FEF 25-75% trajectories from age 7 to 53 years, associations with childhood and parental preconception…

Cohort studyThe Lancet. Respiratory medicine· Jul 2026

FEF 25-75% trajectories from age 7 to 53 years, associations with childhood and parental preconception factors, and midlife COPD risk: a prospective cohort study.

Jiacheng Liu, Caroline J Lodge, Jennifer L Perret … Dinh S Bui

Allergy & ImmunologyCohort studyPrognosisQ1IF 9.4

Persistently low mid-to-small-airway function linked to much higher chronic obstructive pulmonary disease odds.

FEF 25-75% trajectories from age 7 to 53 years, associations with childhood and parental preconception factors, and midlife COPD risk: a prospective cohort study.

Jiacheng Liu … Dinh S Bui

The Lancet · Jul 2026

Background

Existing trajectory studies have emphasised large-airway indices, but chronic obstructive pulmonary disease (chronic obstructive pulmonary disease) might originate in smaller airways.

Purpose

This study aimed to investigate mid-to-small-airway function trajectories, their associated factors, and chronic obstructive pulmonary disease risk.

Methods

In this prospective cohort study, probands (referred to throughout as offspring) were recruited to the Tasmanian Longitudinal Health Study from local schools across Tasmania, Australia at age 7 years.

Results

persistently low mid-to-small-airway function meant extremely higher chronic obstructive pulmonary disease odds

aOR 112 (95% CI 42 to 304)

CI excludes the null - significant

More results

Six FEF 25-75% trajectories were identified: persistently low (144 [6·2%]); early normal-reduced growth-rapid decline (168 [7·3%]); early below average-reduced growth (740 [32·0%]); early low-accelerated growth (80 [3·5%]); average (976 [42·2%]; reference); and persistently high (206 [8·9%]).

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Conclusion · 1 of 3

FEF 25-75% across the life course, particularly from early life, could be more relevant to chronic obstructive pulmonary disease than previously recognised.

Conclusion · 2 of 3

Several childhood and novel parental preconception factors were associated with FEF 25-75% trajectories, although causality cannot be inferred due to no clear temporality of these associations.

Conclusion · 3 of 3

Our findings on the relationship between FEF 25-75% and chronic obstructive pulmonary disease should be interpreted as life-course associations rather than as predictive.

FEF 25-75% trajectories from age 7 to 53 years, associations with childhood and parental preconception factors, and midlife COPD risk: a prospective cohort study.

FEF 25-75% trajectories from age 7 to 53 years, associations with childhood and parental preconception factors, and midlife COPD risk: a prospective cohort study.

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