Washko GR, Colangelo LA, Estépar RSJ, et al. - Using data from the population-based CARDIA Study, researchers investigated the prevalence of visually discovered emphysema at multiple time points, and contextualized its development on the basis of the participant's adult life course measures of lung function. A total of 3,171 men and women were recruited at a mean age of 25 years and underwent serial spirometric examinations through a mean age of 55. Five trajectories representing peak and change in forced expiratory volume (FEV₁) in one second—“Preserved Ideal”, “Preserved Good”, “Preserved Impaired”, “Worsening”, and “Persistently Poor”—were determined. Ever smokers were the part of all five trajectories. The prevalence of emphysema was estimated to be 1.7% (n = 46), 2.5% (n = 67), and 7.1% (n = 189). About 18.0% were never smokers amongst those with emphysema at a mean age of 50. Independent of chronic tobacco smoke exposure, worsening and poor lung health trajectories were correlated with raised odds of future emphysema. Therefore, lower peak and accelerated decline in FEV₁ were concluded as the risk factors for future emphysemam independent of smoking status.