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. Chronic respiratory conditions can be grouped in a variety of ways, including obstructive lung diseases and restrictive lung diseases. 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.

Risk factors associated with chronic respiratory conditions can be behavioural, environmental or genetic. Risk factors that cannot be changed include age and genetic predisposition. Risk factors that can be changed include smoking; exposure to environmental fumes, carbon-based cooking and heating fuels; occupational hazards; poor nutrition; overweight/ obesity; and sedentary lifestyle.

How common are chronic respiratory conditions?

The ABS 2017–18 NHS provides estimates of the self‑reported prevalence of chronic respiratory conditions. Chronic respiratory conditions affect almost one-third (31%) of Australians. Of the estimated 7.4 million Australians with these conditions, 4.7 million (19% of the total population) had allergic rhinitis ('hay fever'); 2.7 million (11%) had asthma and 2.0 million (8.4%) had chronic sinusitis.

COPD affects mainly middle-aged and older people. While it is occasionally reported in younger age groups, in those aged 45 and over there is more certainty that the condition is COPD and not another respiratory condition. The 2017–18 NHS estimated that 464,000 (4.8%) Australians aged 45 and over had COPD (ABS 2019). 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.

Trends over time

During the last decade:

• The prevalence of asthma has increased, from 9.9% of the population in 2007–08 to 11% of the population in 2017–18 after adjusting for differences in age structure.
• The prevalence of COPD among people aged 45 and over has remained relatively stable after adjusting for differences in age structure (3.9% of the population in 2007–08 and 4.6% of the population in 2017–18) (Figure 1).

Figure 1: Prevalence of asthma, people of all ages, by sex, 2007–08 to 2017–18

Sex and age

The prevalence of asthma and COPD varied by sex and age (Figure 2):

• Asthma affects people of all ages. Asthma was more common in boys at younger ages (0–14) and more common in women at older ages (25 years and over, with the exception of the 35–44 year age group which was similar between men and women).
• COPD mainly occurs in people aged 45 and over, and the prevalence tends to increase with age. COPD was more prevalent in women than men for those aged 55–64; however, the prevalence was similar between the sexes in other age groups. 

For more information see Asthma and Chronic Obstructive Pulmonary Disease.

Figure 2: Prevalence of COPD, people aged 45 and over, by sex and age, 2017–18

Comorbidity

People with chronic respiratory conditions often have other chronic and long-term conditions. This is called ‘comorbidity’, which describes any additional disease that is experienced by a person with a disease of interest.

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 Comorbidities of asthma.
• COPD: 90% had at least one other chronic condition; among them, 55% had arthritis and 43% had asthma. For more information, see Comorbidities of COPD.

There is an increasing recognition that asthma and COPD may occur together. Overall, about 20% of patients with obstructive airway disease have been diagnosed with both asthma and COPD (Gibson and MacDonald 2015).

Impact

Burden of disease

In 2022, the respiratory conditions disease group accounted for 7.3% of total disease burden (DALY); 8.8% of non-fatal burden (YLD), and 5.6% of fatal burden (YLL). Respiratory conditions were ranked as the eighth leading disease group contributing to total burden after cancer, musculoskeletal disorders, cardiovascular diseases, mental health conditions and substance use disorders, neurological conditions, and injuries.

Chronic respiratory conditions notably contributes to the disease burden in the Australian population. Recent initiatives include the National Asthma Strategy, launched in January 2018 (Department of Health 2018), and the National Strategic Action Plan for Lung Conditions, launched in February 2019 (Department of Health 2019).

Variation by age and sex

In 2022:

• The rate of burden for the respiratory conditions disease group increased with age, with the rate for those aged 75 and over was 4.6 times as high as those aged 25–74 (64.7 and 14.0 DALY per 1,000 population, respectively).
• Within the respiratory conditions disease group, COPD accounted for 51% of total burden (DALY); 38% of non-fatal burden (YLD); and 72% of fatal burden (YLL); whereas asthma accounted for 34% of total burden (DALY); 52% of non-fatal (YLD) and 5.4% of fatal burden (YLL).
• At the individual condition level, COPD was the fourth leading cause of total burden of disease; asthma was ranked as the tenth leading cause of total burden overall but was the leading cause of total burden among children aged 5–14 (Figure 3).

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

Changes over time

The rate of burden from respiratory conditions decreased slightly between 2003 and 2022 (13.8 to 13.1 DALY per 1,000 population, respectively) – 0.3% per year on average, after adjusting for changes in age structure.

