Normal age-related FVC decline follows a linear trajectory in women (~26 mL·year-1) and a biphasic trajectory in men (~22 mL·year-1 before age 40, ~36 mL·year-1 thereafter), averaging ~20-30 mL annually, which is essential for distinguishing healthy ageing from pathological decline.
Key Findings
Results
FVC peaks in the mid-20s and declines continuously without plateau in healthy adults without lung disease.
This pattern was consistent across over five decades of research
The systematic review and meta-analysis identified 50 publications representing 35 cohorts and over 365,000 participants
Follow-up ranged from three to 35 years with three to 12 spirometric assessments per participant
A search of major databases and conference proceedings identified 7,160 citations, of which 50 publications met eligibility criteria
Results
Women show a linear FVC decline trajectory of approximately 26 mL·year-1 throughout adulthood.
This finding came from an individual-level pooled analysis of over 30,000 participants, described as 'the strongest evidence'
The decline is continuous without a plateau phase
This linear pattern contrasts with the biphasic pattern observed in men
The overall normative range averages approximately 20-30 mL annually across sexes
Results
Men show a biphasic FVC decline trajectory, with a slower rate before age 40 and an accelerated rate thereafter.
FVC decline in men is approximately 22 mL·year-1 before age 40
FVC decline in men accelerates to approximately 36 mL·year-1 after age 40
This biphasic trajectory was identified from an individual-level pooled analysis of over 30,000 participants
The sex difference in trajectory shape represents a key finding distinguishing male from female lung ageing patterns
Results
Estimates of FVC decline varied widely across studies due to substantial heterogeneity.
Reported FVC decline estimates ranged from 10 to 80 mL·year-1 across included studies
Heterogeneity was attributed to differences in study design, population composition, outcome reporting, and analytic approach
50 publications representing 35 cohorts and over 365,000 participants were included
Despite wide variation in estimates, a consistent pattern of decline after early adulthood was evident across over five decades of research
Discussion
Normative FVC decline trajectories are critical for interpreting clinical trial endpoints in interstitial lung diseases (ILD).
Attenuation of FVC decline is a primary outcome in most interstitial lung disease trials
Without a benchmark for expected ageing, it is difficult to determine whether therapy preserves lung function by preventing FVC loss or mirrors natural trajectories
The authors state that incorporating normative trajectories into trial design will 'improve diagnostic precision, contextualise therapeutic effects and define clinically meaningful preservation of lung function'
These normative trajectories are described as 'essential for distinguishing healthy ageing from pathological decline'
Methods
The systematic review encompassed a broad evidence base with long-term longitudinal follow-up in healthy adults.
35 distinct cohorts were identified across 50 publications
Total participant count exceeded 365,000
Follow-up duration ranged from three to 35 years
Each participant underwent between three and 12 spirometric assessments, providing repeated measures data
What This Means
This research examined how lung capacity — specifically forced vital capacity (FVC), the maximum amount of air a person can breathe out — naturally declines with age in healthy adults who do not have lung disease. By reviewing 50 studies involving over 365,000 people followed for up to 35 years, the researchers found that lung capacity peaks in a person's mid-20s and then gradually declines for the rest of life, without any leveling off. On average, healthy people lose about 20–30 milliliters of lung capacity per year — roughly equivalent to a small shot glass. The decline pattern differs between men and women: women lose capacity at a fairly steady rate of about 26 mL per year, while men lose it more slowly in younger adulthood (about 22 mL per year before age 40) but faster after age 40 (about 36 mL per year).
This research matters because doctors and researchers need to know what 'normal' aging looks like in order to recognize when something is going wrong. Conditions like pulmonary fibrosis (scarring of the lung) cause FVC to fall faster than expected, and many clinical trials for such diseases measure success by whether a treatment slows FVC decline. Without knowing the natural rate of age-related decline, it is impossible to tell whether a treatment is genuinely preserving lung function or whether any measured changes simply reflect normal aging. The wide variation in previous estimates — ranging from 10 to 80 mL per year — had made this comparison difficult.
This research suggests that using these normative decline rates (~20–30 mL per year depending on sex and age) as a benchmark could improve how doctors diagnose lung disease, track patients over time, and evaluate whether treatments in clinical trials are truly working. It also highlights the need for consistent methods across future studies to reduce the uncertainty that currently makes comparisons between research findings difficult.
Satia I, Brown K, Filkowski J, Babe G, Milan R, Tiggelaar S, et al.. (2026). Normal age-related decline in forced vital capacity: a systematic review and meta-analysis.. European respiratory review : an official journal of the European Respiratory Society. https://doi.org/10.1183/16000617.0329-2025