Chronic Respiratory Diseases Affect Nearly 570 Million People Worldwide, Study Finds

A new global analysis estimates that nearly 570 million people worldwide were living with a chronic respiratory disease in 2023, underscoring the growing and uneven burden of these conditions across regions and age groups.

Chronic respiratory diseases now rank as the fourth leading cause of death globally, according to findings from the Global Burden of Disease 2023 study published in Nature Medicine titled “Global, Regional, and National Burden of Chronic Respiratory Diseases and Impact of the COVID-19 Pandemic, 1990–2023: A Global Burden of Disease Study.”

The study examined trends in prevalence, disability, and mortality from 1990 through 2023 for major chronic respiratory conditions, including asthma, chronic obstructive pulmonary disease (COPD), interstitial lung disease (ILD), pulmonary sarcoidosis, and pneumoconiosis. Researchers also assessed how the COVID-19 pandemic altered patterns of illness and outcomes worldwide.

Globally, chronic respiratory diseases affected nearly 570 million people in 2023, corresponding to an age-standardized prevalence of 6,742 cases per 100,000 people. While age-standardized death rates declined worldwide over the past three decades, the overall burden remains substantial, particularly among older adults and in specific regions.

"Chronic respiratory diseases remain a major global public health challenge, even as overall death rates have declined over the past 30 years. The burden is increasingly concentrated among older adults and in certain regions, including high-income North America, highlighting gaps in access to care that progress alone has not resolved," said Prof. Dong Keon Yon, one of the study’s authors and a physician-scientist and Professor of Pediatrics and Digital Health at Kyung Hee University and Medical Center in South Korea. “Using data from the Institute for Health Metrics and Evaluation's Global Burden of Disease (GBD) 2023, this analysis examined trends across 204 countries from 1990 to 2023. The research shows that advances in prevention and treatment have not benefited all conditions or populations equally. Overall, the findings reinforce the need for sustained investment in early detection, risk factor reduction, and tailored care strategies as populations age and respiratory disease patterns continue to shift."

One of the most striking findings emerged in high-income North America, where mortality trends diverged sharply from global patterns.

“In 2023, chronic respiratory diseases accounted for 569.2 million (95% uncertainty interval, 508.8–639.8) cases and 4.2 million (3.6–5.1) deaths,” according to the authors.

While global chronic respiratory disease mortality fell by 25.7% between 1990 and 2023, mortality in high-income North America increased by 8% over the same period. This increase was driven largely by deaths from ILD and pulmonary sarcoidosis, which nearly doubled. Deaths from these conditions rose 91%, from 2.23 per 100,000 people in 1990 to 4.25 per 100,000 in 2023, representing the steepest increase among chronic respiratory diseases in the region.

Asthma and chronic obstructive pulmonary disease (COPD) continue to dominate the global burden, but in different ways. Asthma accounted for more than half of all chronic respiratory disease cases worldwide, affecting an estimated 363 million people. In contrast, COPD was responsible for more than 80% of deaths from chronic respiratory diseases, highlighting a persistent imbalance between disease prevalence and mortality.

Age played a critical role in shaping outcomes. While chronic respiratory diseases affect individuals across the lifespan, death rates increased most sharply among adults aged 75 years and older. This trend was especially pronounced for ILD and pulmonary sarcoidosis, conditions that are often difficult to diagnose early and manage effectively in older populations.

The study also identified important differences in risk factors across diseases and regions. Smoking remained the leading contributor to COPD burden globally, reinforcing the ongoing impact of tobacco exposure despite decades of control efforts. For asthma, high body mass index emerged as the top risk factor worldwide and was particularly prominent in high-income regions.

“We provided estimates of chronic respiratory disease burden at the global, regional, and national levels from 1990 to 2023,” the authors wrote. “Although global age-standardized incidence rates for chronic respiratory disease increased modestly during the COVID-19 pandemic, the age-standardized mortality rates, which had been declining before the pandemic, showed a reversal and began to rise during the pandemic period.”

Together, these findings point to both progress and persistent challenges. Declines in global mortality demonstrate the impact of improved treatment and prevention strategies, yet rising deaths in certain regions and among older adults reveal important gaps. The authors emphasize the need to strengthen prevention efforts, improve early diagnosis, and address modifiable risk factors to reduce the long-term impact of chronic respiratory diseases as populations continue to age worldwide.