World health day observances in November 2022: pneumonia, chronic obstructive pulmonary disease, preterm birth, and antimicrobial resistance in focus.

Abstract

EditorialWorld health day observances in November 2022: pneumonia, chronic obstructive pulmonary disease, preterm birth, and antimicrobial resistance in focusMiša Gunjak and Rory E. MortyMiša GunjakDepartment of Translational Pulmonology and the Translational Lung Research Center, University Hospital Heidelberg, member of the German Center for Lung Research (DZL), Heidelberg, GermanyDepartment of Lung Development and Remodelling, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany and Rory E. MortyDepartment of Translational Pulmonology and the Translational Lung Research Center, University Hospital Heidelberg, member of the German Center for Lung Research (DZL), Heidelberg, GermanyDepartment of Lung Development and Remodelling, Max Planck Institute for Heart and Lung Research, Bad Nauheim, GermanyPublished Online:09 Nov 2022https://doi.org/10.1152/ajplung.00342.2022This is the final version - click for previous versionMoreSectionsPDF (2 MB)Download PDF ToolsExport citationAdd to favoritesGet permissionsTrack citations INTRODUCTIONSeven observances are held in November 2022 that are of relevance to respiratory health (Fig. 1). First among these is World Pneumonia Day, typically observed on 12th November every year, and this year is the third World Pneumonia Day observed during the coronavirus disease 2019 (COVID-19) pandemic. Four days later, the burden of chronic obstructive pulmonary disease (COPD) is highlighted on World COPD Day, this year, taking place on 16th November, which appropriately finds itself in the middle of COPD Awareness Month, observed only in the United States, over the entire month of November. The following day, 17th November, is World Prematurity Day, a day of advocacy for the more than 1 in every 10 infants that are born preterm. And finally, the week of 18th–24th November is World Antimicrobial Awareness Week (WAAW), which includes U.S. Antibiotic Awareness Week (USAAW) over the same period and European Antibiotic Awareness Day (EAAD) on the first day of that week, 18th November. Given the tremendous relevance of pneumonia, COPD, preterm birth, and antimicrobial resistance (AMR) to lung pathophysiology, our Journal contributes to promoting awareness and advocating for progress in the prevention and management of pneumonia, COPD, preterm birth, and AMR by highlighting all four issues in articles in the pages of the November issue of the American Journal of Physiology-Lung Cellular and Molecular Physiology (AJP-Lung), which are further highlighted at our social media facilities.Figure 1.Logos and publicity material for the observance of World Pneumonia Day (https://stoppneumonia.org/latest/world-pneumonia-day/) and World COPD Day (https://goldcopd.org/world-copd-day-2022) (top row, left to right); World Prematurity Day (https://www.efcni.org/) (second row); World Antimicrobial Awareness Week (https://www.who.int/campaigns/world-antimicrobial-awareness-week/2022, https://www.fao.org/antimicrobial-resistance/world-antimicrobial-awareness-week/en/, https://www.unep.org/, https://www.woah.org/en/home/), European Antibiotic Awareness Day (https://antibiotic.ecdc.europa.eu/en/), and U.S. Antibiotic Awareness Week (https://www.cdc.gov/antibiotic-use/week/) (bottom two rows, clockwise from top, left). The publicity material has been provided to the public for use to assist in the promotion of activities related to these six world health observances by the Every Breath Count Coalition, the Global Initiative for Chronic Obstructive Lung Disease, the European Foundation for the Care of Newborn Infants, the World Health Organization, the European Centre for Disease Prevention and Control, and the Centers for Disease Control and Prevention.Download figureDownload PowerPointWORLD PNEUMONIA DAYWorld Pneumonia Day was first observed on 12th November 2010 (1), and has been observed every year since. The Every Breath Counts Coalition hosts World Pneumonia Day, which has a digital presence at https://stoppneumonia.org/latest/world-pneumonia-day/. One year into the COVID-19 pandemic, in an Editorial (2) in our Journal to mark World Pneumonia Day in 2020, Ms. Leith Greenslade, Coordinator of the Every Breath Counts Coalition, highlighted the obstacles faced by nations trying to meet the challenges presented by a new coronavirus pandemic. One year later, in November 2021, Drs. Na Zhu and Wenjie Tan penned an Editorial (3) in our Journal to observe World Pneumonia Day in which they related their discovery, at the Chinese Center for Disease Control and Prevention, of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as the etiological agent of COVID-19. World Pneumonia Day this year is particularly poignant given that not only does the world remain firmly in the grip of the COVID-19 pandemic, but that a harsh influenza season is anticipated in Winter 2022 (4). Indeed, infection trends in the Southern Hemisphere, which are used to predict what is likely to come in the later Northern Hemisphere influenza season, revealed that influenza notifications in Australia 1) started earlier, 2) increased at a more rapid rate, and 3) attained higher numbers compared with both the pre-COVID-19 2019 influenza season data as well as the 5-year averaged data for prior influenza seasons (5). Furthermore, as of mid-2022, >85% of Australian influenza cases were caused by influenza A (H3N2), which causes more severe epidemics (6). Worldwide, it is anticipated that relaxation of nonpharmacological measures put in place to mitigate the COVID-19 pandemic such as handwashing, social distancing, mask-wearing, and travel bans would contribute to enhanced influenza transmission in the 2022 season (7). That is likely to be further exacerbated by low herd immunity, as there had been little influenza transmission over the past 2 years while those same measures were in place; indeed, an entire cohort of children younger than 2 years of age have never been exposed to influenza. The lack-of-immunity issue is further compounded by declining uptake of seasonal influenza vaccine due to vaccine hesitancy (8, 9). These predictions suggest that we may see more influenza pneumonia this influenza season than in the preceding two seasons, possibly exacerbated by a “twindemic” of peaks of both influenza and COVID-19 cases simultaneously (4, 9).This year, to mark World Pneumonia Day, our Journal turned its attention to community acquired pneumonia (CAP) and solicited an Editorial from the leadership of the Excellence Network for Community Acquired Pneumonia (CAPNETZ; https://www.capnetz.de), established under the auspices of the German Ministry of Education and Research (10). In their Editorial, Drs. Julius, Pletz, Rupp, Witzenrath, Barten-Neiner, and Rohde describe changes in the CAP pathogen landscape and the role of comorbidities in patients with CAP. Notably, the authors also touch on the impact of antimicrobial resistance, a topic of WAAW, which is addressed later in this Editorial, particularly related to second- and third-line therapy that is of limited availability in the developing world: an area of the globe that presents us with the most intractable challenges in the management of CAP.AJP-Lung is a highly regarded repository for reports on the pathomechanisms of bacterial, viral, and fungal pneumonia, including that attributed to COVID-19 and influenza. A Call for Papers on “The Pathophysiology of COVID-19 and SARS-CoV-2 Infection” remains open, as a collaboration between AJP-Lung and our sibling journal, Physiological Reports (11). More information about that Call is available at https://journals.physiology.org/ajplung/The-Pathophysiology-of-CoV-2-COVID-19-and-SARS-Infection. Other Calls for Papers related to COVID-19 remain open at other journals within the American Physiological Society publications portfolio. For matters related to the gut and liver, information about a Call for Papers on “Coronavirus Disease (COVID-19) and the Digestive System” at our sibling journal, the American Journal of Physiology-Gastrointestinal and Liver Physiology, is available at https://journals.physiology.org/ajpgi/coronavirus-disease-(covid-19)-and-digestive-system. Turning to the cardiovascular system, further information about a Call for Papers on “Cardiovascular Consequences of COVID” at our sibling journal, the American Journal of Physiology-Heart and Circulatory Physiology, is available at https://journals.physiology.org/ajpheart/cardiovascular-consequences-of-covid. The long-term consequences of COVID-19 have not been neglected, and further information about a Call for Papers “Long-Term Recovery from SARS-CoV-2 (COVID-19)” at our sibling journal, the Journal of Applied Physiology, is available at https://journals.physiology.org/jappl/long-term-recovery-from-sars-cov-2-covid-19. Using the plethora of -omics technologies currently available to investigators to study viral infection is addressed at a Call for Papers “Omics of Viral Infection” at our sibling journal, Physiological Genomics; with further information on that Call available at https://journals.physiology.org/physiolgenomics/omics-of-viral-infection. Over the past 3 years, all Editorials published in our Journal to observe World Pneumonia Day have highlighted the need for more preclinical experimental research to identify new pathologic mechanisms at play, which might be targeted by new pharmacological and other approaches. Our Society would welcome the submission of such reports under any of the Calls for Papers listed above.WORLD COPD DAYCOPD is the third leading cause of death in our global population, after ischemic heart disease (1st) and stroke (2nd; 12). In 2019, ≈212.3 million cases of COPD were reported globally, with ≈3.3 million deaths. More than 150,000 Americans die every year of COPD: 1 death every 4 minutes (13). To draw attention to the burden of