As global populations age and environmental exposures increase, chronic respiratory diseases (CRDs) have become a critical health challenge across the life course. The World Health Organization (WHO) and the European Respiratory Society (ERS) advocate for a "life-course" approach to care, emphasizing that lung health is not confined to a single stage of life. Instead, it begins in utero and is continuously shaped by environmental, behavioral, and physiological factors.
Lung function follows a cumulative trajectory. Exposure to adverse factors—such as secondhand smoke, air pollution, or recurrent respiratory infections—during critical growth periods from gestation through adolescence can restrict lung development, ultimately compromising respiratory function in later years.

Respiratory Risks in Children and Adolescents: Asthma, Obesity, and E-cigarettes

• Asthma and Early Immune Response：Asthma is one of the most common chronic diseases in children. First exposure to airborne viruses and potential allergens during infancy can trigger immune pathways that profoundly affect long-term lung health.
• The Link Between Obesity and Asthma：According to long-term monitoring by the WHO European Childhood Obesity Surveillance Initiative (COSI) , childhood overweight and high BMI are significantly linked to a higher risk of developing asthma and experiencing poorer disease control.
• E-cigarettes and Dual Use：The rising prevalence of "dual use"—the simultaneous consumption of both e-cigarettes and traditional cigarettes among adolescents—poses a severe public health threat. Dual users exhibit the greatest severity in asthma symptoms, suffer from the highest risk of acute exacerbations, and face a significantly higher likelihood of developing COPD in later life.

Respiratory Burden in Older Adults: COPD, Multimorbidity, and Frailty

• Aging Populations Drive Disease Burden：Between 2015 and 2050, the proportion of the world's population over 60 is expected to nearly double from 12% to 22%. Advanced age is a critical risk factor for chronic respiratory diseases (CRDs), particularly chronic obstructive pulmonary disease (COPD).
• The Clinical Complexity of Multimorbidity：Approximately 75% of patients with chronic respiratory diseases have comorbidities, such as cardiovascular disease (heart failure, hypertension), diabetes, lung cancer, and mental health issues (depression, anxiety), which significantly complicate clinical management and increase treatment complexity.
• Frailty as a Key Clinical Indicator：Frailty is a prominent feature of older patients with COPD. An estimated 25% to 40% are underweight, and approximately 35% exhibit a severely low fat-free mass index (FFMI), indicating significant muscle mass depletion.

Respiratory Disease Prevention: Vaccination and Public Health Interventions

Prevention is the most cost-effective strategy in life-course respiratory care. Respiratory infections drive acute exacerbations of asthma and COPD, especially in children and older adults. Therefore, incorporating influenza and COVID-19 vaccines, as well as pneumococcal and respiratory syncytial virus (RSV) vaccines for high-risk groups, into routine immunization programs is a vital strategy to reduce hospitalization and severe illness.

For patients with chronic respiratory diseases, long-term pharmacological management is a core treatment strategy. Inhalation therapy is the cornerstone of respiratory care and is recommended by the WHO as a "Best Buy" intervention for managing conditions such as asthma and COPD. Compared to oral or subcutaneous medications, the primary advantage of inhalation therapy is its ability to deliver medication directly to the targeted lung lesions, significantly reducing systemic side effects.
However, clinical efficacy depends not only on the drug formulation but also on matching the delivery device to the patient's physiological and cognitive condition. According to the AARC's A Guide to Aerosol Delivery Devices for Respiratory Therapists, 5th Edition, , the operational capabilities and challenges vary significantly across age groups:

Advances in Nebulization Technology: Solutions for All-Age Inhalation Therapy

Next-generation technology resolving operational constraints across age groups:

• Natural Breathing Delivery：Requiring no active coordination or a post-inhalation breath-hold, mesh nebulizers allow patients to receive medications through normal tidal breathing, converting liquid into 1–5 µm particles that penetrate deep into the lower airways.
• Vibrating Mesh Technology：Compared to traditional jet nebulizers, new generation mesh nebulizer offers high delivery efficiency, quiet operation, portability, and shorter treatment times, which may help reduce children's resistance to treatment caused by prolonged nebulization sessions.
• Breath-Actuated Technology：These devices are designed to trigger aerosol generation "only during inspiration," significantly reducing drug waste during expiration and allowing for the tracking of the actual delivered dose, helping ensure that young children or older adults with cognitive impairment receive the intended dose.
• Drug-Device Co-Development：Integrated drug-device combinations for specific indications are gaining attention, such as pairing specific antibiotics with nebulizers to potentially enhance targeted local treatment.
• Green Sustainability：In response to international environmental regulations phasing out high Global Warming Potential (GWP) propellants, propellant-free vibrating mesh modules and soft-mist platforms have emerged as the premier green alternatives, offering zero greenhouse gas emissions during inhalation therapy.

From Disease Treatment to Integrated Respiratory Care

As respiratory care evolves from disease-specific acute treatment toward a life-course approach, healthcare is increasingly expanding beyond treatment after disease onset to encompass prevention, continuous monitoring, timely intervention, and rehabilitation.

The World Health Organization (WHO) and the European Respiratory Society (ERS) have also continued to advocate for more resilient and accessible respiratory healthcare systems, promoting a life-course approach to respiratory health and supporting appropriate respiratory care for people across different ages and backgrounds.