Hacia una pediatría del aire: salud respiratoria infantil y medicina ambiómica (2030-2050)

For much of the 20th century, pediatric pulmonology approached childhood respiratory disease from a predominantly reactive perspective, focusing on infections, allergies, and individual biological factors, while air pollution was relegated to the realm of public health. This view is now insufficient. Evidence demonstrates that poor air quality is a major determinant of childhood respiratory health, with profound effects on lung development, susceptibility to infections, the expression of chronic diseases, and health inequalities from an early age. This article proposes a syndemic view of the relationship between air pollution and childhood respiratory health, in which multiple environmental exposures interact with biological vulnerabilities and social contexts to shape disease trajectories. From this perspective, the need arises to evolve toward clinical models capable of anticipating risk and modifying disease progression before crises occur. Within this framework, the ÍTACA Model (Territorial Integration, Ambiomics, and Anticipatory Clinical Practice) is presented. This integrative clinical architecture incorporates individualized exposome assessment, environmental surveillance systems, ambiomics biomarkers, and anticipatory decision-making. The model shifts the focus of care toward community, home, and community pediatrics, relying on pioneering centers to pilot advanced strategies in particularly vulnerable pediatric populations. The main lines of ambiomics therapeutic innovation are also reviewed, including air-targeted therapies, epithelial barrier protection, mitochondrial and immune modulation, personalized biologics, and context-aware pharmacology. Finally, the 2030-2050 timeline is explored through the concept of the Pediatric Respiratory Digital Twin, as a synthesis of an anticipatory, community-based, and equity-oriented air pediatrics. The aim of this special article is to offer a conceptual and operational framework for integrating air as a clinical variable in pediatric practice, anticipating childhood respiratory disease, and protecting development in an atmospherically altered world.