COPD worldwide, World COPD Day was launched in 2002 by the Global Initiative for Chronic Obstructive Lung Disease (GOLD; https://goldcopd.org/) (14), which also hosts the digital presence of World COPD Day at https://goldcopd.org/world-copd-day-2022/. This year, World COPD Day will be held on 16th November, occurring in the middle of National COPD Month, which is observed in the United States only (15), and is supported by the U.S. COPD Coalition (https://uscopdcoalition.org/) and the COPD Foundation (https://www.copdfoundation.org/). The 2022 theme for World COPD Day is “Your Lungs for Life,” to reflect the increasing awareness that early life events may predispose lungs to the later development of COPD in adulthood (16, 17). Over the past 2 years, the leadership of GOLD, represented by Dr. Alvár Àgusti, Chair of the GOLD Board of Directors, and Dr. Claus Vogelmeier, Chair of the GOLD Science Committee, have contributed Editorials to our Journal to mark World COPD Day: in 2021, detailing how the COVID-19 pandemic has provided us with new insights into the pathophysiology of COPD (18), and in 2020, reviewing the evolution of thinking about COPD (19), from the model proposed by Fletcher and Peto in 1977 (20), up until 2020. The latter theme was also touched upon in a 2021 Editorial (21) by the leadership of the COPD Foundation.To mark World COPD Day this year, the GOLD leadership, again represented by Drs. Àgusti and Vogelmeier, penned an Editorial (22) that reflects upon how COPD has traditionally been considered a consequence of tobacco-smoking (and thus, “self-inflicted”), despite 1 in 3 patients with COPD worldwide being never-smokers, and that half of patients who develop COPD do not present evidence of acceleration of the physiological rate of loss of lung function. The authors go on to discuss a spectrum of gene-environment interactions that occur throughout life, starting in utero, that should be considered as important factors in the onset and development of COPD. The authors thoughtfully reflect in the concluding sentence of their Editorial (22) that “It would be fantastic if World COPD Day would be expendable and instead we could celebrate healthy lungs for life.” The readership of AJP-Lung would certainly agree that it would be a great achievement to remove World COPD Day from the list of world health observances in the month of November! And, it is the hope of the authors of this Editorial that the 475 articles published to date in the pages of our Journal, and its forerunner, the American Journal of Physiology, contribute to that eventual outcome.WORLD PREMATURITY DAYMore than 1 in every 10 infants is born prematurely, and World Prematurity Day, held on 17th November every year since 2009 (23), serves to promote advocacy for public awareness about preterm birth. World Prematurity Day is hosted by the European Foundation for the Care of Newborn Infants (EFCNI; https://www.efcni.org/), in association with a number of partner organizations; and the EFCNI also hosts the digital presence of World Prematurity Day at https://www.efcni.org/activities/campaigns/wpd/. The theme of this year’s World Prematurity Day is “A parent’s embrace: a powerful therapy. Enable skin-to-skin contact from the moment of birth.” In a sense, that theme is an extension of last year’s theme, “Zero Separation: Act now! Keep parents and babies born too soon together,” which reflected COVID-19-related restrictions on contact between parents and preterm born infants then in place in many perinatal healthcare facilities. This year’s theme highlights the utility of skin-to-skin contact in the management of preterm born infants, a practice with newborns that may well have existed for centuries, and was reported in mainstream medical literature for term infants by Drs. Pierre de Chateau and Britt Weberg working in Umeå, Sweden in 1977 (24). This approach was used with some success for preterm infants in the early 1980s, out of necessity, in a resource-limited neonatal intensive care unit at the Instituto Materno Infantil in Bogotá, Colombia, by Drs. Edgar Rey Sanabria and Héctor Martínez Gómez, who also coined the term “kangaroo mother method” (25). This idea, now termed “kangaroo care” for preterm born infants, was introduced into the English-speaking world by nurses Drs. Gene Cranston Anderson, Elizabeth A. Marks, and Vivian Wahlberg in 1986 (26), and it continues to receive attention in Cochrane Systematic Reviews (27).A previous Editorial (28) by the leadership of the EFCNI to mark World Prematurity Day in 2020 drew attention to bronchopulmonary dysplasia (BPD), the most common complication of preterm birth that presents a significant challenge to the medical management of preterm-born infants. BPD was also addressed last year, in an Editorial (29) by Drs. Luca Bonadies and Eugenio Baraldi titled “World Prematurity Day: the long journey of the preterm lung,” to mark World Prematurity Day 2021. In their report, Drs. Bonadies and Baraldi discussed