The registries can provide an alternative and important source of clinical data, significantly contribute to better understanding of pulmonary diseases and outline requirements for their effective management. Moreover, the registries can support both regulatory and routine clinical decision-making. Randomized controlled trials (RCTs) are essential for the approval of new therapies; however, because of their design, they provide little insight concerning disease epidemiology/etiology and current clinical practice. Particularly, in lung disease, rigid inclusion/exclusion criteria can limit the generalizability of pivotal trial data. Noninterventional studies (NIS), conducted through the well-established mechanism of patient registries, are undervalued as a means to close data gaps left by RCTs by providing essential data that can guide patient care at different levels from clinical decision-making to health-care policy.
In particular in rare diseases their importance cannot be underestimated. In respiratory disease, registries have been essential in understanding the natural history and different phenotypes of rare conditions, such as alpha 1 antitrypsin deficiency, cystic fibrosis, and idiopathic pulmonary fibrosis. Importantly, additional therapeutic outcome data were generated. While measures for enhancing data quality in RCTs have evolved significantly, the approach and effectiveness of registries is variable. Specific limitations of registry data should be recognized as well as challenges to registry operation, including the impact of the European Union General Data Protection Regulation.
Therefore, RCTs and registry studies should be viewed in parallel, with both providing distinct but complementary data.

The World Health Oraganixation updated its Global Air Quality Guidelins in September 2021 and the new guidelines recommend the peak season mean 8-hour ozone concentration not exceeding 60 μg/m3 as well as more strict standards for annual mean PM2.5 and NO2 concentraions. For reference, there was no recommendation for long-term ozone concentrations before. This change was supported by the studies which suggested that long-term exposure to ozone is associated with an increased risk of cardiovascular and respiratory mortality. Longitudinal studies using large cohorts also revealed that long-term exposure to ozone was associated with a greater decline of lung function and progression of emphysema.
Ozone is known to cause bronchial inflammation and airway hyperresponsiveness via oxidative injury and inflammation. Short-term exposure to high concentration of ozone has been associated with increased mortality and cardiovascular and respiratory morbidity in many regions of the world.
While other ambient air pollutants including PM2.5 and NO2 showed decreasing trends of mean annual concentrations, ozone concentration did not decline recently even in developed countries. Keeping ozone standards as well as standards for particulate matter is needed to protect respiratory health of general population and subjects with chronic respiratory diseases and a reduction of ozone concnetrations will also beneficial in the mitigation of climate change.