Climate change and respiratory health: a European Respiratory Society position statement

Environmental exposure assessment in the German National Cohort (NAKO)

We aimed to assess the exposure to multiple environmental indicators and compare the spatial variation across participants of the German National Cohort (NAKO) to lay the foundation for health analyses. We collected highly resolved German-wide data to capture the following environmental drivers: urbanisation by population density; outdoor air pollution by particulate matter (PM2.5), nitrogen dioxide (NO2), ozone; road traffic noise; meteorology by air temperature, relative humidity; and the built environment by greenspace and land cover. All assessed exposures were assigned to the NAKO participants based on their baseline residential addresses. The NAKO study regions ranged from highly urbanised areas (Berlin, Hamburg) to rural regions (Neubrandenburg). This large variation is reflected in the individual environmental exposures at the place of residence. In 2019, annual PM2.5 and NO2 levels ranged from 6.0 to 14.6 and 3.7-33.6 μg/m3, respectively. Annual mean air temperature ranged between 7.8 and 12.7 °C. Noise data was available for a subset of urban residents (22 %), of which 42 % fell into the lowest and 1.8 % into the highest category of Lden 55-59 and Lden >75 dB(A), respectively. Greenspace also showed considerable differences (Normalised Difference Vegetation Index between 0.08 and 0.84). Spearman correlation was moderate to high within the different exposure groups, but mostly low to moderate between the groups. For the first time, a comprehensive population-based dataset with high quality environmental indicators is available for the whole of Germany. Expanding the database by adding innovative indicators such as light pollution, walkability, biodiversity as well as contextual socioeconomic factors will further increase its usefulness for science and public health.

[Respiratory medicine in climate change]

DGP pneumologists advocate measures for adaptation, prevention and the implementation of sustainable health care. To protect patients and mitigate the health threat posed by climate change, resilient systems should be built. To protect lung health, they call for action to counteract rising temperatures and the development of extreme weather events, and for further reductions in air pollution. They point out particularly vulnerable population groups that need to be protected.

The impact of climate change on respiratory health: current understanding and knowledge gaps

PURPOSE OF REVIEW

To present an overview of the impact of climate change upon human respiratory health.

RECENT FINDINGS

Climate change is directly impacting air quality. Particulate matter clearly increases mortality rates. Ozone, a longstanding suspect in climate-related injury, turns out not to have the major impact that had been projected at current levels of exposure. The key factors in global warming have been clearly identified, but while these factors collectively cause deleterious changes, a close look at the literature shows that it is unclear to what extent each factor individually is a driver of a specific process. This article summarizes some of those studies.

SUMMARY

A better understanding of which components of climate change most impact human health is needed in order to re-define environmental standards. PM 2.5 needs to be broken down by chemical composition to study the differential impacts of different sources of PM 2.5 . The detection and study of climate-related changes in respiratory infectious diseases is in a state of relative infancy.

Climate change and suicide epidemiology: a systematic review and meta-analysis of gender variations in global suicide rates

Background

Climate change is reshaping public health, introducing extreme weather conditions and environmental stressors-such as high temperatures, atmospheric pollution, desertification, and storms (rain, thunder, and hail)-that critically impact mental health. Evidence increasingly links these factors to higher rates of suicide-related outcomes, including suicidal ideation, attempts, and self-harm. Such interactions underscore the importance of understanding how climate-driven mental health risks vary by environmental factor and gender, as gender-specific vulnerabilities shape responses to climate stressors.

Methods

By April 16, 2024, we conducted a comprehensive search of PubMed, Web of Science, Cochrane Library, PsycINFO, Scopus, ProQuest, and Embase. Two researchers independently reviewed studies and collected demographic data, systematically tracking and recording rates of suicidal ideation, suicide attempts, suicide deaths, self-harm, and anxiety. Data were rigorously cross-verified for accuracy and consistency.

