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Uncertainty remains regarding the effects of outdoor air pollution in rural areas on childhood asthma, rhinitis, and eczema. Although these diseases often coexist, few studies have examined the effects of air pollution on their multimorbidity. The objective of this study was to investigate the associations of pregnancy exposure to outdoor fine particulate matter (PM 2.5 ) and nitrogen dioxide (NO 2 ) with childhood asthma, rhinitis, eczema, and their multimorbidity. We included children from the 6-year (n = 1322) and 12-year (n = 1118) follow-up of the Pélagie mother-child cohort in Brittany, France where 64% of the participants lived in rural areas. Asthma, rhinitis, eczema, and a multimorbidity phenotype (concomitant presence of ≥2 diseases) were defined by validated questionnaires. PM 2.5 and NO 2 concentrations during pregnancy were modeled at residential address using land use regression. We assessed associations using logistic regressions per interquartile range (PM 2.5 : 3 μg/m 3 ; NO 2 : 10 μg/m 3 ). We also performed stratification by type of area (urban and rural). Asthma, rhinitis, eczema, and the multimorbidity phenotype prevalence were 12%, 20%, 22% and 12% at 6-years, and 10%, 23%, 19% and 11% at 12-years of follow-up. At 6-years, for eczema, a tendency of an association was observed with NO 2 (OR = 1.15, 95% CI = 0.97-1.36, p-value = 0.10), and stratification by type of area showed statistically significant associations for PM 2.5 (1.49 (1.03-2.13), p = 0.03) and NO 2 (1.40 (1.08-1.82), p = 0.01) in the urban stratum. At 12-years, main analyses showed a tendency of associations of PM 2.5 (1.38 (0.98-1.93), p = 0.07) and NO 2 (1.25 (0.98-1.59), p = 0.07) with asthma, and of NO 2 with the multimorbidity phenotype (1.23 (0.97-1.56), p = 0.09). While overall results were not statistically significant, associations in urban settings were stronger than in rural ones at 6-years suggesting that possible differences between the effects in urban and rural areas should be further explored., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Only few studies report long-term evolution of patients with neuroendocrine cell hyperplasia of infancy (NEHI). We report data from a 54-patient cohort followed up in the French network for rare respiratory diseases (RespiRare). Demographic characteristics and respiratory and nutritional evolution were collected at the time of the patient's last scheduled visit. The mean duration of follow-up was 68 months (5 months to 18 years). Fifteen patients (27.8%) were considered clinically cured. During follow-up, hospitalizations for wheezy exacerbations were reported in 35 patients (55%), and asthma diagnosed in 20 (37%). Chest CT scan improvement was noted in 25/44 (56.8%). Spirometry showed a persistent obstructive syndrome in 8/27 (29.6%). A sleep disorder was rare (2/36, 5.5%). Oxygen weaning occurred in 28 of the 45 patients initially treated (62.2%) and was age-dependent (35.7% under 2 years, 70.5% between 2 and 6 years, and 100% after 7 years). Oxygen duration was linked to a biopsy-proven diagnosis (p = 0.02) and to the use of a nutritional support (p = 0.003). Corticosteroids were largely prescribed at diagnosis, with no evident respiratory or nutritional effect during follow-up. Among 23 patients with an initial failure to thrive, 12 (52.2%) had no weight recovery. Initial enteral feeding (17/54, 31.5%) was stopped at a mean age of 43 months (3 to 120), with no effect on cure and oxygen liberation at the last visit.  Conclusion: Our results show that NEHI has a globally positive, but unequal, improvement over time. Further prospective studies are needed to better clarify the different trajectories of patients with NEHI. What is Known: • Neuroendocrine cell hyperplasia of infancy (NEHI) is an interstitial lung disease whose long-term outcome is considered positive from very few studies including heterogeneous populations. What is New: • The 68-month follow-up of our 54-patient cohort showed respiratory/nutritional symptom persistence in 72.2%, oxygen requiring in 34%, and asthma in 37%. When controlled, radiological or functional improvement was noted in 56.8 and 40.7%. Further prospective studies are needed to better clarify the different trajectories of patients with NEHI., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The role of seasons should be taken into account in the management of asthma. The environment varies between seasons and it is well documented that asthma is modulated by environment. Viruses cause asthma exacerbations peak, in winter, in adults while the peak is present in September in children. Allergens are probably a less powerful source of asthma exacerbation than viruses but pollen involvement in spring and summer and dust mites in autumn are indisputable. Air pollutants, present in summer during the hottest periods, are also highly involved in asthma exacerbations. Indoor air pollution, in winter, is also implicated in asthma disease. All these environmental factors are synergistic and increase the risk of asthma exacerbation. Therapies should be adapted to each season depending on environmental factors potentially involved in the asthma disease., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)