Further detail is available in the Australian Burden of Disease Study 2022.

Variation between population groups

In 2018, after adjusting for age:

• Remote and very remote areas combined saw 1.5 times the respiratory conditions burden of Major cities (18.0 and 12.3 DALY per 1,000 population, respectively).
• Fatal burden (YLL) saw the greatest contrast between socioeconomic groups - the lowest group (people living in areas with the highest level of disadvantage) had 2.8 times the rate of burden for respiratory conditions than the highest group (people living in areas with the lowest level of disadvantage) (6.7 and 2.4 YLL per 1,000 population, respectively) (AIHW 2021b) (Figure 4).

Further detail is available in the Australian Burden of Disease Study 2018: Interactive data on disease burden.

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

Health system expenditure

In 2019–20 (AIHW 2022b) an estimated $4.7 billion of expenditure in the Australian health system was for respiratory conditions, representing 3.3% of total health expenditure.

Where is the money spent?

Figure 5 presents a detailed breakdown of estimated expenditure for respiratory conditions by area of the health system, showing that:

• Hospital services represented 61% ($2.9 billion) of respiratory condition expenditure, which was very similar to the proportion of total health expenditure for hospital services (63%). However, the public emergency department proportion of respiratory condition expenditure was relatively high, at 1.6 times that for total health expenditure (7.6% compared with 4.7%).
• Primary care accounted for 31% ($1.4 billion) of all respiratory condition spending, which was slightly higher than the primary care portion of total health expenditure (28%). The Pharmaceutical Benefits Scheme proportion of respiratory condition expenditure was higher in comparison to the average, at 1.6 times the proportion for total health expenditure (19% compared with 12%).
• Referred medical services represented 8.4% ($391.1 million) of referred medical services for respiratory conditions, which was similar to the proportion of total health expenditure for referred medical services (9.1%).

Figure 5: Amount and proportion (%) of respiratory conditions expenditure attributed to each area of the health system, compared to expenditure for all disease groups, 2019–20

Figure 6 presents the component (%) that respiratory conditions expenditure makes up for each for each area of the health system, showing that in 2019–20, respiratory conditions accounted for:

• 5.4% ($356.3 million) of all public hospital emergency department expenditure

• 5.0% ($868.0 million) of all pharmaceutical benefits scheme expenditure.

Figure 6: Proportion of expenditure attributed to respiratory conditions, for each area of the health system, 2019–20

Who is the money spent on?

In 2019–20:

• The age distribution of spending on respiratory conditions reflects the prevalence distribution, with most spending being for older age groups (68% for people aged 40 and older).
• The sex distribution of spending on respiratory conditions was similar amongst females and males ($2.3 billion).

Further detail is available in Disease expenditure in Australia 2019–20.

In 2018–19, it was estimated that:

• Respiratory condition expenditure per case was 1.1 times greater for males than females ($530 and $480 per case, respectively).
• Average expenditure for all burden of disease groups was approximately 3.8 times higher compared to total respiratory conditions ($2,000 and $515 per case, respectively) (AIHW 2022c).

Further detail is available in Health system spending per case of disease and for certain risk factors.

Deaths

How many deaths were associated with respiratory conditions?

Respiratory conditions were recorded as an underlying or associated cause for 46,551 deaths or 135 deaths per 100,000 population in Australia in 2021, representing 27.1% of all deaths. Respiratory conditions were the underlying cause for 13,593 deaths (29% of respiratory conditions deaths) and an associated cause only, for 32,958 deaths (71% of respiratory conditions 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) was concentrated amongst:

• older people (73% aged 75 and over), which was more than the proportion of people aged 75 and over for total deaths (67%).
• males (55% of respiratory conditions deaths were males compared with 52% of total deaths) (Figure 7).

Figure 7: Age profile of respiratory mortality statistics, by sex

Trends over time

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

• decreased from 172 to 135 per 100,000 population
• remained stable over time with the mortality rate for males always higher than females. During this period mortality rates were 1.5 to 1.6 times higher among males compared to females (Figure 8).

Figure 8: Historical respiratory mortality statistics, by sex, 2011–2021

Variation between population groups

Remote and very remote areas had 1.4 times more respiratory condition deaths per population when compared with Major cities.

The lowest socioeconomic group (people living in areas with the highest level of disadvantage) had 1.7 times more respiratory condition deaths per population than the highest group (people living in areas with the lowest level of disadvantage) in 2021.

