Chronic respiratory diseases

21 May 2025

Key facts

  • Chronic respiratory diseases (CRDs) are among the most common noncommunicable diseases (NCDs) and are crucially linked to cardiovascular disease, cancer and other causes of death.
  • CRDs are the sixth leading cause of death in the WHO European Region, with almost 400 000 deaths every year. Nearly 80% of all CRD deaths are caused by chronic obstructive pulmonary disease (COPD).
  • There are 81.7 million people living with CRD in the Region, with 6.8 million newly diagnosed cases in 2021.
  • Despite progress in reducing mortality, CRD prevalence, death rates and disability-adjusted life years vary widely across the Region’s 53 countries.
  • CRDs contribute to US$ 20.7 billion in productivity losses for people aged 30 to 74 in the Region.
  • There’s a significant lack of population-based studies on CRDs compared to other major diseases, highlighting unmet needs.
  • While asthma and COPD are the most common, lesser-known respiratory conditions also strain health-care systems and need better recognition and diagnosis.

What are CRDs?

CRDs are chronic diseases of the airways and other structures of the lung. Some of the most common are asthma, COPD, respiratory allergies, occupational lung diseases and pulmonary hypertension.

Major causes of CRDs

The most important risk factors for developing or exacerbating preventable CRDs are:

  • tobacco smoke
  • indoor air pollution (caused by mould, dampness, tobacco smoke or the burning of biomass fuels)
  • outdoor pollution
  • allergens
  • low birth weight, poor nutrition or acute respiratory infections of early childhood
  • occupational dusts and chemicals. 

CRDs and tobacco

  • At 25.3% – above the global average – tobacco use is the leading avoidable risk factor for respiratory diseases in the Region.
  • Rising tobacco and e-cigarette use among youth increases risks, from asthma to heart disease, demanding urgent action to protect future generations.
  • Industry influence from tobacco and processed food sectors underscores the need for strong regulation to protect respiratory health.

CRDs and air pollution

  • Over 90% of people in the Region breathe polluted air, with most exposed to particulate matter levels that exceed WHO guidelines.
  • Indoor and outdoor air pollution is the second leading risk factor for CRDs, especially for children.
  • Household air pollution contributes to 154 000 deaths annually in the Region, disproportionately affecting marginalized communities.
  • Clean energy, sustainable practices and public awareness are key to reducing the health impact of air pollution.

Social determinants and high-risk populations

People living in low- and middle-income countries, especially those facing socioeconomic challenges, are at significantly higher risk of developing or worsening CRDs. Several key factors contribute to this vulnerability:

  • greater exposure to indoor pollution from solid fuels and unsafe occupational environment
  • occupational CRDs are often not adequately recognized as a problem
  • limited access to essential medications, which are frequently unaffordable or unavailable
  • tobacco use tends to be higher among poor people than among wealthier members of society.

Certain conditions and situations can further increase the risk of CRDs or worsen outcomes for those already affected.

  • Obesity (Body Mass Index > 30) is linked to a higher risk of asthma, while a low Body Mass Index is associated with worse outcomes and increased mortality in people with COPD.
  • Public health emergencies such as pandemics or armed conflicts can disrupt health-care systems and limit access to necessary respiratory care.
  • Poor health-care infrastructure, particularly in rural or underserved regions, often means delayed diagnosis and limited treatment options for CRDs.

Prevention and response through strong health systems and policies

Health systems can support the prevention and control of CRDs through the adoption of strong policies. However, many countries in the Region lack effective national respiratory health strategies, underscoring the need for prioritized policies. When addressing the challenges of CRDs, policy-makers should consider that:

  • sustainable financing is crucial to fund CRD-related health initiatives;
  • CRD prevention requires a multisectoral approach, including tobacco control, air quality improvement and community engagement;
  • incorporating essential CRD interventions into universal health coverage reduces health inequities and improves outcomes;
  • coordinated governance and resilient health systems that align CRD policies with broader NCD strategies boost results;
  • countries should prioritize evidence-based policy options, known as NCD best buys, which are cost–effective and impactful for improving CRD and tobacco management;
  • investing in primary care ensures accessible and well-connected specialized care, as well as integrated CRD management across the care continuum; and
  • integrating cost–effective CRD interventions can protect families from financial hardship due to out-of-pocket expenses.

Importance of access to medicines and diagnostics in reducing the burden of CRDs

  • Ongoing monitoring of availability and pricing helps to reduce financial barriers for patients with CRDs.
  • Expanding access to high-quality diagnostic services, such as spirometry, enables timely diagnosis and management of CRDs in primary care settings.
  • Many underserved populations lack access to inhaled corticosteroids and combined therapies, often excluded from health benefit packages.
  • Reaching 80% availability of essential CRD medicines and technologies is key to better health outcomes and equity.

Improving quality of care and investing in health workforce

  • Inconsistent CRD care persists, with only 56.5% of countries having updated clinical guidelines in the past 5 years.
  • Training and clear protocols are essential for effective CRD care, especially when specialists are scarce.
  • Supported self-management is key, yet only 50% of patients adhere to long-term pharmacotherapy.
  • Effective workforce distribution addresses shortages and ensures equitable access to CRD care, particularly in rural and underserved areas.
  • Multidisciplinary teams improve holistic CRD care, boosting outcomes and patient satisfaction.
  • Empowering nurses and community health workers to take on expanded roles reduces family physician burden and strengthens chronic respiratory care delivery.

Integrating rehabilitation and palliative care

  • Around 6% of people with chronic lung diseases need palliative care, yet 65% of them lack access in the Region.
  • WHO urges integrating rehabilitation and palliative care to enhance service quality and accessibility for patients nearing end of life.
  • Tailored pulmonary rehabilitation programmes improve outcomes for CRD patients and can be delivered even in low-resourced settings.
  • WHO’s Package of interventions outlines the necessary resources and workforce skills for effective rehabilitation in cardiopulmonary conditions.

Investing in research, innovation and digital health

  • Fostering accessible CRD research and innovation is key to improving health outcomes and supporting informed policy-making.
  • Translating research into clinical solutions improves the quality of life for patients and facilitates personalized CRD treatments.
  • Embracing emerging technologies such as artificial intelligence and ensuring equitable access to innovative CRD interventions closes care gaps and reduces disparities.
  • Artificial intelligence supports accurate diagnosis, remote monitoring and timely interventions via tools such as smart inhalers and telemedicine.
  • Digital health expands access to specialist care, especially in remote areas, but requires validation for safety and efficacy.
  • Equitable digital access depends on stable internet, reimbursement policies and efforts to prevent new disparities.

WHO response in the WHO European Region

WHO supports countries in their efforts to reduce the toll of morbidity, disability and premature mortality related to CRDs and coordinates the exchange of country experiences, advocates for fostering implementation research to drive innovation and informed policy-making process, and provides guidelines and recommendations. 

Specific areas of focus include:

  • elaboration of CRDs in the integrated national NCD policies, strategies and action plans with a joint approach to preventable and treatable CRDs;
  • strengthening of surveillance to assess the current problem and monitor progress;
  • reduction of exposure to risk factors;
  • strengthening of health systems to improve care, strengthening diagnostic capacity and access to essential services, medicines and medical devices for people suffering from CRDs; and
  • adoption of a comprehensive and integrated approach to address risk factors that span many policy sectors, including environmental, transportation, industry, housing, occupational health and safety, education and health care.