Long term lung health in children: new emerging threats and preventive strategies.

The long-term consequences of early adverse exposures are well known but is becoming clear that early means not just in pregnancy but also in at least the two preceding generations. Furthermore, there are new existential threats to long term respiratory health, some of which have been presented at the INSPiRED meeting in Bologna and are reviewed in this manuscript. One such is premature delivery, with ever smaller babies surviving with new respiratory and systemic complications, but there is also an appreciation that even those who do not develop bronchopulmonary dysplasia may have long term complications. New environmental hazards include vapes and other devices designed to produce a new generation of nicotine addicts; gas flaring which ruthlessly maximises profit at the expense of the environment and those living close by; and climate change, perhaps the greatest threat of all. Compounding these challenges is the effects of displacement by war or natural disasters on increasing numbers of children. On the other hand, encouragingly, two new highly effective strategies for the prevention of respiratory syncytial virus infection are becoming widely available, namely maternal immunisation with a pre-fusion vaccine in the third trimester of pregnancy and a long-acting monoclonal antibody. We await data as to whether these strategies will prevent impairment of lung function and later asthma. However, strong political action is essential if the expanding range of threats to the health of children and young people are to be averted. Awareness of new threats and advocacy are important roles for all paediatricians.