Results

The meta-analysis demonstrated significant associations between climate change variables and mental health outcomes. High temperatures and air pollution were linked to increased suicide attempts (OR: 1.40, 95% CI: 1.34-1.45) and suicide deaths (OR: 1.51, 95% CI: 1.44-1.58), particularly among males. Conversely, atmospheric pollution and desertification correlated with a reduced likelihood of suicidal ideation (OR: 0.73, 95% CI: 0.63-0.85). These findings highlight gender-specific mental health impacts, with females exhibiting higher rates of anxiety and self-harm, underscoring the urgent need for targeted interventions addressing climate-induced mental health risks.

Conclusions

This systematic review and meta-analysis reveal significant gender-specific mental health impacts of climate change, with females experiencing higher rates of anxiety, self-harm, and suicidal ideation, while males show greater incidences of suicide attempts and deaths. These findings emphasize the urgent need for targeted interventions and the integration of mental health services into climate policies to address these gender disparities.

Systematic review registration

This study is registered with PROSPERO [PROSPERO (york.ac.uk)] under the identifier [CRD42024534961].

The Associations of Long-Term Temperature and Precipitation with Chronic Respiratory Symptoms: Projections for the Changing Climate

PURPOSE

To clarify the associations of climatic indices with chronic respiratory symptoms, with a final aim to approximate the effects of climate change on them.

METHODS

An e-mail survey was directed to the members of the Finnish Pensioners` Federation. The mean 20-years' precipitation and temperature in each subjects' home municipality were obtained from the Finnish Meteorological Institute, separately for summer and winter. Adjusted multivariate models were utilized to investigate the associations of the climatic indices with chronic rhinosinusitis, chronic cough, wheezing with dyspnea, and sleep apnea.

RESULTS

There were 6189 responders from 283 municipalities. Chronic rhinosinusitis and chronic cough were most prevalent in the southeastern regions of the country, where the precipitation counts were highest. In the multivariate models, winter precipitation in the home municipality increased the risks of chronic rhinosinusitis and chronic cough [adjusted OR 1.80 (1.30-2.51) per 100 mm, p < 0.001, and 1.57 (1.19-2.07) per 100 mm, p = 0.001, respectively]. Wheezing with dyspnea and sleep apnea were not associated with the climatic indices.

CONCLUSION

Chronic rhinosinusitis and chronic cough were associated with long-term winter precipitation. Given the anticipated increase in winter precipitation in Northern America and Northern Europe, the prevalences of chronic rhinosinusitis and chronic cough may increase there.

Seasonal and climatic influence on respiratory infections in children with cystic fibrosis

Pseudomonas aeruginosa (Pa) and Methicillin susceptible Staphylococcus aureus (MSSA) are the predominant bacteria found in the airways of people with cystic fibrosis (pwCF), significantly contributing to lung disease progression. While various factors influencing the initial acquisition (IA) of these pathogens are known, the impact of environmental conditions remains understudied. This epidemiological study assessed the risk of MSSA and Pa initial acquisitions in relation to seasonality and climatic zones among 1,184 French pwCF under 18 years old. The age at IA for Pa (Pa-IA) and MSSA (MSSA-IA) was estimated using the Kaplan-Meier method. Seasonality and climatic zones were analysed as risk factors using time-varying Cox regression models. The median age at MSSA-IA was notably earlier (2.0 years) than that at Pa-IA (5.1 years). MSSA-IA occurred increasingly younger in more recent birth cohorts, while the age at Pa-IA remained stable over time. The risk of Pa-IA was consistently higher in all seasons compared with spring, peaking in autumn (HR = 1.53), irrespective of climatic zones. In Oceanic and Continental climates, the highest risk for MSSA-IA was in winter (HRs = 1.45 and 1.20 respectively). In the Mediterranean climate, the risk of MSSA-IA was lower in winter compared to spring (HRs = 0.68 and 0.61 respectively), and the median age at MSSA-IA later than for Pa-IA. This study demonstrates that seasonality and meteorological factors may influence acquisition of MSSA and Pa in pwCF. These findings suggest that environmental factors play a role in pathogen acquisition dynamics in CF and could inform the development of preventive strategies.

