International Respiratory Coalition: article

Authored by: Professor Marc Humbert – ERS President, Professor Guy Joos – Pulmonologist, Ghent University and Ghent University Hospital. November 2021.

The International Respiratory Coalition is coordinated by the European Respiratory Society, in partnership with founding member organisations: the Global Allergy & Airways Patient Platform, AstraZeneca and Amgen. Now established, the International Respiratory Coalition will seek to grow its membership – welcoming other organisations with an interest in respiratory health to join and help progress this initiative. Each partner will provide funding or contributions of time and expertise to deliver the aims of the Coalition at a global or national level.

Improving chronic respiratory care is central to building more resilient healthcare systems

The emergence of COVID-19 has put respiratory diseases in the spotlight like never before, exacerbating existing gaps in the delivery of care with significant consequences for patients and health systems.1

Prior to the pandemic, progress to improve chronic respiratory diseases care was slow, and in some countries had stagnated over the past decade.2 To support people living with chronic respiratory diseases, and to better ready ourselves in case of future pandemics, improving respiratory care must be central to government and healthcare system post-pandemic recovery plans. High-level political prioritisation and intervention will be key to achieving this.

The International Respiratory Coalition aims to support governments and healthcare systems in their recovery from COVID-19 by strengthening respiratory care. The Coalition will seek to improve outcomes for people living with respiratory diseases including asthma, chronic obstructive pulmonary disease (COPD), cystic fibrosis, bronchiectasis, idiopathic pulmonary fibrosis and pulmonary arterial hypertension, by supporting the creation of ambitious national-level respiratory strategies and by building resilience in managing pandemics.

Ahead of World COPD Day on 17 November, the Coalition will join a Summit session organised at the Swedish Pavilion by AstraZeneca at Expo 2020 Dubai, to raise awareness amongst policymakers and political decision makers from around the world of the need to reform chronic respiratory care as a post-pandemic priority.

Urgent Unmet Needs: The Burden of Chronic Respiratory Diseases

Chronic respiratory diseases, which impair quality of life and increase a patient’s likelihood of developing other serious conditions, affect nearly 550 million people globally3 and lead to four million premature deaths each year. 4

Among all chronic respiratory conditions, the largest burden is from COPD affecting 384 million people worldwide and asthma affecting over 339 million people worldwide.5-7 COPD has risen to become the third leading cause of death worldwide8 and according to The Global Alliance Against Chronic Respiratory Diseases is under prioritised, under-funded and undertreated.9 One in 5 patients die within a year of their first COPD hospitalisation10 and the global cost of COPD is estimated to rise to $4.8 trillion in 2030.11 For the hundreds of millions of patients living with asthma, significant unmet needs remain with an estimated 176 million asthma attacks that occur each year globally.12 Despite this, respiratory conditions do not receive the same global recognition and prioritisation a s other well-known chronic conditions.13

Recently, the burden of chronic respiratory diseases has increased as a result of health inequalities, environmental factors, and growing and aging populations, which threaten health-system resilience in the face of external challenges like the COVID-19 pandemic.14

Millions of people living with airway diseases have faced disruption in their treatment and routine due to strained hospital capacity, inability to attend health appointments during lockdowns.1 For example, during the pandemic, patients with chronic respiratory diseases that contracted COVID-19 were shown to be at greater risk of hospitalisation.14 Furthermore, many health systems were unable to pivot quickly to new remote models of care and effectively use telemedicine to contact and diagnose patients remotely,15 all the while high-risk chronic respiratory patients were having to isolate more urgently than the average citizen.14

Building Stronger Healthcare Systems through Improved Respiratory Health

As organisations and individuals with a common interest in improving outcomes for respiratory patients, we want to ensure current challenges are addressed now and remain a priority going forward.

The Coalition believes new or updated National Respiratory Strategies, which carry ambitious targets and accountable leadership will be key to this reform. By focusing on increasing prevention and supporting earlier diagnosis, to improving pathways, prioritising disease control and ensuring continuity of care there is an immense opportunity to transform respiratory health.

Change won’t happen on its own. The respiratory community must come together and speak as a single, consistent voice to motivate policymakers and Health Ministers to promote respiratory healthcare reform. The conversations at World Expo 2020 will be critical in advancing our mission for respiratory care reform but it will be important to maintain these at the local and regional level. Not only will it benefit our long-affected, current chronic respiratory disease patients, it will prepare us, our colleagues and wider society to better handle potential future challenges which may arise, like the COVID-19 pandemic.

The International Respiratory Coalition is open to all who share its vision of advancing respiratory care. We’re excited to see what the future holds for us, and most importantly, for our patients.



  1. Huang BZ, et al. Asthma Disease Status, COPD, and COVID-19 Severity in a Large Multiethnic Population. J Allergy Clin Immunol Pract. 2021.
  2. Commissions from the Lancet journals. After asthma: redefining airways diseases. After asthma: redefining airways diseases ( 12 September 2017. Available at:
  3. GBD Chronic Respiratory Disease Collaborators. Prevalence and attributable health burden of chronic respiratory diseases, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Respir Med, 2020 Jun;8(6):585-596.
  4. Forum of International Respiratory Societies. The Global Impact of Respiratory Disease – Second Edition. Sheffield, European Respiratory Society, 2017. Available online via
  5. Carvalho, T., Krammer, F., & Iwasaki, A. The first 12 months of COVID-19: a timeline of immunological insights. Nature Reviews Immunology. 2021:245–25
  6. 6.Adeloye D, et al. Global Health Epidemiology Reference Group (GHERG). Global and regional estimates of COPD prevalence: Systematic review and meta-analysis. J Glob Health. 2015; 5 (2): 020415.
  7. The Global Asthma Network. The Global Asthma Report 2018. [Online]. Available at: [Last accessed: 2 July 2021].
  8. Adeloye D, Chua S, Lee C et al. Global and regional estimates of COPD prevalence: Systematic review and meta–analysis. J of Glob Heath. 2015; 5(2):020415.
  9. Yorgancioglu A, Khaltaev N, Bousquet J, Varghese C. The Global Alliance Against Chronic Respiratory Diseases: journey so far and way ahead. Chin Med J 2020;133:1513–1515. doi: 10.1097/CM9.0000000000000851
  10. Ho TW, Tsai YJ, Ruan SY, et al. In-Hospital and One-Year Mortality and Their Predictors in Patients Hospitalized for First-Ever Chronic Obstructive Pulmonary Disease Exacerbations: A Nationwide Population-Based Study. PLOS ONE. 2014; 9 (12): e114866.
  11. Bloom, D.E., Cafiero, E.T., Jané-Llopis, E., Abrahams-Gessel, S., Bloom, L.R., Fathima, S., Feigl, A.B., Gaziano, T., Mowafi, M., Pandya, A., Prettner, K., Rosenberg, L., Seligman, B., Stein, A.Z., & Weinstein, C. (2011). The Global Economic Burden of Noncommunicable Diseases. Geneva: World Economic Forum.
  12. AstraZeneca Pharmaceuticals. Data on File. Budesonide/formoterol Data on File: Annual Rate of Asthma Exacerbations Globally. (ID: SD-3010-ALL-0017).
  13. Forum of International Respiratory Societies. The Global Impact of Respiratory Disease – Second Edition. Sheffi eld, European Respiratory Society, 2017.
  14. AstraZeneca. A Blueprint for Change. Available at: Accessed August 2021.
  15. Press V G, et al. Concerns About Coronavirus Disease–Related Collateral Damage for Patients With COPD. Chest. 2020; 158 (3): 866-868.