at length how early life events such as BPD in infancy may lead to COPD in later life. Indeed, Dr. Baraldi and coworkers have previously observed that BPD is “the earliest and perhaps the longest-lasting obstructive lung disease in humans” (30). These ideas make a striking connection with the suggestions of Drs. Àgusti and Vogelmeier, discussed above and presented in their Editorial to observe World COPD Day this year: that COPD may well have its origins in early life events. It is gratifying to see neonatologists and adult pulmonologists both working toward the same idea from opposite starting points: that early life events in the perinatal period may have consequences for chronic respiratory disease in adulthood.This year, the leadership of the EFCNI, represented by Dr. Christina Tischer, Dr. Johanna Kostenzer, Ms. Silke Mader, and Dr. Luc J. I. Zimmermann, have contributed an Editorial (31) to our Journal to mark World Prematurity Day, in which they address the threat posed to newborns by respiratory syncytial virus (RSV). Their Editorial is a call-to-action for a multidisciplinary approach to tackle the ever-present threat of RSV to child health. Our Journal, together with its forerunner, the American Journal of Physiology, is a proud contributor of reports to the body of scientific literature on RSV, having published 59 reports to date on the pathomechanisms of RSV infection in the respiratory system. As outlined below, to mark World Prematurity Day this year, our Journal has launched a Call for Papers on “Novel Insights into Preterm Respiratory Physiology: Celebrating the 100th Birthday of Dr. Mildred T. Stahlman,” which aims to attract a broad spectrum of studies related to lung (patho)physiology including studies on RSV and related Orthopneumovirus members of the Pneumoviridae.In a second Editorial (32) to mark World Prematurity Day this year, Dr. Daniele De Luca, Medical President of the European Society for Paediatric and Neonatal Intensive Care (ESPNIC), highlights the need for more active translational research to better understand and diagnose neonatal respiratory disease, and identify new approaches for the medical management of those diseases. Dr. De Luca identifies a number of neonatal respiratory diseases for which adequate diagnostic and therapeutic strategies are lacking, and goes on to discuss why that may be the case, and has made some suggestions for a path forward. Indeed, our recently launched Call for Papers on “Novel Insights into Preterm Respiratory Physiology” mentioned above, and described in detail below and in an accompanying Editorial, aims to address exactly these gaps in our knowledge.Our Journal has taken the opportunity on World Prematurity Day this year to highlight two outstanding women physician-scientists who have made profound contributions not only to our understanding of neonatal cardiorespiratory physiology, but who have also made fundamental advances in the clinical management of preterm-born infants that continue to have tangible impact on newborn care today. Both of these phenomenal physician-scientists also exemplify the innovative translational research in the neonatal arena that Dr. De Luca so eloquently laments the lack of today, in his Editorial to mark World Prematurity Day 2022 (32).The first of these two phenomenal physician-scientists is Dr. Mildred T. Stahlman (Fig. 2), who celebrated her 100th birthday on July 31, 2022! Dr. Stahlman is probably known first and foremost for being the first physician to successfully ventilate a preterm newborn over the course of severe respiratory distress syndrome (then called hyaline membrane disease), and for establishing one of the world’s first modern neonatal intensive care units, at Vanderbilt University in 1961. Furthermore, Dr. Stahlman is a pioneer of newborn cardiorespiratory physiology, engaged in thoughtful consideration of the ethics of newborn medicine, and conducted novel studies addressing the role of vitamin A and growth factors and hormones in the context of preterm birth. Dr. Stahlman’s life and work are reviewed in an accompanying Perspective article (33) penned by her associates and colleagues: Ms. Corey Nason Reese (CNR Communications) and Dr. Jennifer M.S. Sucre (one of our AJP-Lung Editorial Board members), Dr. Håkan Sundell, and Dr. John J. (“Jeff”) Reese (from Vanderbilt University). In honor of Dr. Stahlman’s 100th birthday this year, and her centenary year, our Journal has teamed up with our sibling journal, Journal of Applied Physiology (two journals of the American Physiological Society in which Dr. Stahlman published some of her outstanding reports), to launch a Call for Papers: “Novel Insights into Preterm Respiratory Physiology: Celebrating the 100th Birthday of Dr. Mildred T. Stahlman”. That Call for Papers has been launched in the accompanying Editorial (34) in this issue of our Journal penned by Dr. Sue C. Bodine and Dr. Rory E. Morty, the Editors-in-Chief of the Journal of Applied Physiology and