Bitwarden is absolutely solid,yes.
Local server wise: If OP uses it in a local only setup behind a proper VPN implementation from my point of view the risk is acceptable. It's not that hard to secure a home server in a way that Vaultwarden is not at risk - and when you're so compromised that it is, then the attacker can easily use other vectors to gain the same data (RAt,keyloggers, etc.)
Air pollution was far worse everywhere besides the extremely rural areas since the middle ages in terms of the Asthma relevant particles and noxes. Combine that with a far worse indoor climate due to mold, animals, humidity, sooth, materials and that leads to a far higher prevalence for Asthma and respiratory illnesses. Which we basically know both from contemporary literature as well as bodies found.
Unless you worked mostly outside in a very very rural area your lungs were worse off 200 years ago than they are now.