Lung-function trajectories: relevance and implementation in clinical practice.

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.

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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.