Developing evidence-based Korean medicine clinical practice guidelines for pediatric anorexia.

Climate change has heightened the global risk of wildfire (bushfire) by promoting conditions conducive to fire ignition and spread, such as higher temperatures, stronger winds and anomalous rainfall patterns []. Growing attention is being paid to wildfire smoke exposure due to its substantial environmental, economic and health impacts worldwide [–]. The 2019–2020 Australian Black Summer bushfires, for example, are estimated to have released 806 megatons of carbon dioxide, incurred economic losses of A$100 billion and resulted in 450 deaths [–]. The frequency and severity of wildfires are predicted to increase in the future, leading to burning for longer durations in many parts of the world [–]. For example, the reports from the United Nation Environment Programme and the Intergovernmental Panel on Climate Change predict that climate change will lead to 50% increase wildfire events in Western US, Northern Siberia, Central India and Eastern Australia [], and 10–30% in North America and a 74–118% increase in the area burned in Canada by 2100 []. Epidemiological evidence has shown that wildfire smoke is associated with a broad range of adverse health outcomes, including mortality and morbidity related to respiratory diseases [–], cardiovascular diseases [, –], cancers [, ], mental health illnesses [–], diabetes [, ] and adverse birth outcomes [–]. These effects of wildfire on health will exert substantial pressure on the health system, such as the need to expand emergency services to address the immediate acute health effects of wildfire exposure and ongoing healthcare services for the treatment of chronic conditions exacerbated by wildfire, particularly in the context of climate change [, ]. Globally, wildfires contribute to approximately 1.53 million all-cause deaths annually, primarily from cardiovascular and respiratory mortality []. A study conducted in 749 cities from 43 countries also showed that exposure to fine particulate matter (≤ 2.5 µm or less in diameter) from wildfire was associated with 33,510 all-cause deaths (95% CI: 26,204–40,763), 6993 cardiovascular deaths (95% CI: 5466–8510) and 3503 respiratory deaths (95% CI: 2739–4259) []. A recent study conducted in Australia, analysing 416,057 records of cardiorespiratory emergency department visits during the 2019–2020 wildfire season, showed that a 6.0% (95% CI: 1.9–10.3) increase in respiratory-related emergency department visits and 10.0% (95% CI: 5.0–15.2) increase in cardiovascular-related emergency department visits due to wildfire smoke []. Likewise, Korsiak et al. [] analysed a cohort of 20 million participants and found that exposure to wildfire smoke within 50 km of a wildfire source increased the risk of lung cancer by 4.9% (adjusted hazard ratio [HD] = 1.049, 95% CI 1.028–1.071). However, not all findings are consistent. Some studies reported mixed or non-significant associations between certain wildfire-related air pollutants and health outcomes [–]. For instance, a study conducted in California indicated that exposure to particulate matter (PM) from wildfire was significantly associated with hospital admissions for asthma and chronic obstructive pulmonary disease, while exposure to ozone (O) from wildfire showed a non-significant association with hospital admissions for respiratory diseases but a significant association with asthma-related emergency department visits []. These findings highlight the need for further research in this field.