Chronic respiratory conditions

Chronic respiratory conditions affect the airways, including the lungs and the passages that transfer air from the mouth and nose into the lungs. These conditions are characterised by symptoms such as wheezing, shortness of breath, chest tightness and cough.

Obstructive lung diseases are diseases that cause more difficulty with exhaling air, such as asthma, chronic obstructive pulmonary disease (COPD) and bronchiectasis.

Restrictive lung diseases are diseases that can cause problems by restricting a person's ability to inhale air, such as pulmonary fibrosis, chronic sinusitis and occupational lung diseases (Leader 2019).

This page focuses on asthma and COPD as these are common respiratory conditions and are associated with poor health and wellbeing.

How common are chronic respiratory conditions?

According to the NHS, in 2017–18:

• 7.4 million (31%) people in Australia were affected by chronic respiratory conditions
• 2.7 million (11%) people reported having asthma
• 464,000 (4.8%) people aged 45 and over reported having COPD (ABS 2019).

While COPD is occasionally reported in younger age groups, there is more certainty that the condition is COPD and not another respiratory condition for those aged 45 and over. A range of estimates of the prevalence of COPD have been derived from different surveys (for example, Toelle et al. 2013). It is important to note that accurately estimating the prevalence of COPD requires clinical testing.

Prevalence by age and sex

According to the NHS, in 2017–18:

• for those aged 0–14, asthma was more prevalent among boys than girls
• for those aged 15 and over, asthma was more prevalent among females than males
• COPD prevalence increased with age. It was more prevalent in females than males for those aged 55–64; but prevalence was similar between sexes in other age groups (Figure 1).

Figure 1: Prevalence of asthma and chronic obstructive pulmonary disease by sex and age, 2017–18

Trends over time

Between 2007–08 and 2017–18, after adjusting for differences in age structure, the prevalence of asthma and COPD remained relatively stable (9.9% to 11%, and 3.9% to 4.6%, respectively) (Figure 2).

For more information, see Asthma and Chronic obstructive pulmonary disease.

Figure 2: Prevalence of asthma and chronic obstructive pulmonary disease by sex, 2007–08 to 2017–18

Impact of chronic respiratory conditions

Chronic respiratory conditions have varying degrees of impact on the physical, psychological, and social wellbeing of people living with the conditions, depending on disease severity and their level of control. People with these conditions can also be impacted by one-off natural events which occur on a seasonal basis, such as thunderstorms and bushfires.

Burden of disease

In 2023, the respiratory conditions disease group accounted for 7.2% of total disease burden (DALY); 8.5% of non-fatal burden (YLD), and 5.8% of fatal burden (YLL) (AIHW 2023a).

Variation by age and sex

In 2023:

• the rate of burden for the respiratory conditions disease group varied between 6.4 and 8.4 DALY per 1,000 population between the ages of 10–14 and 45–49, then increased steeply, peaking at 54.8 DALY per 1,000 population for those aged 75–79 
• the rate of burden for the respiratory conditions disease group was split between COPD and asthma:
  • COPD accounted for 50% of total burden (DALY), 38% of non-fatal burden (YLD), and 71% of fatal burden (YLL)
  • asthma accounted for 35% of total burden (DALY), 52% of non-fatal (YLD), and 5.4% of fatal burden (YLL)
• among individual conditions, COPD was the fifth leading cause of total burden of disease. Asthma was ranked tenth, but was the leading cause of total burden among children aged 1–9 (Figure 3).

Figure 3: Burden of disease due to respiratory conditions by sex, age and year

Trends over time

Between 2003 and 2023, the age standardised rate of respiratory conditions burden decreased by 6% (13.8 to 13.0 DALY per 1,000 population, respectively) – or 0.3% per year on average. 

For more information, see Australian Burden of Disease Study 2023.

Variation between population groups

In 2018, the age standardised rate of respiratory condition burden:

• was highest for people living in Remote and very remote areas and lowest for people living in Major cities (18.0 and 12.3 DALY per 1,000 population, respectively)
• was highest for people living in the lowest socioeconomic areas (with the highest level of disadvantage) and lowest for people living in the highest socioeconomic areas (with the lowest level of disadvantage) (6.7 and 2.4 YLL per 1,000 population, respectively) (AIHW 2021b) (Figure 4).

