Chronic Respiratory Disease in the U.S.

A recent study published by The Lancet Respiratory Medicine crunched the numbers on common respiratory conditions in the U.S. over the past couple of decades and predicted the trajectory they would take in the future.

The international group of investigators analyzed data from the Global Burden of Diseases, Injuries and Risk Factors Study 2023 to estimate how prevalence and mortality for asthma, COPD, pneumoconiosis, and interstitial lung disease (ILD) and pulmonary sarcoidosis have changed since 1990 and project where things will be in 2050 as well.

The findings included:

• The estimated number of people living with chronic respiratory disease in the U.S. rose from 33.28 million in 1990 to 54.5 million in 2023.
• The age-standardized prevalence rate rose by 10.24% during that time frame, and the age-standardized mortality rate rose from 19 per 100,000 population to 34.56 per 100,000 population.
• The age-standardized mortality rate went up by 8.9% for COPD and 87.47% for ILD and pulmonary sarcoidosis. The rate dropped by 50.94% for asthma and 75.19% for pneumoconiosis.
• Kentucky, West Virginia, and Mississippi had the highest age-standardized mortality rates due to COPD in 2023. The District of Columbia had the lowest rate. The same pattern was seen when assessing age-standardized mortality rates due to pneumoconiosis.
• Mississippi had the highest age-standardized mortality rate due to asthma in 2023, with the lowest rates found in Rhode Island, Massachusetts, and Connecticut.
• Maine had the highest age-standardized rate for mortality due to ILD and pulmonary sarcoidosis in 2023, and New York had the lowest.
• Modifiable risk factors accounted for 44.54% of total disability-adjusted life-years (DALYs) due to chronic respiratory diseases, driven mainly by high BMI for asthma, smoking for COPD, and occupational exposure to asthmagens for pneumoconiosis.
• The primary contributor to asthma burden was high BMI, whereas the primary contributor for COPD burden was smoking. Occupational exposure to asthmagens was the top contributor to pneumoconiosis burden.
• Factors linked to reduced age-standardized DALY rates for COPD included higher cigarette excise taxes and broader respiratory infection vaccination coverage. The same factors were linked to lower age-standardized DALY rates for pneumoconiosis, and ILD and pulmonary sarcoidosis. No clear pattern or gradient was seen for asthma.
• By 2050, projections suggest the number of people with asthma will reach 45.72 million, and the number of people with COPD will reach 19.61 million. The projected number of people with ILD and pulmonary sarcoidosis will reach 1.05 million, and the projected number for those with pneumoconiosis will reach 0.01 million.
• From 2023 to 2050, the age-standardized prevalence rate of asthma is projected to rise by 9.8%. The rate of ILD and pulmonary sarcoidosis is projected to rise by 24.72%. The rate of COPD is projected to fall by 9.19%, and the rate of pneumoconiosis is projected to drop by 57.91%.

The authors believe state-level preventative measures could have an impact on these respiratory health outcomes. “Integrating tobacco control measures, equitable vaccination programs, and targeted health-system investments could help to address the uneven burden of chronic respiratory diseases across U.S. states and the growing mortality gap despite stable prevalence, although further research is needed to clarify which specific policy determinants underlie these associations,” they write. 

Highlighted in RC Buzz, October 26, 2026