Ambient air ranks number one among the natural resources vital to human beings, with an average individual daily need of 12 kg. Due to the specificities of the Mediterranean region (sunny, hot and ...dry climate; long-range transport converging over the basin), air pollution in reactive compounds over the Mediterranean is often higher than in most European inland regions. Climate change (increase in temperature and drought) and anthropogenic pressure (growing population) should significantly impact the regional air quality. As a result, Mediterranean inhabitants who are already regularly exposed to pollutant loads well above WHO air quality recommendations will be further exposed, resulting in an excess of premature deaths. Exposure monitoring and win-win strategies should be developed in the future both to improve air quality and develop a low carbon economy. The evolution of emissions under climate change is not always clear and much uncertainty remains around present emissions from large urban-industrial centers, although recent progress has been made on emissions of the different regional sources of pollutants. It has been established that the regional climate and water cycle are affected by atmospheric chemistry. By reducing solar radiation at the surface, aerosols reduce the yearly average precipitation in the Mediterranean by 10%, which is a major issue since water is already scarce. Aerosols could further reduce precipitations by reducing the size of cloud droplets or through the formation of cloud droplets and ice crystals. Moreover, recent in situ and model experiments indicate that anthropogenic nitrogen and desert dust phosphorus deposition in nutrient-depleted surface seawater favors phytoplankton development, which stimulates the sink of atmospheric CO2 into marine sediments. But Saharan dust deposition by rain also stimulates bacterial growth, which reemits CO2. The net effect of desert dust deposition at large scales needs to be established.