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, COPD and bronchiectasis 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 Australian Bureau of Statistics (ABS) 2017–18 National Health Survey (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; 2.0 million (8.4%) had chronic sinusitis; and 599,000 (2.5%) had COPD (ABS 2018).

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 estimates that 464,000 (4.8%) Australians aged 45 and over had COPD (ABS 2019). However, a large international study (Burden of Obstructive Lung Disease—BOLD), which used lung function testing plus self‑reported questionnaires of nearly 10,000 people, estimated that the prevalence of COPD in Australia was 7.5% for people aged 40 and over and 30% for people aged 75 and over (Toelle et al. 2013). It is important to note that accurately estimating the prevalence of COPD requires clinical testing.

Trend

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
  • 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).
     

This figure shows the prevalence of asthma by sex from 2007–08 to 2017–18. In general, the prevalence of asthma has increased during last decade, from 9.9% of the population in 2007–08 to 11% of the population in 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.
     

This figure shows the self-reported prevalence of asthma varies by sex and age, and is 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).

Visualisation not available for printing

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 (the index disease).

In the 2017–18 NHS, for people aged 45 and over with:

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 & MacDonald 2015).

Thunderstorm asthma

Thunderstorm asthma can occur suddenly in spring or summer when there is a lot of pollen in the air and the weather is hot, dry, windy and stormy. People with asthma and/or hay fever need to be extra cautious to avoid flare-ups induced by thunderstorm asthma between September and January in Victoria, New South Wales and Queensland because it can be very serious (National Asthma Council Australia 2019b). In 2016, a serious thunderstorm asthma epidemic was triggered in Melbourne when very high pollen counts coincided with adverse meteorological conditions, resulting in 3,365 people presenting at hospital emergency departments over 30 hours, and 10 deaths (Thien et al. 2018). Following this event, a thunderstorm asthma forecasting system has been developed to give Victorians early warning of possible epidemic thunderstorm asthma events in pollen season (Victoria State Government 2019). See Natural environment and health.

Impact

Deaths

In 2018, COPD was the fifth leading underlying cause of death in Australia, with 7,113 deaths (4.5% of all deaths). There were 389 deaths due to asthma (0.2% of all deaths), and 387 deaths due to bronchiectasis, of which 371 (96%) were people aged 60 and over. Trends over the last decade show that the age‑standardised rate of death due to COPD among people aged 45 and over fluctuated, with the highest rate in 2014 at 70 deaths per 100,000 population and the lowest in 2010 at 61 deaths per 100,000 population (Figure 3). See Causes of death.
 

This figure shows the trends of deaths due to selected respiratory conditions from 2009 to 2018. During the last decade, the age-standardised COPD death rate among people aged 45 and over fluctuated, with highest in 2014 at 70 deaths per 100,000 population and lowest in 2010 at 61 deaths per 100,000 population; the age-standardised asthma death rates remained similar; and the age-standardised bronchiectasis death rate among people aged 60 and over ranged from 6.0 to 7.6 deaths per 100,000 population.

Burden of disease

Chronic respiratory diseases contribute substantially to the disease burden in the Australian population. In recognition of this burden, the National Asthma Strategy was launched in January 2018 (Department of Health 2018), and the National Strategic Action Plan for Lung Conditions was launched in February 2019 (Department of Health 2019).

The Australian Burden of Disease Study found that, in 2015, respiratory diseases contributed 7.5% of the total burden of disease and injury in Australia (AIHW 2019a):

  • Respiratory diseases were ranked as the sixth leading disease group contributing to total burden, after cancer, cardiovascular disease, musculoskeletal conditions, mental and substance use disorders, and injuries.
  • COPD contributed 51% of the respiratory diseases burden, and asthma contributed 34%.
  • At the individual disease level: COPD was the third leading cause of total burden; asthma was ranked as the ninth leading cause of total burden overall, but was the first leading cause of total burden among children aged 5 to 14.

See Burden of disease.

Expenditure

The Australian Disease Expenditure Study showed that in 2015–16, an estimated 3.5% ($4 billion) of total disease expenditure in the Australian health system was attributed to respiratory conditions (AIHW 2019b):

  • COPD cost the Australian health system an estimated $976.9 million, representing 24% of disease expenditure on respiratory conditions and 0.8% of total disease expenditure.
  • Asthma cost the Australian health system an estimated $770.4 million, representing 19% of disease expenditure for respiratory conditions and 0.7% of total disease expenditure.

See Health expenditure.

Treatment and management

Primary care

General practitioners (GPs) play an important role in managing asthma 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. The plan outlines what to do if symptoms flare up and what to do in an asthma emergency (National Asthma Council Australia 2019a). According to the 2017–18 NHS, an estimated 839,000 (31%) people with self-reported asthma across all ages had a written asthma action plan. Children aged 0–14 with asthma were most likely to have a plan (67%), and 24% of people with asthma aged 15 and over had a plan (ABS 2019). See Primary health care.

