This issue of the European Respiratory Review features the first articles in a series of reviews entitled “Environment and lung health in a rapidly changing world”. This series aims to highlight and dissect the complex intersections of environmental factors and their impact on human lung health. Additionally, the series addresses some more specific issues that we continue to face in the 21st century, including health inequity, the increasingly fast-paced integration of artificial intelligence (AI) into every day medical practice and climate change.

Vasse and Melgert [1] provide a comprehensive overview of the implications of micro- and nano-plastics (MNP) on human lung health. The authors present and analyse the evidence from in vitro, in vivo, and occupational exposure studies that highlight the capacity of MNP to affect lung tissue in both disease and health. The review emphasises the critical need for a thorough evaluation of environmental MNP exposure levels in everyday life and challenges researchers with a call to action to comprehensively explore the extent to which MNP impact respiratory health under “normal” conditions. An immediate challenge in this regard is to develop and agree upon the most accurate and reliable methods for detection and characterisation of MNP in healthy and diseased lung tissue. Such a consensus would strengthen confidence in data generated within the field especially with regard to much needed studies focusing on environmentally relevant particles and the biological mechanisms that they affect. The take-home message reinforces the current ambiguity surrounding the effects of MNP at common exposure levels and overall prompts the lung research community to address crucial questions in future research.

Moving on, a forthcoming review from Joshi and co-workers provides valuable insights on the impact of climate change on respiratory health, focusing on current understanding and knowledge gaps. Herein, they critically evaluate the intricate relationship between global warming and the human respiratory tract. The review explores the complexities of climate change, and how factors such as seasonality and extreme weather events impact upon air quality and mortality rates. Of particular interest, the authors convincingly dispel existing misconceptions about the major impact of ozone at current exposure levels. Crucial research gaps are articulated including the need for a more nuanced understanding of how specific components of climate change can affect lung health. A key area of focus highlighted in this review is the direct influence climate change can have on air quality and mortality, and the authors prompt relevant stakeholders, including ourselves as lung health advocates, to re-evaluate existing environmental standards. A recalibration of such standards in conjunction with ongoing in-depth exploration of the intricacies surrounding climate change and respiratory health are warranted.

Domingo et al. [2] explore the plethora of environmental factors that can deleteriously affect paediatric respiratory health. This review reminds us of the vulnerability of paediatric populations to respiratory diseases exacerbated by aeroallergens, pollutants and infectious agents. Due to the disproportionate impact of worsening climate change on under-resourced areas there is a clear need to reinforce efforts that can promote the shift from fossil fuels to renewable energy in these regions. This review highlights important existing gaps such as the scarcity of human studies and the need for further research investment to carry out studies that can interrogate complex interactions and large-scale effects across diverse populations. Detailed pan-global mitigation and adaptation strategies for addressing aeroallergen health impacts are presented. These proposed solutions stress the importance of collective efforts that can effectively lead to policy reforms thereby aiming to mitigate impending disparities arising from global climate change that especially impact children's lung health.

The priorities that we face globally in respect of respiratory health are outlined by Greene et al. [3], who neatly summarise contingencies which apply to all health fields, such as health equity, tobacco control, development of new vaccines, antimicrobial resistance, pandemic preparedness, and AI, in addition to specific issues in diseases such as COPD and tuberculosis. Of the former, the incorporation at an accelerated pace of AI in the diagnosis, management and prediction of disease outcomes is a matter for optimism but also caution. At present, there are several applications in the field which have already changed practice to a degree that makes it unrecognisable from only a decade ago, e.g. continuous positive airway pressure follow-up in sleep apnoea. Obstructive sleep apnoea itself is also a matter of growing concern, with some predictions suggesting that it might affect up to 1 billion of the current 8.1 billion inhabitants of planet earth with implications for quality of life, driving and cardiovascular health [4]. However, AI brings with it other challenges, including ethical concerns, risks of data leaks, language issues and insufficiently globally tested algorithms. In a forthcoming review, Ottewill and co-workers maintain a positive outlook on the developments in AI as applied to respiratory medicine, but as ever, technological advances far outstrip the speed at which ethical issues are resolved. The rapid pace at which AI applications are integrated into practice, driven primarily by economic forces, can lead us into impenetrable moral mazes. In this respect, the review by Bush et al. [5] examines health systems and equity within paediatric populations in the 21st century. The review comprises broadly based summaries of the health systems and problems of inequity from several different countries, to try and demonstrate whether we are winning the fight against poor respiratory health overall. Arguably, nurture starts in utero, but if we raise children limited by poor health due to inadequate access to resources, we will end up with adults who continue to be affected by their disabilities resulting in an eternal cycle. Where and how do we break that cycle? This review cannot, and does not, address these questions. Specifically, it does not address the effects of war nor of ongoing ethnic discrimination in various populations regarding health to any great extent. However, we hope that the reader will be encouraged to seek out further writing in the area, which incorporates socioeconomic, political, cultural and behavioural modelling into healthcare, and which may bring greater enlightenment albeit no greater resolution to these questions [6–8].

In summary, this series of review articles provides a comprehensive analysis of issues facing all of us irrespective of the field of thoracic medicine and sleep we practice in, from microplastic pollution, climate change, AI in day to day and future practice, and the vulnerabilities of paediatric populations. As we navigate the ever changing and increasingly complex subject of environmental lung health today, we hope that these articles can serve as a guide to urge researchers, policymakers, and the public to collaborate in addressing the challenges posed in our rapidly changing world.