Impact of climate, air pollution, and urbanization on chronic respiratory infections

Introductionchronic respiratory infections represent a significant source of global morbidity and mortality, especially among individuals with structural lung diseases or compromised defenses. Emerging evidence highlights the role of environmental factors, such as climate change, air pollution, and urbanization, in the epidemiology and progression of these infections.Areas coveredThis review synthesizes current research on the interactions between climate conditions, pollution, and urbanization in bronchiectasis, cystic fibrosis, nontuberculous mycobacterial (NTM) pulmonary disease, and chronic pulmonary aspergillosis. A search of relevant medical literature in the English language was conducted in Medline/PubMed, EMBASE and Scopus up to January 2026.Increases in temperature, fluctuations in humidity, extreme weather events (e.g. heatwaves, floods, and cold spells), and elevated concentrations of particulate matter contribute to both pathogen proliferation and increased host susceptibility, which impact the severity and incidence of chronic respiratory infections, particularly those caused by environmental pathogens such as non-tuberculous mycobacteria and Aspergillus spp. respiratory infections. Higher urban density and changes in microbial ecosystems further enhance transmission and chronicity.Areas coveredThis review synthesizes current research on the interactions between climate conditions, pollution, and urbanization in bronchiectasis, cystic fibrosis, nontuberculous mycobacterial (NTM) pulmonary disease, and chronic pulmonary aspergillosis. A search of relevant medical literature in the English language was conducted in Medline/PubMed, EMBASE and Scopus up to January 2026.Increases in temperature, fluctuations in humidity, extreme weather events (e.g. heatwaves, floods, and cold spells), and elevated concentrations of particulate matter contribute to both pathogen proliferation and increased host susceptibility, which impact the severity and incidence of chronic respiratory infections, particularly those caused by environmental pathogens such as non-tuberculous mycobacteria and Aspergillus spp. respiratory infections. Higher urban density and changes in microbial ecosystems further enhance transmission and chronicity.Expert opinionUnderstanding the complex interactions between environmental stressors and respiratory health and incorporating environmental risk assessment into clinical practice and public health policy is crucial for reducing disease burden in the context of accelerating climate change.