AJP-Lung, respectively.Figure 2.Two women physician-scientists who have profoundly impacted the care of preterm newborns: Dr. Mildred Thornton Stahlman (left) and Dr. Mary Ellen Avery (right). [Photograph of Dr. Stahlman taken by Louise Lasseter Lequire and used with permission of Alan Lequire. Photograph of Dr. Avery is in the public domain and has been modified and reproduced under a Creative Commons Attribution-ShareAlike 4.0 (CCBY-SA 4.0) license.]Download figureDownload PowerPointThe second of these two phenomenal physician-scientists is Dr. Mary Ellen (“Mel”) Avery (May 6, 1927–December 4, 2011; Fig. 2). During a research fellowship at Children’s Hospital Boston and Harvard School of Public Health, Dr. Avery made the groundbreaking discovery that respiratory distress syndrome in preterm newborns was largely caused by a deficiency in surfactant, due to the immaturity of the lungs at birth (35). Given the pioneering work of Dr. John A. Clements on the role of surfactant in the pressure-volume characteristics of lungs [published in the American Journal of Physiology (36)], that discovery laid the groundwork for the subsequent use of artificial surfactant to manage preterm newborns with respiratory distress syndrome. Dr. Avery’s pioneering discovery about surfactant thus revolutionized the care of preterm newborns when it was translated into clinical practice by Japanese pediatrician Dr. Tetsuro Fujiwara in 1980 (37). As a testament to the success of what became known as surfactant replacement therapy, congenital malformations replaced respiratory distress syndrome as the leading cause of death in preterm infants (38). Beyond pioneering work on surfactant, Dr. Avery was also a driver of a second milestone in the management of preterm birth: the use of antenatal steroids. Sir Graham Collingwood (“Mont”) Liggins, working in New Zealand, suggested in 1969 that glucocorticoid administration to pregnant ewes accelerated the production of surfactant in the lungs of fetal lambs (39). That finding was first confirmed in 1970 by Dr. Avery’s group at Johns Hopkins School of Medicine, using twin fetal lambs, one of which received dexamethasone and the other saline (40). This phenomenon was then confirmed in fetal rabbits in 1971, again by Dr. Avery’s group, which had relocated to McGill-Montreal Children’s Hospital in Montreal, Canada, and was published (41) in the Journal of Applied Physiology! Those studies preceded the publication by Sir Graham and neonatologist Dr. Ross Howie of the first clinical trial that documented the utility of antenatal steroids to prevent respiratory distress syndrome in preterm born infants (42).After her groundbreaking discoveries about surfactant, Dr. Avery served as the first woman to head a clinical department at Harvard Medical School and served as first woman Physician-in-Chief at Children’s Hospital Boston. Over the course of her career, Dr. Avery continued her preclinical investigations into the volume-pressure relationships of newborn lungs, and the use of steroids to promote surfactant production and maturation of fetal lungs, some of which she published in the pages of our sibling journal, the Journal of Applied Physiology (41, 43). To highlight Dr. Avery and her achievements on World Prematurity Day 2022, our Journal solicited an Editorial (44) from Dr. David Warburton, who completed a Fellowship under Dr. Avery’s supervision, at Children’s Hospital Boston. In his article, Dr. Warburton provides a thoughtful personal recollection of Dr. Avery, and places in context her varied and paradigm-changing contributions to our understanding of newborn physiology and newborn care.WORLD ANTIMICOBIAL AWARENESS WEEKAMR develops largely as a result of overuse of antibiotics, and in 2014 was estimated to cause ≈50,000 deaths each year in the United States and Europe combined (45), and ≈700,000 deaths each year worldwide (46); with that number rising in 2019 to 1.27 million deaths worldwide that were directly attributable to bacterial AMR alone (47). It has been predicted that if the current AMR trajectory is maintained, in 2050, 10 million people will die annually from drug-resistant bacterial infections, with Africa and Asia predicted to account for 4.1 and 4.7 million of those deaths, respectively (48). In recognition of a progressively worsening AMR outlook, on May 25, 2015, World Health Organization (WHO) member states at the 68th World Health Assembly in Geneva, Switzerland, endorsed a global action plan to tackle antimicrobial resistance (49). One of the five objectives of that plan was “to improve awareness and understanding of AMR through effective communication” (49), and for that reason, WAAW was established, to take place in the third week of November every year, to promote awareness of the problem of AMR both among the public and within the healthcare sector (50).WAAW has been observed every year since 2015, and since 2018, has always taken place over the period 18–24 November. The WHO, together