Chronic respiratory conditions

What are 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.

Asthma and chronic obstructive pulmonary disease (COPD) are 2 common respiratory conditions and are associated with poor health and wellbeing.

For more information on what is covered by the term 'chronic respiratory conditions' for each data source, see the Technical notes and Data tables.

How common are chronic respiratory conditions?

Around 8.5 million (34%) people in Australia were estimated to have chronic respiratory conditions, according to self-reported data in the 2022 Australian Bureau of Statistics (ABS) National Health Survey (NHS) (ABS 2023). This included:

• 2.8 million (11%) people who were estimated to be living with asthma
• 638,000 (2.5%) people who were estimated to be living with COPD (ABS 2023).

In 2022, the prevalence of:

• asthma was similar for boys and girls aged 0–14, but higher for females than males over the age of 15
• asthma did not vary substantially by remoteness area or level of disadvantage (also known as socioeconomic area)
• COPD increased with increasing age and is similar for males and females
• COPD was highest among people living in Outer regional and remote areas and lowest for people living in Major cities (3.9% and 2.2%, respectively)
• COPD was 4.7% for people living in areas of most disadvantage (lowest socioeconomic areas) and 1.5% for people living in the least disadvantaged areas (highest socioeconomic areas) (Figure 1) (ABS 2023).

Between 2001 and 2022, after adjusting for different population age structures over time, the prevalence of asthma and COPD remained stable (12% to 11%, and 3.6% to 2.2%, respectively) (Figure 1) (ABS 2023).

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

Figure 1: Prevalence of selected respiratory conditions, by age and sex, over time (2001 to 2022) and by population group, 2022

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. 

Natural events that affect air quality can have a direct impact on chronic respiratory conditions. Two such natural events in recent times are thunderstorm asthma and the bushfires of 2019–20. 

For more information on thunderstorm asthma, see Asthma and Natural environment and health.

Measures of impact presented in this section include burden of disease, health expenditure and mortality data.

Burden of disease

In 2023, the respiratory conditions disease group accounted for 7.2% of total disease burden (also known as disability adjusted life years or DALY), 8.5% of non-fatal burden (also known as ‘years lived with disability’ or YLD) and 5.8% of fatal burden (also known as years of life lost, or YLL) (AIHW 2023a). 

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).

Variation by age and sex

In 2023:

• The rate of burden for the respiratory conditions disease group remained under 8.4 DALY per 1,000 population up to the age group 45–49. After this, rates increased steeply, to a high at 54.8 DALY per 1,000 population for those aged 75–79.
• Among individual conditions, COPD was the fifth leading cause of total burden of disease. Asthma was tenth but was the leading cause of total burden among children aged 1–9 (Figure 2).

Figure 2: Burden of disease due to respiratory conditions, by age and sex, 2003, 2011, 2015, 2018 and 2023

Trends over time

After adjusting for different population age structures over time, the 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 between 2003 and 2023.

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

Variation between population groups

In 2018, after adjusting for age differences, the 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 areas of most disadvantage (lowest socioeconomic areas) and lowest for people living in the least disadvantaged areas (highest socioeconomic areas) (16.8 and 9.7 DALY per 1,000 population, respectively) (Figure 3) (AIHW 2021b).

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

Figure 3: Burden of disease due to respiratory conditions for remoteness area and socioeconomic area by sex, 2011, 2015 and 2018

Health system expenditure

In 2020–21, an estimated $4.5 billion of expenditure in the Australian health system was attributed to 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. This was similar to the proportion for all disease groups (9.8%) (Figure 4).

Figure 4: 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 
• 4.8% ($294.8 million) of all public hospital emergency department expenditure (Figure 5).

Figure 5: 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 on older people (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).

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
• Health system spending on disease and injury in Australia, 2020–21.

How many deaths were associated with chronic respiratory conditions?

In 2022, respiratory conditions were recorded as an underlying and/or associated cause for 54,776 deaths or 211 deaths per 100,000 population. This represented 29% of all deaths in 2022.

Respiratory conditions were more likely to be recorded as an associated cause of death accounting for 39,573 deaths (72% of respiratory deaths), than as the underlying cause of death (15,203 deaths or 28% of all respiratory deaths).

COPD and asthma accounted for 51% and 3.1% of underlying-cause respiratory deaths, respectively. Furthermore, they contributed to 35% and 4.5% of any-cause respiratory deaths.