Asthma Inception: Epidemiologic Risk Factors and Natural History Across the Life Course

Asthma is a descriptive label for an obstructive inflammatory disease in the lower airways manifesting with symptoms including breathlessness, cough, difficulty in breathing, and wheezing. From a clinician's point of view, asthma symptoms can commence at any age, although most patients with asthma-regardless of their age of onset-seem to have had some form of airway problems during childhood. Asthma inception and related pathophysiologic processes are therefore very likely to occur early in life, further evidenced by recent lung physiologic and mechanistic research. Herein, we present state-of-the-art updates on the role of genetics and epigenetics, early viral and bacterial infections, immune response, and pathophysiology, as well as lifestyle and environmental exposures, in asthma across the life course. We conclude that early environmental insults in genetically vulnerable individuals inducing abnormal, pre-asthmatic airway responses are key events in asthma inception, and we highlight disease heterogeneity across ages and the potential shortsightedness of treating all patients with asthma using the same treatments. Although there are no interventions that, at present, can modify long-term outcomes, a precision-medicine approach should be implemented to optimize treatment and tailor follow-up for all patients with asthma.

Cross-sectional study of the association of respiratory diseases health risk with environmental pollutants and climate change in Saudi Arabia

Saudi Arabia is known for its dry climate. This arid climate of the region makes its ecosystems highly susceptible, with limited water resources and vulnerable agricultural fields. Therefore, it is crucial to comprehend the public's awareness and perceptions of environmental issues and climate change that have an impact on their health and immune system. This study employed a cross-sectional survey to examine the knowledge, attitudes, and practices (KAP) and related health impact of environmental pollutants and climate change in Saudi Arabia. The participants were chosen randomly from various regions across the kingdom. In this study, a total of 437 respondents were selected using convenience sampling (80.78% female and 19.22% male). Participants have fair knowledge on immunological and health effect of environmental pollution and climate change (94.3% and 87.5%, respectively). Participants are well aware of influence of environmental pollutants and climate change on spread of infectious diseases 51-94%. Significant correlation exists between participants of private sector in attitude domain of KAP (P = 0.003, χ2 = 5.139). Significant correlation exists between participants of private sector in attitude domain of KAP (P = 0.003, χ2 = 5.139. Participants are well aware of influence of environmental pollutants and climate change on spread of infectious diseases (51-94%). In conclusion, the health mission in Saudi Arabia has integrated order to manage the diseases that are related to climate change. It is crucial to enhance the knowledge and skills of general public regarding climate change and its impact on health.

The carbon footprint of as-needed budesonide/formoterol in mild asthma: a post hoc analysis

INTRODUCTION

The use of pressurised metered-dose inhalers (pMDIs) and asthma exacerbations necessitating healthcare reviews contribute substantially to the global carbon footprint of healthcare. It is possible that a reduction in carbon footprint could be achieved by switching patients with mild asthma from salbutamol pMDI reliever-based therapy to inhaled corticosteroid-formoterol dry powder inhaler (DPI) reliever therapy, as recommended by the Global Initiative for Asthma.

METHODS

This post hoc analysis included all 668 adult participants in the Novel START trial, who were randomised 1:1:1 to treatment with as-needed budesonide/formoterol DPI, as-needed salbutamol pMDI or maintenance budesonide DPI plus as-needed salbutamol pMDI. The primary outcome was carbon footprint of asthma management, expressed as kilograms of carbon dioxide equivalent emissions (kgCO2e) per person-year. Secondary outcomes explored the effect of baseline symptom control and adherence (maintenance budesonide DPI arm only) on carbon footprint.

RESULTS

As-needed budesonide/formoterol DPI was associated with 95.8% and 93.6% lower carbon footprint compared with as-needed salbutamol pMDI (least-squares mean 1.1 versus 26.2 kgCO2e; difference -25.0, 95% CI -29.7 to -20.4; p<0.001) and maintenance budesonide DPI plus as-needed salbutamol pMDI (least-squares mean 1.1 versus 17.3 kgCO2e; difference -16.2, 95% CI -20.9 to -11.6; p<0.001), respectively. There was no statistically significant evidence that treatment differences in carbon footprint depended on baseline symptom control or adherence in the maintenance budesonide DPI arm.

CONCLUSIONS

The as-needed budesonide/formoterol DPI treatment option was associated with a markedly lower carbon footprint than as-needed salbutamol pMDI and maintenance budesonide DPI plus as-needed salbutamol pMDI.

