Objective:

To assess U.S. prevalence and mortality trends for five chronic respiratory conditions from 1990 to 2023 and project their trajectories through 2050.

Approach:

• Data: The international investigator group used data from the Global Burden of Diseases, Injuries and Risk Factors Study 2023.
• Conditions: Analyses covered asthma, COPD, pneumoconiosis, interstitial lung disease (ILD), and pulmonary sarcoidosis.
• Measures: The study assessed prevalence, mortality, disability-adjusted life-years (DALYs), risk factors, state-level patterns, and future projections.

Key Findings:

• The estimated number of people living with chronic respiratory disease rose from 33.28 million in 1990 to 54.5 million in 2023. Over the same period, the age-standardized prevalence rate increased 10.24%, and the age-standardized mortality rate rose from 19 to 34.56 per 100,000 population.
• From 1990 to 2023, age-standardized mortality rates fell 50.94% for asthma and 75.19% for pneumoconiosis, while rates increased 8.9% for COPD and 87.47% for ILD and pulmonary sarcoidosis.
• In 2023, Kentucky, West Virginia, and Mississippi had the highest age-standardized COPD mortality rates; the District of Columbia had the lowest. Pneumoconiosis showed the same state pattern. Mississippi had the highest asthma mortality rate, while Rhode Island, Massachusetts, and Connecticut had the lowest. Maine had the highest mortality rate for ILD and pulmonary sarcoidosis, while New York had the lowest.
• Modifiable risk factors accounted for 44.54% of chronic respiratory disease DALYs. High BMI was the leading contributor to asthma burden, smoking to COPD burden, and occupational asthmagen exposure to pneumoconiosis burden.
• Higher cigarette excise taxes and broader respiratory infection vaccination coverage were associated with lower age-standardized DALY rates for COPD, pneumoconiosis, ILD, and pulmonary sarcoidosis. No distinct pattern or gradient was observed for asthma.
• By 2050, projected affected populations were 45.72 million for asthma, 19.61 million for COPD, 1.05 million for ILD and pulmonary sarcoidosis combined, and 0.01 million for pneumoconiosis.
• Between 2023 and 2050, age-standardized prevalence rates were projected to rise 9.8% for asthma and 24.72% for ILD and pulmonary sarcoidosis, and to fall 9.19% for COPD and 57.91% for pneumoconiosis.

Interpretation:

The authors suggest that state-level preventive measures may influence respiratory health outcomes. They state that tobacco-control policies, equitable vaccination initiatives, and targeted health-system investments could help address differences in disease burden and mortality among states. They note that further research is needed to identify the specific policy determinants underlying the observed associations.

Limitations:

• The authors state that additional research is needed to determine which policy determinants account for the observed associations.

Conclusion:

The study reports rising overall chronic respiratory disease prevalence and age-standardized mortality in the United States, with differing historical trends and projected trajectories across conditions.

Sources:

• Source article context; RC Buzz feature dated October 26, 2026