What can be done to combat respiratory diseases @ The Global Impact of Respiratory Disease — 2021 report 

Site Editor:

Joaquim Cardoso MSc.
The Health Strategist 
— applied research, strategy and implementation
September 26, 2022

This is an excerpt of the report below.

The Global Impact of Respiratory Disease — 2021 [excerpt]

Forum of International Respiratory Societies (FIRS)
3rd edition

September 2021

Key messages:

FIRS calls for these essential actions to reduce the burden of respiratory disease and improve global health:

  • 1.Improve awareness among the public as well as policy makers that respiratory health is vital to global health and that childhood respiratory disease has long-term negative consequences on adult health.

  • 2.Reduce, and then eliminate, use of all tobacco and smoking products.

  • 3.Adopt and adhere to WHO standards, at a minimum, to reduce ambient, indoor, and occupational air pollution for all countries.

  • 4.Implement universal access to quality health care, including the availability of affordable, quality-assured, essential medicines and universal coverage for all effective childhood and adult immunizations.

  • 5.Improve the prevention and early diagnosis of respiratory diseases.

  • 6.Increase education and training of health-care professionals in respiratory disease worldwide.

  • 7.Standardize the monitoring and reporting of the prevalence, severity, and management of respiratory diseases to enable development of better-informed national strategies through programs of the WHO and governmental and nongovernmental organizations.

  • 8.Boost funding for respiratory research to develop programs, tools, and strategies to better prevent and treat respiratory diseases

Significant progress on these essential actions will help to eliminate respiratory diseases from the top 10 leading causes of death in the world.


Because respiratory illnesses are either caused or worsened by what we breathe, tobacco smoke, air pollution, occupational toxicants, and infectious agents disproportionately impact respiratory diseases. 

Thus, strategies to reduce these exposures and preserve lung health are cost effective and must be a top priority in a global health agenda[1].







Tobacco use causes 8 million avoidable deaths per year, mostly from cardiovascular or respiratory disease[1]

In the United States, individuals who smoke are 25 times more likely to die of lung cancer and three times as likely to die of any cause than individuals who have never smoked[2] [3]

In Europe, total health-care costs from tobacco use are ~€544 billion annually, or ~5% of the EU gross domestic product[4].

Tobacco can also harm individuals who do not smoke. 

Second-hand smoke is an indoor pollutant that contains at least 250 carcinogenic or toxic chemicals[5] . 

Second-hand smoke has been estimated to cause 1.2 million deaths per year worldwide[6], including 7,300 lung cancer–related deaths in the United States[7]

Globally, nearly one-half of all children breathe second-hand smoke, and 65,000 children die each year due to illnesses related to second-hand smoke[8]

Because no level of exposure is safe to second-hand smoke, eliminating all smoking from indoor environments is the only effective measure to tackle this public health threat[9]. 

For example, local and national governments are increasingly implementing smoke-free policies in public places and public housing to protect nonsmokers from exposure to second-hand smoke[10].

Electronic cigarettes (e-cigarettes) are devices that heat a liquid to create an aerosol that is then inhaled by the users. 

E-cigarette use, also known as vaping, impairs respiratory health[11]

Vaping at a younger age is particularly risky, because addictive nicotine exposure can lead to long-term tobacco use that also has damaging effects on brain development[12] and can cause e-cigarette– or vaping-associated lung injury[13]

The WHO recommends regulation of e-cigarettes to prevent vaping initiation by nonsmokers, particularly minors and vulnerable groups[14]

Moreover, e-cigarettes should not be advertised as a smoking cessation aid in the absence of compelling evidence of their effectiveness[15].

Reducing and eliminating tobacco use is a high-priority and cost-effective public health intervention. 

The WHO Framework Convention on Tobacco Control, adopted in 2003, is an essential mechanism by which governments can control the tobacco industry using laws, regulations, administrative decisions, and enforcement measures such as bans on tobacco advertising[16].

Other effective strategies include educational campaigns and high tobacco tax policies[17].


Worldwide, air pollution leads to 7 million deaths per year from such causes as COPD, lung cancer, and respiratory infections[18]

Ninety percent of all people breathe outdoor air that exceeds WHO guideline limits, especially those living in low- and middle-income countries[19]

Pollutants that cause adverse health effects include particulate matter, ozone, nitrogen dioxide, and sulfur dioxide, all of which originate from fuel combustion[20]

No known safe exposure level exists for any of these pollutants. 

Moreover, indoor air pollution is a leading cause of premature death in the developing world, primarily among women and children[21]

Unfortunately, approximately 50% of all households and nearly 90% of rural households worldwide rely on solid fuels for domestic energy, leading to indoor air pollution[22].


Most outdoor air pollutants are emitted by the same sources that emit greenhouse gases, likely contributing to climate change[23]

Global warming and related climate emissions can affect respiratory health directly (heat waves and extreme weather events such as hurricanes and cyclones) or indirectly (increasing air pollutants, wildfire activity, pollens, and molds, as well as by promoting vectors for transmission of infectious diseases). 