For more information, see Australian Burden of Disease Study 2018: Interactive data on disease burden.

Figure 4: Burden of disease due to respiratory conditions for remoteness area and socioeconomic group by sex and year

Health system expenditure

In 2020–21 an estimated $4.5 billion of expenditure in the Australian health system was for respiratory conditions, representing 3.0% of total health expenditure (AIHW 2023b).

Where is the money spent?

In 2020–21:

• hospital services represented 61% ($2.8 billion) of respiratory expenditure, which was very similar to the hospital proportion for all disease groups (63%). However, the public emergency department proportion of respiratory expenditure was 1.6 times the proportion for all disease groups (6.5% compared with 4.1%)
• primary care accounted for 31% ($1.4 billion) of all respiratory condition spending, which was similar to the primary care portion for all disease groups. However, the Pharmaceutical Benefits Scheme (PBS) proportion of respiratory expenditure was 1.6 times more than the proportion for all disease groups (18% compared with 11%)
• referred medical services represented 8.1% ($368.2 million) of expenditure for respiratory conditions, which was similar to the proportion for all disease groups (9.8%) (Figure 5).

Figure 5: Respiratory conditions expenditure attributed to each area of the health system, with comparison to all disease groups, 2020–21

In 2020–21, respiratory conditions accounted for:

• 4.9% ($830.9 million) of all PBS expenditure (Figure 6)
• 4.8% ($294.8 million) of all public hospital emergency department expenditure.

Figure 6: Proportion of expenditure attributed to respiratory conditions, for each area of the health system, 2020–21

Who is the money spent on?

In 2020–21:

• the age distribution of spending on respiratory conditions reflects the prevalence distribution, with most spending being for older age groups (63% for people aged 45 and over)
• the distribution of spending on respiratory conditions was similar amongst females and males ($2.2 billion and $2.3 billion, respectively).

For more information, see Health system spending on disease and injury in Australia, 2020-21.

In 2018–19, it was estimated that respiratory condition expenditure per case was:

• 10% higher for males compared with females ($530 and $480 per case, respectively)
• 74% lower than expenditure per case for all disease groups $510 and $2,000 per case, respectively) (AIHW 2022b).

For more information, see Health system spending per case of disease and for certain risk factors.

How many deaths were associated with chronic respiratory conditions?

In 2021:

• respiratory conditions were recorded as an underlying and/or associated cause for 46,551 deaths or 135 deaths per 100,000 population in Australia, representing 27.1% of all deaths
• respiratory conditions were the underlying cause for 13,593 deaths (29% of respiratory deaths) and an associated cause only, for 32,958 deaths (71% of respiratory deaths)
• COPD and asthma accounted for 52% and 2.6% of underlying-cause respiratory deaths, respectively. Furthermore, they contributed to 36% and 4.3% of any-cause respiratory deaths.

Variation by age and sex

In 2021, respiratory conditions mortality (as the underlying and/or associated cause) in comparison to all deaths, was relatively more concentrated among:

• older people (73% of respiratory deaths were among people aged 75 and over, compared with 67% for total deaths)
• males (55% of respiratory deaths were among males compared with 52% of total deaths) (Figure 7).

Figure 7: Age distribution for respiratory conditions mortality, by sex, 2011 to 2021

Trends over time

Age standardised mortality rates for respiratory conditions (as the underlying and/or associated cause) between 2011 and 2021:

• trended down from 172 to 135 per 100,000 population
• were 1.5 to 1.6 times as high as for males compared with females (Figure 8).

Figure 8: Trends over time for respiratory conditions mortality, 2011 to 2021  

Variation between population groups

In 2021, age standardised mortality rates for respiratory conditions (as the underlying and/or associated cause of death) were:

• highest for people living in Remote and very remote areas and lowest for people living in Major cities (183 and 129 per 100,000 population, respectively)
• highest for people living in the lowest socioeconomic areas (with the most level of disadvantage) and lowest for people living in the highest socioeconomic areas (with the least disadvantage) (160 and 94 per 100,000 population, respectively).

Treatment and management of chronic respiratory conditions

Primary care

General practitioners (GPs) play an important role in managing chronic respiratory conditions in the community, but there is currently no nationally consistent primary health care data collection to monitor provision of care by GPs.

For more information, see General practice, allied health and other primary care services.