Variation by age and sex

In 2022, respiratory conditions mortality (as the underlying and/or associated cause) in comparison to all deaths, was relatively more concentrated among:

• older people (74% of respiratory deaths were among people aged 75 and over, compared with 68% for total deaths)
• males (55% of respiratory deaths were among males compared with 48% of total deaths) (Figure 6).

Figure 6: Age distribution for respiratory conditions mortality, by sex, 2012 to 2022

Trends over time

After adjusting for different population age structures over time, mortality rates for respiratory conditions (as the underlying and/or associated cause) between 2012 and 2022:

• decreased from 167 to 154 per 100,000 population
• were 1.5 to 1.6 times as high for males compared with females (Figure 7).

Figure 7: Trends over time for respiratory conditions mortality, 2012 to 2022

Variation between population groups

In 2022, after adjusting for age differences, 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 (186 and 149 per 100,000 population, respectively)
• highest for people living in areas of most disadvantage (lowest socioeconomic areas) and lowest for people living in the least disadvantaged areas (highest socioeconomic areas) (197 and 119 per 100,000 population, respectively).

Treatment and management of chronic respiratory conditions

Primary care

General practitioners (GP) 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 2021–22:

• asthma was the principal diagnosis in 25,500 hospitalisations for people of all ages
• COPD was the principal diagnosis in 53,300 hospitalisations for people aged 45 and over. 

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

• asthma decreased from 170 to 100 hospitalisations per 100,000 population 
• COPD, for people aged 45 years and over, decreased steeply from 2016–17 to 2020–21 (805 to 510 hospitalisations per 100,000 population) after which the rate of decrease slowed (500 hospitalisations per 100,000 population) (Figure 8).

Figure 8: Trends over time for asthma and chronic obstructive pulmonary disease hospitalisations, by sex, 2011–12 to 2021–22

COVID‑19 impact on chronic respiratory conditions

The COVID‑19 pandemic had substantial impacts on hospital activity generally. The range of social, economic, business and travel restrictions, including restrictions on, or suspension of, some hospital services, and associated measures in other healthcare services to support physical distancing in Australia, resulted in an overall decrease in hospital activity between 2019–20 and 2020–21. As a result, the hospitalisation rates for asthma and COPD in these years were the lowest recorded in the last 10 years (AIHW 2022a).

For more information on how the pandemic has affected the population’s health in the context of longer-term trends, see 'Changes in the health of Australians during the COVID‑19 period’ in Australia’s health 2022: data insights.

Emergency department presentations for asthma and COPD were also affected by the pandemic, decreasing from March (when the national lockdown started) to May 2020 (from 26 to 11 and 39 to 28 presentations per 100,000 population, respectively).

In June 2020, emergency department presentations increased again as restrictions began to ease across the country (to 19 presentations per 100,000 population for asthma and to 33 presentations per 100,000 population for COPD) (Figure 9).

Figure 9: Monthly emergency department presentation rates for asthma and chronic obstructive pulmonary disease by age, 2019 to 2022

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 2022) 

Death rates due to all respiratory diseases combined also showed a substantial fall in 2020, with rates particularly low for females and during the winter months compared with previous years, though rates have increased since (Figure 10). 

Figure 10: Age-standardised deaths rate due to asthma and chronic obstructive pulmonary disease, 2012 to 2022

While the long-term impact of COVID‑19 on the respiratory system is still being assessed, 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). 

For more information, see ‘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 living with chronic respiratory conditions often also live with other chronic and long-term conditions, known as ‘comorbidity’. According to the NHS, in 2022:

• an estimated 1.8 million (65%) people who were living with asthma also had one or more other chronic conditions. Among them, 41% were estimated to be living with mental and behavioural conditions and 25% were estimated to be living with back problems
• an estimated 553,000 (87%) people who were living with COPD also had one or more other chronic conditions. Among them, 49% were estimated to be living with mental and behavioural conditions and 45% were estimated to be living with arthritis (Figure 11) (ABS 2023). 

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

Figure 11: Number of selected chronic conditions and types of comorbidity in people with asthma and chronic obstructive pulmonary disease, 2022

Where do I go for more information?

For more information on chronic respiratory conditions, see:

• ABS National Health Survey
• ABS Health Conditions Prevalence
• Australian Centre for Monitoring Population Health

For more on this topic, visit Chronic respiratory conditions.