BACKGROUND-AIM:
Chronic respiratory diseases (CRDs) remain a major contributor to morbidity, mortality and long-term health inequalities across Europe. Early-life exposures, including tobacco smoke, second-hand smoke, air pollution, respiratory infections and socio-economic disadvantage, influence children’s lung health trajectories. Strengthening prevention in childhood is therefore essential. School-based programmes offer a strategic opportunity to enhance lung health literacy, prevent tobacco and nicotine products uptake, reduce exposure to second-hand smoke, and support healthy respiratory development. The LungHealth4Life (LH4L) project addresses this by integrating comprehensive health education and lung function testing with inequality mapping across three European settings. At submission, the protocol is finalised and pilot implementation has begun, with first findings forthcoming.

METHODS:
LH4L is a multicentric, pre–post intervention study in primary schools in Hungary, Poland and Portugal. The intervention includes a total of 900 children aged 6-11 receiving: (1) age-appropriate education on lung health, tobacco and nicotine harms, clean air and respiratory infection prevention, and (2) standardised lung function testing. Questionnaires are completed by children (knowledge, attitudes, behaviours), parents/caregivers (symptoms, exposures, socioeconomic context) and teachers/school staff (feasibility and implementation feedback). Schools were selected via inequality mapping.

RESULTS:
The intervention was co-developed through an evidence-based, multi-country process integrating educational frameworks, clinical guidance and contextual inequality data to define the optimal early-life prevention package. The protocol outlines educational content, lung function testing procedures, data collection and implementation monitoring. Country adaptations demonstrated flexible delivery models suitable for diverse school and health system structures. With the protocol available through the LH4L Community of Practice (CoP), replication across Europe and beyond is feasible.

CONCLUSIONS:
LH4L aims to demonstrate the feasibility of a school-based approach combining comprehensive health education and lung function testing to support healthy lung trajectories and strengthen early CRD prevention. Special focus is given to early detection of impaired lung function among children. A substantial component of the programme addresses tobacco and novel nicotine products, equipping children to avoid early uptake and reduce second-hand exposure. Findings will inform scalable strategies for child-focused lung health promotion across Europe.