Washko GR, et al. - Using data from the population-based CARDIA Study, experts illustrated the predominance of visually discovered emphysema at various time points and contextualized its development on the basis of an individual's adult life course measures of lung function. A total of 3,171 men and women recruited. Five trajectories representing peak and change in FEV₁ were identified, ie, “Preserved Ideal,” “Preserved Good,” “Preserved Impaired,” “Worsening,” and “Persistently Poor.” Ever smokers included part of all five trajectories. Moreover, irrespective of chronic tobacco smoke exposure, worsening and poor lung health trajectories were related to raised odds of future emphysema. Thus, for future emphysema, lower peak and accelerated deterioration in FEV₁ are risk factors, despite smoking status.