Lung function-associated exposome profile in the era of climate change: Pooled analysis of 8 population-based European cohorts within the EXPANSE project.

Summary

Across eight European cohorts (N≈10,776), elastic net modeling revealed that air pollution, greenness, and ambient temperature interactively relate to FEV1, with stronger, more stable effects in adults. Cleaner air and increased greenness are associated with better lung function, but climate change scenarios predict FEV1 declines and attenuate benefits of air-quality and greenness improvements.

Key Findings

• Elastic net identified multiple non-zero interaction terms among air pollution, greenness, and temperature for FEV1, particularly in adults.
• Scenarios improving air quality or greenness predicted FEV1 gains, whereas climate change (warmer summers, colder winters) predicted FEV1 declines.
• Benefits of improved air quality/greenness on FEV1 were attenuated under climate change conditions.

Clinical Implications

Clinicians should anticipate climate-related respiratory risk, particularly for adults with impaired lung function, and advocate for environmental interventions alongside patient-level prevention.

Limitations

• Cross-sectional analysis limits causal inference and may be affected by residual confounding.
• Exposure assignment based on residential address may not reflect individual mobility or indoor exposures.

Future Directions

Longitudinal modeling with repeated lung function and exposure updates, vulnerable subgroup analyses, and integration with climate adaptation strategies.