Burden of chronic respiratory disease in Asia, 1990-2023: a systematic analysis for the Global Burden of Disease Study 2023
- PMID: 41579872
- DOI: 10.1016/S2213-2600(25)00404-7
Burden of chronic respiratory disease in Asia, 1990-2023: a systematic analysis for the Global Burden of Disease Study 2023
Abstract
Background: Chronic respiratory diseases are an important global issue, particularly in Asia, where burden patterns vary widely across countries. With more than half the world's population living in Asia, understanding the national and regional burden of chronic respiratory diseases is essential; however, research on this area remains inadequate. We aimed to investigate the burden of chronic respiratory diseases in Asia at national and regional levels, and to identify key risk factors.
Methods: The Global Burden of Diseases, Injuries, and Risk Factors Study 2023 provides estimates for assessing the burden of chronic respiratory diseases, including chronic obstructive pulmonary disease (COPD), asthma, pneumoconiosis, interstitial lung disease (ILD), and pulmonary sarcoidosis. We focused on 34 countries in Asia, encompassing the high-income Asia Pacific region and central, east, south, and southeast Asia. Estimates for age-standardised prevalence and disability-adjusted life-year (DALY) rates per 100 000 population, including 95% uncertainty intervals (UIs), were extracted by location, sex, year, and Socio-demographic Index (SDI). The average annual percentage change was calculated and presented as a percentage with 95% CIs. Estimates of modifiable attributable risk factors for DALYs and mortality were also included.
Findings: In Asia, the age-standardised prevalence and DALY rates for chronic respiratory diseases generally declined from 1990 to 2023; however, the trend varied substantially by disease and country. In 2023, the age-standardised prevalence rate of COPD was highest in south Asia (3044·18 [95% UI 2748·67-3303·04] per 100 000 population), while the age-standardised asthma prevalence rate was highest in the high-income Asia Pacific region (4870·24 [4046·70-5962·78] per 100 000 population) and southeast Asia (4778·18 [3970·25-5735·61] per 100 000 population). Despite southeast Asia and the high-income Asia Pacific region having a similar age-standardised asthma prevalence rate, southeast Asia had a higher age-standardised DALY rate (508·67 [95% UI 394·89-669·92] per 100 000 population) compared with the high-income Asia Pacific region (204·40 [129·23-290·41] per 100 000 population). A decrease in the age-standardised DALY rate for chronic respiratory diseases was observed with increasing SDI, contrasting with its prevalence patterns. Age-standardised DALY rates of COPD decreased in all Asian countries except for Georgia (average annual percentage change 1·37 [95% CI 1·26-1·48]) and Kazakhstan (0·73 [0·55-0·93]), and age-standardised DALY rates of asthma decreased in all countries. Smoking and ambient particulate matter pollution were identified as leading attributable risk factors for chronic respiratory diseases across Asia. Household air pollution from solid fuels was a regionally pronounced risk factor for chronic respiratory diseases, particularly in south Asia (age-standardised DALY rate 657·58 [95% UI 485·04-880·45] per 100 000 population). Although smoking was a major risk factor in males, ambient particulate matter pollution and secondhand smoke emerged as important attributable risk factors for chronic respiratory diseases in females.
Interpretation: Countries with lower SDI had markedly higher DALY rates, highlighting the need to address socioeconomic and health-care inequities. Household air pollution from solid fuels continues to impose a substantial but preventable burden in south Asia, calling for clean energy adoption and improved ventilation.
Funding: Gates Foundation.
