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Cohort studyThe Lancet. Respiratory medicine · 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 study

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 et al. · The Lancet. Respiratory medicine · 2026

Background

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

Purpose

This study aimed to investigate mid-to-small-airway function trajectories, their associated factors, and COPD 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 COPD 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 COPD should be interpreted as life-course associations rather than as predictive.

Post

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.

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

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