Burden, risk factors, and health system response to chronic respiratory diseases in the WHO South-East Asia Region

Abstract

Background: Chronic respiratory diseases (CRDs), particularly chronic obstructive pulmonary disease (COPD) and asthma, are among the leading noncommunicable diseases (NCDs) in the WHO South-East Asia Region. They cause significant morbidity, mortality, and economic loss. While substantial attention has been given to cardiovascular diseases and cancer, CRDs in low- and middle-income countries remain under-prioritized.

Objective: To provide a comprehensive overview of the burden of chronic respiratory diseases, associated risk factors, projected economic impact, and health system responses in the WHO South-East Asia Region.

Methods: The analysis is based primarily on the data of the Global Burden of Disease (GBD) 2021 and published WHO data sources. A set of key indicators were identified to reflect the different aspects of the status of chronic respiratory diseases to be presented and secondary analysis was conducted to reflect the status of the 10 South-East Asia countries.

Results: In 2021, chronic respiratory diseases affected an estimated 84.03 million people in the Region (pooled prevalence 4.8%). Chronic obstructive pulmonary disease accounted for 45.04 million cases and asthma for 40.31 million. Mortality exceeded 1.46 million deaths, with disproportionately higher rates among women in several countries, which may be attributable, at least in part, to higher exposure to household air pollution.  Disability-adjusted life year (DALY) rates for chronic obstructive pulmonary disease ranged from 411 per 100,000 population in Maldives to 2,283 in the Democratic People’s Republic of Korea.  Major risk factors—including tobacco use (up to 37%), PM₂.₅ pollution (up to 9× WHO guideline levels), and reliance on polluting fuel (up to 89%)—remain widespread. The projected economic losses between 2020 and 2050 exceed INT$ 584 billion, with India alone accounting for INT$ 418 billion. Availability of spirometry and essential inhaled medicines at the primary care level remains limited across the Region.

Conclusion: Chronic respiratory diseases represent a major and under-recognised public health and economic challenge in the WHO South-East Asia Region. Comprehensive action integrating tobacco control, clean cooking initiatives, air quality management, and strengthened primary care services is urgently needed to reduce the morbidity, premature mortality, and economic losses.