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Peer-reviewedCC BY-NC 4.0European Respiratory Review

Climate change as a modifier of paediatric lung-function trajectories

  • David Drummond1,2
  • Harald E. Renz3,4,5,6
  • Cihan Beri3,4,6
  • Maria José Rosa7
  • Jaime E. Hart8,9
  • Mark P. Murphy10
  • Noel G. McElvaney10
10 affiliations
  1. 1Department of Paediatric Pulmonology and Allergology, AP-HP, University Hospital Necker-Enfants Malades, Paris, France
  2. 2Université Paris Cité, Inria, Inserm, HeKA, Paris, France
  3. 3Institute of Laboratory Medicine, Philipps University Marburg, Marburg, Germany
  4. 4University Hospitals Giessen and Marburg GmbH, Marburg, member of the German Center for Lung Research (DZL) and the Lung Center of the Universities of Giessen and Marburg (UGMLC), Marburg, Germany
  5. 5Kilimanjaro Christian Medical University KCMCU Moshi, Moshi, Tanzania
  6. 6Tongji Medical School, Shanghai, China
  7. 7Department of Environmental Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
  8. 8Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
  9. 9Harvard Chan NIEHS Center for Environmental Health, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
  10. 10Department of Medicine, Irish Center for Genetic Lung Disease, Royal College of Surgeons in Ireland, Dublin, Ireland
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Abstract

Lung function follows a life-course trajectory, rising through childhood and adolescence to a peak in early adulthood; a low peak is associated with later COPD, cardiovascular morbidity and premature mortality. Childhood and adolescence are therefore the key periods during which adult respiratory reserve is built. Climate change is relevant to paediatric respiratory health not only because it triggers acute symptoms, but because it intensifies, prolongs and reschedules exposures already known to affect the developing lung, including heat, air pollution, wildfire smoke, aeroallergens and indoor damp. In this mini-review, we use lung-function trajectories as the organising framework and examine how climate-sensitive exposures may shift them downwards through three developmental pathways. First, early developmental disruption, including gestational air pollution and ambient temperature, may lower the starting point of the trajectory through fetal growth restriction, preterm birth and possibly direct effects on developing airways. Second, sustained exposure to air pollution, heat and indoor dampness across childhood and adolescence may impair postnatal lung growth and reduce lung-function growth and the peak attained. Third, climate-sensitive triggers increasingly precipitate exacerbations followed by incomplete recovery, particularly in asthma and cystic fibrosis, resulting in exacerbation-related step-down events. Crucially, these trajectories are not fixed; evidence that improving air quality accelerates lung-function growth shows that respiratory reserve can still be protected. We translate this trajectory-centred evidence into practical, climate-aware paediatric care, shifting the focus from short-term symptom prevention to preserving the lung-function reserve children carry into adulthood.

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Cite

BibTeXRIS
BibTeX
@article{drummond2026climate,
  title = {{Climate change as a modifier of paediatric lung-function trajectories}},
  author = {David Drummond and Harald E. Renz and Cihan Beri and Maria José Rosa and Jaime E. Hart and Mark P. Murphy and Noel G. McElvaney},
  journal = {European Respiratory Review},
  year = {2026},
  month = nov,
  doi = {10.1183/16000617.0222-2026},
  url = {https://doi.org/10.1183/16000617.0222-2026},
  note = {CC BY-NC 4.0},
}
RIS
TY  - JOUR
TI  - Climate change as a modifier of paediatric lung-function trajectories
AU  - David Drummond
AU  - Harald E. Renz
AU  - Cihan Beri
AU  - Maria José Rosa
AU  - Jaime E. Hart
AU  - Mark P. Murphy
AU  - Noel G. McElvaney
PY  - 2026
DA  - 2026/11/04
JO  - European Respiratory Review
DO  - 10.1183/16000617.0222-2026
UR  - https://doi.org/10.1183/16000617.0222-2026
AB  - Lung function follows a life-course trajectory, rising through childhood and adolescence to a peak in early adulthood; a low peak is associated with later COPD, cardiovascular morbidity and premature mortality. Childhood and adolescence are therefore the key periods during which adult respiratory reserve is built. Climate change is relevant to paediatric respiratory health not only because it triggers acute symptoms, but because it intensifies, prolongs and reschedules exposures already known to affect the developing lung, including heat, air pollution, wildfire smoke, aeroallergens and indoor damp. In this mini-review, we use lung-function trajectories as the organising framework and examine how climate-sensitive exposures may shift them downwards through three developmental pathways. First, early developmental disruption, including gestational air pollution and ambient temperature, may lower the starting point of the trajectory through fetal growth restriction, preterm birth and possibly direct effects on developing airways. Second, sustained exposure to air pollution, heat and indoor dampness across childhood and adolescence may impair postnatal lung growth and reduce lung-function growth and the peak attained. Third, climate-sensitive triggers increasingly precipitate exacerbations followed by incomplete recovery, particularly in asthma and cystic fibrosis, resulting in exacerbation-related step-down events. Crucially, these trajectories are not fixed; evidence that improving air quality accelerates lung-function growth shows that respiratory reserve can still be protected. We translate this trajectory-centred evidence into practical, climate-aware paediatric care, shifting the focus from short-term symptom prevention to preserving the lung-function reserve children carry into adulthood.
SN  - 0905-9180
SN  - 1600-0617
ER  -