Between 2030 and 2050, climate change is expected to cause nearly 250,000 additional deaths every year as result of malnutrition, malaria, diarrhea, and heat stress[24]

Policies that reduce air pollution from fossil fuel combustion offer a “win–win” strategy for both climate and health, immediately lowering disease burden from air pollution while also mitigating climate change.

In response to pollution-related health effects, the first WHO Global Conference on Air Pollution and Health set an aspirational goal of reducing the number of deaths from air pollution by two-thirds by 2030[25]

Reaching this target requires scaling up global efforts for cities to reach the WHO air quality guidelines. 

Policies are needed to promote sustainable land use, cleaner household energy and transportation, energy-efficient housing, power generation, better municipal waste management, and access to clean energy technologies in resource-poor settings. 

Interactions between public and private stakeholders are key to ensure national and local policies that effectively address both air pollution and climate change


Occupational hazards can lead to respiratory diseases under certain working conditions. 

For example, exposure to asbestos can cause lung fibrosis and mesothelioma; exposure to mineral dust can cause silicosis and coal workers’ pneumoconiosis; and exposure to organic antigens in agricultural settings can cause hypersensitivity pneumonitis and occupational asthma[26].

Exposure to occupational hazards is much higher among economically disadvantaged individuals living in low-income countries, thereby leading to a greater burden of occupational diseases that are often unrecognized or inadequately addressed through occupational safety and health programs. 

If not prevented or diagnosed at early stages, this continued occupational exposure can lead to severe respiratory disease.

Occupational lung diseases can be avoided by setting exposure limits based on scientific evidence and implementing preventive interventions to reduce exposure, particularly to carcinogens and sensitizing agents[27]

Implementing effective workplace preventive measures also requires up-to-date knowledge about occupational respiratory hazards and periodic surveillance of exposed workers (eg, routine chest clinic visits, lung function testing, chest radiographs) to identify any early signs of adverse respiratory effects.


Respiratory infections are a major public health threat worldwide. 

Indeed, acute lower respiratory infections such as bacterial pneumonia and influenza are among the top global causes of death and loss of disability-adjusted life years in adults.

Pneumonia is the worldwide leading cause of death in children younger than 4 years[28]

Although prevention and control policies have reduced deaths from childhood pneumonia from 4 million in 1981 to 808,000 in 2017, pneumonia still accounts for one-fifth of childhood deaths in the world. 

Because such mortality is linked to malnutrition, poverty, and inadequate health care, more than 98% of pneumonia-related deaths in children occur in 68 under-resourced countries[29]

The Global Action Plan for the Prevention and Control of Pneumonia developed by WHO and the United Nations Children’s Emergency Fund has proposed feasible low-cost interventions that aim to reduce deaths from childhood pneumonia to fewer than three per 1,000 live births by 2025[30]

As part of this global plan, prevention strategies include promoting adequate nutrition (eg, breast feeding, good zinc intake), reducing indoor pollution, and increasing immunization rates against H. influenzae type b, pneumococcus, measles, and pertussis. 

Moreover, evidence-based guidelines are available for early detection and appropriate antibiotic treatment of pneumonia[31].

In 2020, the COVID-19 pandemic claimed the lives of more than 2 million people worldwide, and total deaths to date exceed 4.5 million[32]

Many of these deaths could have been prevented through better public health infrastructure and preparedness. 

Moreover, the ongoing pandemic has exposed lack of vital resources such as personal protective equipment and ventilators around the globe[33]

Alternatively, the COVID-19 pandemic has also shown the key role of science-based approaches to global health threats, and scientists have developed multiple vaccines shown to be safe and protective against COVID-19. 

However, inequitable distribution of available vaccines threatens global control of COVID-19[34]

To address this, a global alliance (COVAX) is working to ensure access to SARS-CoV-2 vaccines for all countries, regardless of their wealth[35].

TB is one of the top 10 causes of death worldwide, killing 1.4 million people in 2019. 

In 2014, the World Health Assembly approved the post-2015 Global TB Strategy, which provides a global framework for TB control and elimination with a focus on the most vulnerable populations[36] [161]. 

This strategy, known as End TB, aims to reduce TB-related deaths by 95% and the incidence rate of new cases by 90% between 2015 and 2035. 

The three main pillars of End TB are (1) integrated, patient-centered TB care and prevention, (2) bold policies and supportive systems, and (3) intensified research and innovation. 

Achieving its 2035 targets will require more coordinated global efforts to address social determinants of TB and provide better diagnostics focusing on early detection, easier and shorter treatment regimens, and effective pre- and post-exposure vaccines.

Controlling common respiratory diseases requires availability and optimal use of public health tools and vigorous advocacy for sound health policies to reduce or eliminate key risk factors such as tobacco use, air pollution, occupational hazards, and respiratory infections[37]

To be most effective, such efforts must be accompanied by continued innovation and discovery and access to quality health care. 

Indeed, basic, clinical, and population-based research are critical to improve the prevention, diagnosis, and management of respiratory diseases. 