with the Food and Agriculture Organization of the United Nations, the United Nations Environment Programme, and the World Organisation for Animal Health (collectively referred to as “The Quadripartite”) jointly manage WAAW, which has a digital presence at the homepages of all four organizations (for WHO, at https://www.who.int/campaigns/world-antimicrobial-awareness-week/2022). WAAW has a perennial slogan, “Antimicrobials: Handle with Care,” as well as a specific theme that changes with each annual campaign, which in 2022 is “Preventing antimicrobial resistance together.” The U.S. Antibiotic Awareness Week (USAAW; https://www.cdc.gov/antibiotic-use/week/), hosted by the Centers for Disease Control and Prevention, takes place over exactly the same time-frame, and the first day of WAAW and USAAW, 18th November, is also European Antibiotic Awareness Day (EAAD), hosted by the European Centre for Disease Prevention and Control (https://antibiotic.ecdc.europa.eu/en).Unfortunately, several recent analyses of WAAW impact in the United States, United Kingdom, Canada, Australia, India, South Africa, Mainland China, Hong Kong, and Taiwan over 2015–2018 (51), worldwide over 2015–2020 (52), and in Italy over 2016–2021 (53) have indicated that WAAW did not improve public awareness about AMR. Furthermore, awareness of WAAW and EAAD by physicians in Poland was estimated at 20% and 24%, respectively (54), and poor awareness continues to be identified as a barrier to optimal antimicrobial stewardship in Nigeria (55). Given the extraordinary impact of AMR on lung diseases, including pneumonia, cystic fibrosis, bronchiectasis, pulmonary tuberculosis, and sepsis, as well as exacerbations of COPD and pulmonary fibrosis (56), our Journal has added its voice to calls for increased awareness of AMR and improved antimicrobial stewardship during WAAW, USAAW, and EAAD.To that end, our Journal solicited an Editorial (57) by Drs. Henry F. (“Chip”) Chambers and Vance G. Fowler, Jr., who together direct the Scientific Leadership Center of the Antibacterial Resistance Leadership Group (ARLG; https://arlg.org/), which was launched by the National Institute of Allergy and Infectious Diseases (NIAID) at the National Institutes of Health (NIH) in 2013 (58). In their Editorial, Drs. Chambers and Fowler describe the importance of the One Health approach embraced by The Quadripartite to encourage prudent use of antimicrobials and strengthen infection prevention. The authors provide thoughtful discussion about the impact of AMR on human society, taking as examples tuberculosis, human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), and malaria, as well as six bacterial pathogens all of which are “known offenders” in respiratory tract infections: Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Streptococcus pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa. The report from Drs. Fowler and Chambers makes for sobering reading, and highlights how a comprehensive, integrative approach such as the One Health strategy of The Quadripartite may present a means of tackling and ultimately overcoming the currently largely intractable issues of AMR, an ever-present problem in any pulmonary healthcare setting.Pneumonia, COPD, the pulmonary sequelae of preterm birth, and antimicrobial resistance remain critically important issues in pulmonary medicine today. In 2019, COPD was the third leading cause of death worldwide, whereas lower respiratory tract infections (pneumonia) were the fourth leading cause of death worldwide, and the “number 1” communicable cause of death worldwide (12). “Neonatal conditions,” including preterm birth, were the fifth leading cause of death worldwide in 2019 (12). Furthermore, AMR is a massive contributor not only to the burden of pneumonia, COPD, and the causes and complications of preterm birth, but also other respiratory diseases that are not addressed by the world health observances highlighted in this Editorial. Several of these health advocacy Editorials have highlighted the utility of public health, public education, and public awareness campaigns and comprehensive integrative approaches such as the One Health strategy to tackle and overcome these pressing and widespread threats to the health of human society. All four groups of articles have also highlighted the importance of further basic, translational, and clinical research to advance our ability to prevent, diagnose, and manage pneumonia, airways, and distal lung disease in COPD, and preterm birth. The American Journal of Physiology-Lung Cellular and Molecular Physiology will take pride in continuing to be a trusted vehicle for the communication of that research to our community of lung scientists and pulmonary physicians.GRANTSR. E. M. is supported by the University of Heidelberg Hospital and the Medical Faculty of the University of Heidelberg; the Max Planck Society (MPI-HLR); the German Center for Lung Research (Deutsches Zentrum für Lungenforschung; DZL) through DZL