Impact of climate change on paediatric respiratory health: pollutants and aeroallergens

Abstract

Paediatric populations are particularly vulnerable to respiratory diseases caused and exacerbated by aeroallergens, pollutants and infectious agents. Worsening climate change is expected to increase the prevalence of pollutants and aeroallergens while amplifying disease severity and causing disproportionate effects in under-resourced areas. The purpose of this narrative review is to summarise the role of anthropogenic climate change in the literature examining the future impact of aeroallergens, pollutants and infectious agents on paediatric respiratory diseases with a focus on equitable disease mitigation. The aeroallergens selected for discussion include pollen, dust mites and mould as these are prevalent triggers of paediatric asthma worldwide. Human rhinovirus and respiratory syncytial virus are key viruses interacting with climate change and pollution and are primary causal agents of viral respiratory disease. Within this review, we present the propensity for aeroallergens, climate change and pollution to synergistically exacerbate paediatric respiratory disease and outline measures that can ameliorate the expected increase in morbidity and severity of disease through a health equity lens. We support shifting from fossil fuels to renewable energy worldwide, across sectors, as a primary means of reducing increases in morbidity.

FIGURE 1

Keeling curve [82] of carbon dioxide (CO₂) concentration measurements in parts per million (ppm) taken daily at Mauna Loa and plotted over time. Full record ending 2 February 2024. Mauna Kea data are shown in blue. Reproduced courtesy of the Scripps Institution of Oceanography at UC San Diego (https://keelingcurve.ucsd.edu/; Creative Commons Attribution 4.0 International License, https://creativecommons.org/licenses/by/4.0/). No changes to the figure were made.

FIGURE 2

Factors leading to increased paediatric respiratory vulnerability. This diagram summarises the interplay between paediatric physiological/behavioural factors, climate change factors and health equity factors that contribute to increased respiratory vulnerability in the paediatric population. GHG: greenhouse gas; SES: socioeconomic status.

FIGURE 3

Climate change-related effects and proposed mechanisms of lung inflammation. This diagram summarises climate change-related effects, including thunderstorm asthma, epigenetic effects and adjuvant and epithelial barrier effects, and respective mechanisms that have been proposed in the literature. Human studies are largely lacking. PM_2.5: particulate matter <2.5 μm; DEP: diesel exhaust particulate; HDM: house dust mite; DC: dendritic cell; MC: mast cell; IL-4: interleukin 4; IgE: immunoglobulin E; IL-17: interleukin 17; Th-17: T-helper 17.

FIGURE 4

Air pollution and aeroallergen summary. This figure summarises the impact of climate change on paediatric respiratory conditions and proposed strategies to adapt to and mitigate these effects.