeneca, Chiesi, GSK, Menarini, MSD, Sanofi, and Zambon; and research grants from AstraZeneca, GSK, Menarini, and Sanofi. SS has received lecture fees from Vyaire Medical, and consulting fees from Chiasi and NDD. JG-A's institution has received consulting and lecture fees from AstraZeneca (not related to this study); JGA has received lecture fees from Esteve and Chiesi (not related to this study). SCD has received investigator-initiated grants from GlaxoSmithKline and AstraZeneca. HP has received lecture fees (not related to this review) from Teva and Sandoz. AC reports personal fees from Novartis, Sanofi, Stallergenes Greer, AstraZeneca, GlaxoSmithKline, and La Roche-Posay, outside the submitted work. LEGWV has received lecture fees and advisory board fees from GlaxoSmithKline, AstraZeneca, Chiesi, Boehringer, Pulmonx, and Menarini. RF has received lecture fees Chiesi, AstraZeneca, and Zambon, advisory board fees from AstraZeneca, and research grants from AstraZeneca, GSK, Menarini, and Sanofi. JPA has received lecture fees from AstraZeneca. All other authors declare no competing interests., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: During the past century, socioeconomic and scientific advances have resulted in changes in the health and physique of European populations. Accompanying improvements in lung function, if unrecognised, could result in the misclassification of lung function measurements and misdiagnosis of lung diseases. We therefore investigated changes in population lung function with birth year across the past century, accounting for increasing population height, and examined how such changes might influence the interpretation of lung function measurements., Methods: In our analyses of cross-sectional data from ten European population-based studies, we included individuals aged 20-94 years who were born between 1884 and 1996, regardless of previous respiratory diagnoses or symptoms. FEV 1 , forced vital capacity (FVC), height, weight, and smoking behaviour were measured between 1965 and 2016. We used meta-regression to investigate how FEV 1 and FVC (adjusting for age, study, height, sex, smoking status, smoking pack-years, and weight) and the FEV 1 /FVC ratio (adjusting for age, study, sex, and smoking status) changed with birth year. Using estimates from these models, we graphically explored how mean lung function values would be expected to progressively deviate from predicted values. To substantiate our findings, we used linear regression to investigate how the FEV 1 and FVC values predicted by 32 reference equations published between 1961 and 2015 changed with estimated birth year., Findings: Across the ten included studies, we included 243 465 European participants (mean age 51·4 years, 95% CI 51·4-51·5) in our analysis, of whom 136 275 (56·0%) were female and 107 190 (44·0%) were male. After full adjustment, FEV 1 increased by 4·8 mL/birth year (95% CI 2·6-7·0; p<0·0001) and FVC increased by 8·8 mL/birth year (5·7-12·0; p<0·0001). Birth year-related increases in the FEV 1 and FVC values predicted by published reference equations corroborated these findings. This height-independent increase in FEV 1 and FVC across the last century will have caused mean population values to progressively exceed previously predicted values. However, the population mean adjusted FEV 1 /FVC ratio decreased by 0·11 per 100 birth years (95% CI 0·09-0·14; p<0·0001)., Interpretation: If current diagnostic criteria remain unchanged, the identified shifts in European values will allow the easier fulfilment of diagnostic criteria for lung diseases such as chronic obstructive pulmonary disease, but the systematic underestimation of lung disease severity., Funding: The European Respiratory Society, AstraZeneca, Chiesi Farmaceutici, GlaxoSmithKline, Menarini, and Sanofi-Genzyme., Competing Interests: Declaration of interests JPA has received speaker fees from Pulmonx, travel costs from Boehringer Ingelheim to deliver a lecture, and travel costs from GlaxoSmithKline to attend an advisory board meeting. YÇ received personal fees from Boehringer Ingelheim, AstraZeneca, and Sanofi Genzyme. HB has received payment from AstraZeneca and Boehringer Ingelheim for presentations made at scientific meetings. MvdB has received institutional research grants from GlaxoSmithKline, Roche, Genentech, and Novartis. GB has received honoraria from AstraZeneca, Boehringer Ingelheim, Chiesi Farmaceutici, GlaxoSmithKline, Novartis, Sanofi, and TEVA. OCB has received grants or contracts, consulting fees, and payment or honoraria from AstraZeneca, Abbvie, Boehringer Ingelheim, Chiesi Farmaceutici, GlaxoSmithKline, Menarini, MSD, Novartis, Roche, Takeda, and TEVA for lectures, presentations, speakers bureaus, manuscript writing, or educational events. RF has received research grants from GlaxoSmithKline, Menarini, AstraZeneca, ISC-III, and the Spanish Health Service, consulting fees from GlaxoSmithKline, and honoraria from Chiesi Farmaceutici. SH has received grants or contracts, consulting fees, and payment or honoraria from AstraZeneca, Abbvie, Boehringer Ingelheim, Chiesi Farmaceutici, GlaxoSmithKline, Menarini, MSD, Novartis, Roche, Takeda, and TEVA for lectures, presentations, speakers bureaus, manuscript writing, or educational events. AL has received payment for lectures from Boehringer Ingelheim and travel costs from Novartis and AstraZeneca to attend meetings, has participated in an AstraZeneca advisory board, has contributed to the Norwegian Primary Care Respiratory Group, and has been a member of the Norwegian Health Directorate. BL has received grants from AstraZeneca and ThermoFisher and has participated in a Sanofi advisory board. SAAV has received support from AstraZeneca to attend meetings. SRAW has received travel grants from GlaxoSmithKline. PL has received institutional grants, personal consulting fees, and personal lecture fees from AstraZeneca, GlaxoSmithKline, and Boehringer Ingelheim. GCD has received institutional grants from Genentech and AstraZeneca, book chapter royalties from Elsevier, and payment from AstraZeneca and Novartis for participation in advisory boards. JAW has received institutional grants from GlaxoSmithKline, AstraZeneca, Chiesi Farmaceutici, Boehringer Ingelheim, Novartis, and Genentech, and has participated in a Virtus data and safety monitoring board. JV is supported by the National Institute for Health Research Manchester Biomedical Research Centre, has received a research grant from Boehringer Ingelheim, honoraria from AstraZeneca, Boehringer Ingelheim, Chiesi Farmaceutici, GlaxoSmithKline, and Novartis for presentations at meetings, and honoraria from AstraZeneca, Boehringer Ingelheim, Chiesi Farmaceutici, GlaxoSmithKline, Novartis, and TEVA for participation in advisory boards, is a member of the Panel for Clinical and Translational Research for the Novo Nordisk Foundation, has chaired the Asthma UK Research Review Panel, and is a member of the Medical and Chemicals Technical Options Committee for the Montreal Protocol, the UN Environment Programme. LEGWV has received institutional grants from AstraZeneca, personal payments from AstraZeneca, GlaxoSmithKline, Boehringer, Linde, Novartis, Menarini, and Zambon for lectures, presentations, speakers bureaus, manuscript writing, or educational events, personal payments from AstraZeneca, GlaxoSmithKline, and Boehringer Ingelheim for participation on data safety monitoring boards or advisory boards, and payment from Chiesi Farmaceutici for medical writing. All other authors declare no competing interests., (Copyright © 2022 Elsevier Ltd. All rights reserved.)