Moreover, patients with respiratory diseases need, and deserve, proper and compassionate care.

Those who are economically disadvantaged and those from other vulnerable populations (eg, racial/ ethnic minorities, migrants, refugees) share a disproportionate burden of respiratory disease, because these populations are often exposed to major risk factors and lack adequate health care[38] [39]

Such health disparities are not only unethical but also pose tremendous costs to health-care systems around the world. 

Thus, global prevention and treatment of respiratory disease moves us closer to the laudable, cost effective, and shared goal of health equity.

We must be encouraged by our progress in reducing the worldwide impact of respiratory diseases over the last few decades. 

Indeed, investments in research and public health have paid substantial dividends, as evidenced by decreasing rates of pneumonia and TB, as well as reduced tobacco use in certain nations. 

However, the dire toll of the COVID-19 pandemic is awakening us to the need to strengthen and expand global public health, research, and health-care systems. 

Moving forward, we must build the capacity, infrastructure, and resources needed to confront, and hopefully prevent, the next worldwide emergency, be it a pandemic or a climactic catastrophe, while also addressing the existing and terrible burden of respiratory diseases.


Lung health is vital for life, whereas respiratory diseases are a clear threat to life, health, and productive human activity. 

Prevention, control, and cure of these diseases and promotion of respiratory health must be a top priority in global decision-making in the health sector. 

The control, prevention, and cure of respiratory diseases are among the most cost effective health interventions available — a “best-buy” in the view of the WHO[40]

Genuine investment in respiratory health will pay exponential dividends in longevity, healthy living days, and national economies.

Public awareness and control of the environment are important steps to preventing respiratory diseases. 

The key controllable factors are reduction in tobacco smoking and improvement in air quality, which includes reduction in second-hand tobacco smoke, indoor air pollution, and unhealthy public and workplace air. 

Strengthening childhood immunization programs and providing greater availability of the pneumococcal conjugate vaccine and SARS-CoV-2 vaccines must be a priority in low-income countries. 

Prevention and timely treatment of HIV infection can have major impact in reducing the burden of respiratory illness. 

Effective training of health-care professionals and ensuring the availability of medications and appropriate diagnostic tools are keys to better lung and respiratory health. 

A vital need exists for better access to basic and effective affordable medicines, including oxygen and WHO-essential inhaled medicines, for people in living in low- and middle-income countries with respiratory diseases.

FIRS calls on all governments, communities, health-care professionals, and individuals to promote the achievable and effective preventive measures that have reduced tobacco consumption in many countries.

The health benefits of clean air policies are far reaching. 

It is well known that improvement in air quality has reduced deaths and hospitalizations for cardiovascular and pulmonary diseases. 

Legislation and political action on clean air make a difference. 

The respiratory societies of the world believe that everyone has the right to breathe clean air[41], and we ask lawmakers to enact and enforce clean air standards in all countries.

Finally, research in respiratory diseases is the hope for today and the promise for tomorrow. 

The advances we enjoy today are the direct result from research undertaken in the past. 

Research must still answer many questions, to name a few: how lung diseases arise, how do they spread, who is most vulnerable, and what are the best actions that can be used to control or cure them. 

Research must also help us understand and adopt what keeps people healthy. 

Measures developed from the research must be cost effective and widely applicable. 

Increased funding to support respiratory research is needed to ensure our children’s lung health is preserved in the future.


References and additional information.

See the original publication


Stephanie Levine (co-chair)
UT Health- San Antonio and South Texas Veterans Health Care System San Antonio, Texas, USA

Darcy Marciniuk (co-chair)
University of Saskatchewan Saskatoon, SK, CANADA

Amro Agla
Beth Israel Deaconess Medical Center Boston MA, USA

Juan C. Celedón
University of Pittsburgh Pittsburgh, Pennsylvania, U.S.A.

Kwun Fong
The Prince Charles Hospital, Brisbane QLD AUSTRALIA UQ Thoracic Research Centre Brisbane QLD AUSTRALIA

Robert Horsburgh
Boston University School of Public Health, Boston MA, USA

Atul Malhotra
Pulmonary, Critical Care and Sleep Medicine, UC San Diego La Jolla, CA, USA

Refiloe Masekela
University of KwaZulu Natal Durban, South Africa

Kevin Mortimer
Liverpool School of Tropical Medicine Liverpool, UK

Hellen Redde
The Woolcock Institute of Medical Research and the University of Sydney, Sydney, AUSTRALIA

Mary Rice
Beth Israel Deaconess Medical Center Boston MA, USA

Anita Simonds
Royal Brompton and Harefield Hospital, NHLI, London UK

Lynn Tanoue
Yale School of Medicine New Haven, CT, USA

Heather Zar
Red Cross Childrens Hospital University of Cape Town, South Africa

Originally published at: https://www.firsnet.org

Cite this publication as:

Forum of International Respiratory Societies. The global impact of respiratory disease. Third Edition. European Respiratory Society, 2021. Accessed 22 September, 2021.


Respiratory System in Action – (Infographic by Eleanor Lutz)

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