COVID-19 impact

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 March 2022), 17.4% of COVID-19 related deaths due to pre-existing conditions was contributed to by chronic respiratory conditions, the fourth highest of all chronic conditions. In addition, higher than expected deaths were observed for chronic lower respiratory conditions in 2021. For more information see ‘Chapter 1 The impact of a new disease: COVID-19 from 2020, 2021 and into 2022’ in Australia’s health 2022: data insights (Figure 9).

Figure 9: Age-standardised deaths rate due to asthma and COPD, 2009 to 2020

Treatment and management

Primary care

General practitioners (GPs) play an important role in man aging 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.

One of the key steps in managing asthma is for patients to follow a personal asthma action plan developed with their GP. An asthma action plan is a written self-management plan which is prepared by a health care professional and can help people with asthma to manage their condition and reduce the severity of acute asthma flare-ups (AIHW 2020). The plan outlines what to do if symptoms flare up and what to do in an asthma emergency (National Asthma Council Australia 2021). According to the 2020–21 NHS, an estimated 35% of people with self-reported asthma across all ages had a written asthma action plan. Two-thirds (66%) of children under 18 years of age had a written action plan, while just over one quarter (27%) of people aged 18 and over had a written action plan (ABS 2022). See General practice, allied health and other primary care services.

Hospitalisations

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. In 2020–21, asthma was the principal diagnosis in 25,000 hospitalisations for people of all ages and COPD was the principal diagnosis in 53,600 hospitalisations for people aged 45 and over. Trends over time show that:

• The hospitalisation rate for asthma was steady between 2010–11 to 2015–16 and then trended downwards to 2020–21, with the highest rate at 170 per 100,000 population in 2011–12 and the lowest at 95 per 100,000 population in 2020–21.
• The hospitalisation rate for COPD also fluctuated, with the highest at 755 per 100,000 population aged 45 years and over in 2016–17 and the lowest at 465 per 100,000 population aged 45 years and over in 2020–21 (Figure 10).

Hospitalisations due to asthma and COPD are classified as potentially preventable. Potentially preventable hospitalisations are defined as admissions to hospital where the hospitalisation could have potentially been prevented through the provision of appropriate individualised preventative health interventions and early disease management usually delivered in primary care and community-based care settings (AIHW 2019).

Figure 10: Historical asthma and COPD hospitalisation statistics, 2010–11 to 2020–21

COVID-19 impact

The overall rate of hospitalisations and emergency department presentations decreased since the beginning of the COVID-19 pandemic. See Hospitals. The hospitalisation rates for asthma and COPD in 2019–20 and 2020–21 were the lowest in the last 10 years, 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. Furthermore, the health protection measures encouraged a reduction in travel and traffic contributing to improved air quality for a period of time (Abrams et al. 2020; Thompson 2021). These measures not only reduced the transmission of the COVID-19 virus during the 2019­–20 and 2020–21 periods, but also potentially the spread of colds and flu which are common triggers for asthma and COPD exacerbations that can lead to hospitalisation (National Asthma Council Australia 2022). 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, the rate of presentations fell from 26 per 100,000 population in March 2020 to 12 per 100,000 population in April 2020. This continued in May 2020 (11 per 100,000 population) until June 2020 when restrictions began to ease across the country and presentations rose to 19 per 100,000 population (Figure 11). When compared with April and May in 2019, the rates of asthma presentations observed in 2020 were halved.
• For COPD, the rate of presentations for COPD fell from 39 per 100,000 population in March 2020 to 28 per 100,000 population in April 2020. This rate increased slightly in May 2020 to 30 per 100,000 population and June 2020 at 33 per 100,000 population, during which the restrictions began to ease across the country. When compared with April and May in 2019, the rates of COPD presentations observed in 2020 fell by 29% and 34%, respectively (Figure 11).

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; Rawand 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.

Figure 11: Monthly emergency department presentation rates for asthma and COPD (45 years and over), 2018–19 compared with 2019–20

Variation between population groups

The impact of asthma and COPD varies between population groups, with rates of prevalence, hospitalisation, death and disease burden being up to 3.2 times as high in Remote and very remote areas as in Major cities. Meanwhile, the impact of asthma and COPD increases with decreasing socioeconomic position. In 2020–21, rates were 1.3–3.3 times as high in the lowest socioeconomic areas compared with the highest (Figure 12).

Figure 12: Impact of selected chronic respiratory conditions, by selected population groups

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

Visit Chronic respiratory conditions for more on this topic.