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 2017–18, asthma was the principal diagnosis in 38,800 hospitalisations; COPD was the principal diagnosis in 77,700 hospitalisations of people aged 45 and over; and bronchiectasis was the principal diagnosis in 7,700 hospitalisations. Trends over time show that:

  • the hospitalisation rate for asthma fluctuated during the last decade, with the highest rate at 183 per 100,000 population in 2009–10 and the lowest at 158 per 100,000 population in 2017–18
  • the hospitalisation rate for COPD also fluctuated, with the highest at 757 per 100,000 population in 2016–17 and the lowest at 663 per 100,000 population in 2013–14 (Figure 4).

See Hospital care.
 

This figure shows the trends of hospitalisation due to selected respiratory conditions from 2008–09 to 2017–18. During the last decade, the hospitalisation rate of asthma fluctuated, with the highest at 183 per 100,000 population in 2009–10, and the lowest at 158 per 100,000 population in 2017–18; the hospitalisation rate of COPD also fluctuated, with the lowest at 663 per 100,000 population in 2013–14, and the highest at 757 per 100,000 population in 2016–17; and the hospitalisation rate of bronchiectasis increased steadily and slightly from 20 per 100,000 population in 2008–09 to 28 per 100,000 population in 2016–17.

Visualisation not available for printing

Hospitalisations due to asthma, COPD and bronchiectasis 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 2019c).

Variation between population groups

The impact of asthma, COPD and bronchiectasis varies between population groups, with rates of prevalence, hospitalisation, death and disease burden being 1.1–2.0 times as high in Remote and very remote areas as in Major cities. Meanwhile, the impact of asthma, COPD and bronchiectasis increases with decreasing socioeconomic position. Rates were 1.2–2.8 times as high in the lowest socioeconomic areas compared with the highest (Figure 5).
 

This figure shows the impact of selected chronic respiratory conditions on different population groups in 2017–18. In general, the impact of chronic respiratory conditions varies among population groups, with prevalence, hospitalisation, death and disease burden rates being 1.1–2.0 times as high in Remote and very remote areas than in Major cities. The impact of chronic respiratory conditions increases with increasing socioeconomic position. Rates were 1.2–2.8 times as high in lowest compared with highest socioeconomic areas.

Where do I go for more information?

For more information on chronic respiratory conditions, see:

Visit Chronic respiratory conditions for more on this topic.

References

ABS (Australian Bureau of Statistics) 2010. Microdata: National Health Survey, 2007–08. ABS cat. no. 4324.0.55.001. Findings based on Expanded Confidentialised Unit Record File analysis. Canberra: ABS.

ABS 2013. Microdata: National Health Survey, 2011–12. ABS cat. no. 4324.0.55.001. Findings based on Expanded Confidentialised Unit Record File analysis. Canberra: ABS.

ABS 2016. Microdata: National Health Survey, 2014–15. ABS cat. no. 4324.0.55.001. Findings based on Expanded Confidentialised Unit Record File analysis. Canberra: ABS.

ABS  2018. National Health Survey: first results, 2017–18. ABS cat. no. 4364.0.55.001. Canberra: ABS.

ABS 2019. Microdata: National Health Survey, 2017–18. ABS cat. no. 4324.0.55.001. Findings based on Detailed Microdata analysis. Canberra: ABS.

AIHW (Australian Institute of Health and Welfare) 2019a. Australian Burden of Disease Study: impact and causes of illness and death in Australia 2015. Australian Burden of Disease series no. 19. Cat. no. BOD 22. Canberra: AIHW.

AIHW 2019b. Disease expenditure in Australia. Cat. no. HWE 76. Canberra: AIHW.

AIHW 2019c. National Healthcare Agreement: PI 18—Selected potentially preventable hospitalisations, 2018. METeOR Metadata Online Registry. Canberra: AIHW.

Department of Health 2018. National Asthma Strategy. Canberra: Department of Health.

Department of Health 2019. National Strategic Action Plan for Lung Conditions. Canberra: Department of Health.

Gibson PG & MacDonald VM 2015. Asthma-COPD overlap 2015: now we are six. Thorax 70(7):683-91.

Leader D 2019. An overview of Obstructive vs. Restrictive Lung Diseases. New York: verywell health.

National Asthma Council Australia 2019a. Australian Asthma Handbook, Version 2.0. Melbourne: National Asthma Council Australia.

National Asthma Council Australia 2019b. Thunderstorm asthma. Melbourne: National Asthma Council Australia.

Thien F, Beggs PJ, Csutoros D, Darvall J, Hew M, Davies JM et al. 2018. The Melbourne epidemic thunderstorm asthma event 2016: an investigation of environmental triggers, effect on health services, and patient risk factors. Lancet Planet Health 2: e255–e263.

Toelle BG, Xuan W, Bird TE, Abramson MJ, Atkinson DN, Burton DL et al. 2013. Respiratory symptoms and illness in older Australians: The Burden of Obstructive Lung Disease (BOLD) study. Medical Journal of Australia 198:144–8.

Victoria State Government 2019. Epidemic thunderstorm asthma forecast. Melbourne: Victoria State Government.