Hospital treatment

People with chronic respiratory conditions require admission to hospital when they cannot be managed at home or by a GP, or their symptoms exacerbate acutely. Hospitalisations due to asthma and COPD are classified as potentially preventable. Data from the National Hospital Morbidity Database (NHMD) show that in 2020–21:

• asthma was the principal diagnosis in 25,500 hospitalisations for people of all ages
• COPD was the principal diagnosis in 54,400 hospitalisations for people aged 45 and over.

From 2011–12 to 2021–22, the hospitalisation rate for:

• asthma decreased from 170 to 100 per 100,000 population
• COPD for people aged 45 years and over, decreased steeply from 2016–17 to 2021–22 (805 to 500 per 100,000 population) (Figure 9).

Figure 9: Age distribution for asthma and chronic obstructive pulmonary disease hospitalisations, by sex, 2011–12 to 2021–22

COVID-19 impact on chronic respiratory conditions

The overall rate of hospitalisations and emergency department presentations decreased at the start of the COVID-19 pandemic. The hospitalisation rates for asthma and COPD in 2019–20 and 2020–21 were the lowest recorded in the last 10 years. This was potentially attributable to an indirect impact of the COVID-19 pandemic and the health protection measures put in place which supported physical distancing, promotion of hand-hygiene and mask wearing. See ‘Chapter 2 Changes in the health of Australians during the COVID-19 period’ in Australia’s health 2022: data insights.

During the national lockdown beginning on 23 March 2020 following the pandemic outbreak, emergency department presentations for asthma and COPD decreased:

• For asthma, rates decreased from March to May 2020 (26 to 11 per 100,000 population). In June 2020, when restrictions began to ease across the country, rates increased to 19 per 100,000 population (Figure 10). When compared with April and May in 2019, the rates of asthma presentations observed in 2020 were halved.
• For COPD, rates decreased from March to April 2020 (39 to 28 per 100,000 population). This rate increased slightly in May and June 2020 (30 and 33 per 100,000 population). When compared with April and May in 2019, the rates of COPD presentations observed in 2020 fell by 29% and 34%, respectively (Figure 10).

Figure 10: Monthly emergency department presentation rates for asthma and chronic obstructive pulmonary disease (45 years and over), 2018–19 compared with 2019–20

Death rates from all respiratory diseases combined showed a substantial fall in 2020, with rates particularly low for females and during the winter months compared with previous years. This is discussed in detail in ‘Chapter 2 Changes in the health of Australians during the COVID-19 period’ in Australia’s health 2022: data insights.

During the COVID-19 pandemic (as at 31 October 2022), chronic respiratory conditions were certified as a pre-existing condition in 18% of the deaths with a chronic condition mentioned, the third highest of all chronic conditions (ABS 2022b). Between January and August 2022, the overall deaths due to chronic respiratory conditions were slightly higher (2.5%) than historical average for the same period (Figure 11). 

Figure 11: Age-standardised deaths rate due to asthma and chronic obstructive pulmonary disease, 2009 to 2020

While the long-term impact of COVID-19 on the respiratory system is being researched, evidence shows that COVID-19 does not directly impact the risk of increasing asthma severity and vice versa (Lee et al. 2020; Lieberman-Cribbin et al. 2020; Mather et al. 2021). However, there is increasing evidence showing that COPD patients with COVID-19 have greater risk of mortality, severity of infection and higher likelihood of requiring Intensive Care Unit (ICU) support than those without COPD (Cazzola et al. 2021; Clark et al. 2021; Wells 2021).

See ‘Chapter 1 The impact of a new disease: COVID-19 from 2020, 2021 and into 2022’ in Australia’s health 2022: data insights.

Comorbidities of chronic respiratory conditions

People with chronic respiratory conditions often have other chronic and long-term conditions (comorbidities). In the 2017–18 NHS, for people aged 45 and over with:

• asthma: 81% had at least one other chronic condition; among them, 49% had arthritis and 37% had back problems. For more information, see Asthma
• COPD: 90% had at least one other chronic condition; among them, 55% had arthritis and 43% had asthma. For more information, see COPD.

Where do I go for more information?

For more information on chronic respiratory conditions, see:

• ABS National Health Survey: first results (2017–18) 
• ABS Health Conditions Prevalence
• Australian Centre for Monitoring Population Health.

For more on this topic, visit Chronic respiratory conditions.