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Conflict of interest statement
Declaration of interests Q E S Adnani reports grants or contracts from the NIHR-Global Health Research Unit on Respiratory Health (RESPIRE) as National Stakeholder Engagement Champion for Indonesia, outside the submitted work. X Ding reports grants or contracts from the American Heart Association for a 2-year predoctoral fellowship (DOI: 10.58275/AHA.25PRE1373497.pc.gr.227106), with quarterly payments made to their institution, outside the submitted work. N E Ismail reports a leadership or fiduciary role in other boards, societies, committees, or advocacy groups, unpaid, as the Bursar and Council Member of the Malaysian Academy of Pharmacy, Malaysia, and as a Committee Member of the Malaysian Pharmacists Society Education Chapter Committee, outside the submitted work. K Krishan reports non-financial support from the UGC Centre of Advanced Study, CAS II, awarded to the Department of Anthropology, and RUSA 2.0 grant awarded to Panjab University, Chandigarh, India, outside the submitted work. M-C Li reports grants or contacts from the National Science and Technology Council, Taiwan (NSTC113-2314-B-003-002) and the “Higher Education Sprout Project” of National Taiwan Normal University, outside the submitted work. H Liu reports other financial or non-financial interests as a mentor of the National Medical Research Association (NMRA, UK), a member of the British Society for Cardiovascular Research (BSCR, UK), and a member of Cardiovascular Analytics Group (CVAG, Hong Kong Special Administrative Region, China); all are non-profit organisations and all outside the submitted work. R J Maude reports support for their participation in the current work from the Wellcome Trust (grant number 220211) as it provides core funding for Mahidol Oxford Tropical Medicine Research and contributes to their salary. R J Maude is required by Wellcome to acknowledge this grant in all publications. S A Meo reports grants or contracts from the Ongoing Research Funding Program (ORF-2025-47), King Saud University, Riyadh, Saudi Arabia, outside the submitted work. S Nomura reports support for their participation in the current manuscript from Ministry of Education, Culture, Sports, Science and Technology of Japan (24H00663), and Precursory Research for Embryonic Science and Technology from the Japan Science and Technology Agency (JPMJPR22R8). Y L Samodra reports grants or contracts from the National Science and Technology Council and Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taiwan, for a post-doctoral fellow contract and from the School of Public Health, Taipei Medical University, Taiwan for a doctoral scholarship; leadership or fiduciary roles in other boards, societies, committees, or advocacy groups, paid or unpaid, as co-founder of Benang Merah Research Center; and other financial or non-financial interests as a mentor at Jago Beasiswa; all outside the submitted work. J I Shin reports support for the present manuscript from the Yonsei Fellowship, funded by Lee Youn Jae. J A Singh reports consulting fees from ROMTech, Atheneum, Clearview Healthcare Partners, American College of Rheumatology, Yale, Hulio, Horizon Pharmaceuticals, DINORA, ANI/Exeltis, USA Inc., Frictionless Solutions, Schipher, Crealta/Horizon, Medisys, Fidia, PK Med, Two Labs, Adept Field Solutions, Clinical Care Options, Putnam Associates, FocusForward, Navigant Consulting, Spherix, MedIQ, Jupiter Life Science, UBM LLC, Trio Health, Medscape, WebMD, Practice Point Communications, and the US National Institutes of Health; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Simply Speaking; support for attending meetings or travel from OMERACT, an international organisation that develops measures for clinical trials and receives arm's length funding from 12 pharmaceutical companies, as past steering committee member to attend their meeting every 2 years; participation on a data safety monitoring board or advisory board with the US Food and Drug Administration (FDA) Arthritis Advisory Committee (unpaid); a leadership or fiduciary role in other boards, societies, committees, or advocacy groups, paid or unpaid, as a past steering committee member of the OMERACT; stock or stock options in Atai Life Sciences, Kintara Therapeutics, Intelligent Biosolutions, Acumen Pharmaceutical, TPT Global Tech, Vaxart Pharmaceuticals, Atyu Biopharma, Adaptimmune Therapeutics, GeoVax Labs, Pieris Pharmaceuticals, Enzolytics, Seres Therapeutics, Tonix Pharmaceuticals Holding, Aebona Pharmaceuticals, and Charlotte's Web Holdings; and previous ownership of stock options in Amarin, Viking, and Moderna Pharmaceuticals; all outside the submitted work. J H V Ticoalu reports a leadership or fiduciary role in other boards, societies, committees, or advocacy groups, paid or unpaid, as co-founder of Benang Merah Research Center, outside the submitted work. E Upadhyay reports patents published (“A system and method of reusable filters for anti-pollution mask”, “A system and method for electricity generation through crop stubble by using microbial fuel cells”, “A system for disposed personal protection equipment (PPE) into biofuel through pyrolysis and method”, “A novel herbal pharmaceutical aid for formulation of gel and method thereof”, “Herbal drug formulation for treating lung tissue degenerated by particulate matter exposure”, “A method to transform cow dung into the wall paint by using natural materials and composition thereof”) and patents filed (“Biodegradable packaging composition and method of preparation thereof”, “Eco-friendly bio-shoe polish from banana and turmeric”, “Honey-based polyherbal syrup composition to treat air pollution-induced inflammation and preparation method thereof”, and “Process for preparing a caffeine free, antioxidant and nutrient rich beverage”); a leadership or fiduciary role in other boards, societies, committees, or advocacy groups, paid or unpaid, as Executive Council Member, Indian Meteorological Society, Jaipur Chapter, and Member Secretary-DSTPURSE Program; outside the submitted work. C Yang reports two grants from the Canadian Institutes of Health Research (grant numbers 177747 and 202409PJT) as payment to his institution to support his work in Canada, outside the submitted work.
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