Environmental factors play an important role in altering host resistance to respiratory diseases in childhood. It is likely that the accession of a number of former Soviet Union countries to the European Community will be accompanied by changes in the patterns of disease among children in those countries. These are likely to include increases in asthma and allergic conditions and decreases in serious and life threatening infections. It is recommended that prospective research be targeted at such changes in order to establish likely causative factors and methods of intervention.
The factors most likely to be associated with benefits to children's respiratory health are those with other general benefits, namely good housing and nutrition, avoidance of exposure to cigarette smoke, active encouragement of physical exercise in a clean air environment and avoidance of obesity, and good health care including immunisation programmes. It is recommended that steps be taken to encourage physical activity and a good balanced diet in children, with adequate amounts of fresh fruit and vegetables, to discourage parental smoking and to provide maintain clean air both in the internal (home) and external environment.
Many environmental factors thought to influence children's respiratory health remain unclear and sometimes controversial. This is especially the case with respect to asthma and allergies. Since it is likely that these conditions will increase in a number of European countries over the next decade, it is important to target research towards this area. Hence the recommendations to investigate the influence of the environmental and potentially modifiable factors while recognising that the risk factors may differ between the respiratory diseases and symptoms of childhood. Once these issues have been clarified, it is recommended that Community-wide intervention trials be carried out.
It is highly unlikely that there is any single measure that will reverse the rise in asthma and allergies in prosperous countries, since these diseases have multiple interacting causes. There is therefore a need to address all the identifiable risk factors and to establish the evidence base for whole population interventions by systematic reviews of existing evidence and by further research in the areas of uncertainty including the medium to long term outcomes of exposures in early life.