Geospatial Science for the Environmental Epidemiology of Cancer in the Exposome Era

Geospatial science is the science of location or place that harnesses geospatial tools, such as geographic information systems (GIS), to understand the features of the environment according to their locations. Geospatial science has been transformative for cancer epidemiologic studies through enabling large-scale environmental exposure assessments. As the research paradigm for the exposome, or the totality of environmental exposures across the life course, continues to evolve, geospatial science will serve a critical role in determining optimal practices for how to measure the environment as part of the external exposome. The objectives of this article are to provide a summary of key concepts, present a conceptual framework that illustrates how geospatial science is applied to environmental epidemiology in practice and through the lens of the exposome, and discuss the following opportunities for advancing geospatial science in cancer epidemiologic research: enhancing spatial and temporal resolutions and extents for geospatial data; geospatial methodologies to measure climate change factors; approaches facilitating the use of patient addresses in epidemiologic studies; combining internal exposome data and geospatial exposure models of the external exposome to provide insights into biological pathways for environment-disease relationships; and incorporation of geospatial data into personalized cancer screening policies and clinical decision making.

Healthcare in the era of climate change and the need for environmental sustainability

ABSTRACT

Climate change is an existential threat to humanity. While the healthcare sector must manage the health-related consequences of climate change, it is a significant contributor to greenhouse gas emissions, responsible for up to 4.6% of global emission, aggravating global warming. Within the hospital environment, the three largest contributors to greenhouse gas emissions are the operating theatre, intensive care unit and gastrointestinal endoscopy. Knowledge of the health-related burden of climate change and the potential transformative health benefits of climate action is important to all health professionals, as they play crucial roles in effecting change. This article summarises the available literature on the impact of healthcare on climate change and efforts in mitigation, focusing on the intrinsic differences and similarities across the operating theatre complex, intensive care unit and gastrointestinal endoscopy unit. It also discusses strategies to reduce carbon footprint.

Selected updates on chronic obstructive pulmonary disease

PURPOSE OF REVIEW

Chronic obstructive pulmonary disease (COPD) is preventable disease and yet it remains the third greatest cause of death worldwide. This review focuses on recent updates in COPD research which have had an impact on our understanding of the epidemiology and pathophysiology of COPD.

RECENT FINDINGS

Epidemiological studies of COPD have moved towards trying to understand the global impact of COPD particularly in low- and middle-income countries where disease prevalence continues to increase. In addition, we are beginning to uncover the impact of air pollution on COPD development with recent work showing a relationship between air pollution and COPD exacerbations. Advances in understanding early origins and early development of COPD have the potential to intervene earlier in the disease course to prevent disease progression. Although biomarkers such as peripheral blood eosinophilia have led to trials of biologic agents in COPD suggesting we may be entering an exciting new biologic era in COPD.

SUMMARY

Recent advances suggest there may be a relationship between air pollution and COPD exacerbations. This requires further research to influence environmental policy. New clinical trials of biologics targeting TH2 inflammation in COPD suggest that targeted treatments with biologics may be a possibility COPD.

Medical Industry Contributions to the Climate Crisis: Behind the Green Drapes

The climate crisis is rapidly unfolding with immediate, disastrous consequences including rising surface temperatures, melting of icecaps and glaciers, rising of sea levels, and destructive wildfires spanning the globe. The impact of these climate changes on human health is broad, ranging from immediate heat-related deaths to acute and chronic respiratory and cardiovascular illness. Ironically, the healthcare industry itself contributes to climate change in many ways including waste generation, energy consumption, pharmaceutical production, equipment manufacturing, transportation, and infrastructure. In addition to these obvious ways, the use of HFA-propelled MDIs contributes significantly to the climate footprint of healthcare and is easily addressed immediately by changing to DPIs and soft mist inhalers where feasible and appropriate based on patient needs, safety, and availability of inhalers. Implementing carbon offset programs, investing in research and development, and raising awareness among healthcare professionals are crucial components to reform. The healthcare industry must lead by example and commit to long term sustainable practices that not only mitigate the environmental footprint of the healthcare industry but also improve patient outcomes.