Respiratory disease kills more people than most other conditions, yet receives far less attention than cardiovascular disease, diabetes or cancer. In 2019 alone, lung disease accounted for three of the top ten causes of death worldwide according to the World Health Organization, contributing to more than 8 million deaths annually. Despite those numbers, funding, research and policy attention have not followed at anywhere near the same scale.
The Forum of International Respiratory Societies, known as FIRS, has been tracking this imbalance for years. Its third edition of the Global Impact of Respiratory Diseases report identified five conditions driving the most harm. Those five are asthma, chronic obstructive pulmonary disease (COPD), acute lower respiratory tract infections, lung cancer and tuberculosis (TB). Together, they are responsible for a staggering share of preventable illness and death around the world.
The weight of the ‘Big Five’ on global health
Each of those five conditions carries its own devastating footprint. Nearly 200 million people have COPD, and 3.2 million die from it each year, making it the third leading cause of death worldwide. Asthma affects 262.4 million people and is the most common chronic disease in children globally. Low- and middle-income countries bear 96% of asthma-related deaths and 84% of global disability-adjusted life years.
Lung cancer kills 1.8 million people annually, more than any other cancer. TB infected more than 10 million people and claimed 1.5 million lives in 2020 alone, making it the deadliest infectious disease after COVID-19. Pneumonia, often overlooked in these conversations, killed more than 2.5 million people in 2019 and remains a leading cause of death in children under 5 and adults over 65.
The COVID-19 pandemic made all of this worse. Beyond its own death toll of more than 6.3 million, the pandemic disrupted vaccination programs, TB treatment, asthma care and cancer screening, pushing patients to seek care only after conditions had advanced significantly.
Respiratory disease and the inequality problem
The burden falls hardest on countries least equipped to handle it. An estimated 544.9 million people had a chronic respiratory disease in 2017, but the tools to diagnose and manage those conditions are unevenly distributed. At least 2.4 billion people are exposed to indoor air pollution. About 90% of the global population breathes outdoor air that exceeds WHO safety guidelines. More than 1.3 billion people are exposed to tobacco smoke.
In low- and middle-income countries, these exposures combine with health system constraints and limited access to affordable medications to produce outcomes that diverge sharply from those in wealthier nations. The problem is compounded early. Childhood exposures, including poor nutrition and inadequate infection control, shape lung development in ways that affect health for decades.
What would actually make a difference
The path forward involves several overlapping strategies. Expanding immunization coverage against pneumococcal disease, influenza, RSV and other respiratory pathogens is among the most actionable near-term steps. Strengthening clean air policies, reducing tobacco use including e-cigarettes and heat-not-burn devices, and investing in pulmonary rehabilitation and self-management programs all carry measurable impact.
Access to affordable, quality-assured medicines for asthma, COPD and lung infections remains a significant gap. FIRS is working with the WHO to identify barriers and solutions, but progress has been slow. A World Health Assembly resolution on chronic respiratory diseases, similar to what has been achieved for diabetes and cancer, would represent a meaningful shift in how the international community prioritizes lung health.
Research remains foundational. Without investment in basic, clinical and population-based respiratory science, prevention and treatment advances will stall.
