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The big 5 respiratory diseases give insight into respiratory health and beyond

In the latest report on global causes of death by the World Health Organization in 2019, COPD ranked the third highest, while lower respiratory diseases ranked fourth and lung cancer ranked sixth, following ischemic heart disease and stroke as the top and the second, respectively (https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death). The situation is different when we look at low-income countries where lower respiratory infections ranked the second in mortality while tuberculosis comes in as the eighth highest cause of mortality. Non-communicable diseases like COPD and lung cancer contribute more to the mortality in high-income countries, reflecting the impact of lifestyle factors, such as smoking, playing significant roles in mortality in high-income countries. Although asthma is not a significant cause of mortality, it is still the most common respiratory disease, affecting up to 18% of people, including both children and adults, in different countries. It is not good enough to know how common are these big 5 respiratory diseases. It is important for health care professionals to know how to manage them and to understand what could be driving them to become ‘big’. The differences in mortality between low- and high-income countries are important reflections of the impact of poverty on communicable diseases, accounting for the high incidences and mortality rates of respiratory infections and tuberculosis in low-income countries. Climate change from global warming is believed to make an increasing impact on food supply and hence population immunity, and eventually prevention of communicable diseases. There are other important ‘over-arching’ risk factors contributing to the prevalence of respiratory diseases, namely tobacco smoking and air pollution. Tobacco smoking is a firmly established cause for most cases of COPD and lung cancer. Health care workers are faced with increasing difficulties in persuading people, especially the younger generation, not to smoke or not to pick up the habit of smoking, with the ever-increasing varieties of newer products from the tobacco industry, namely vaping with electronic cigarettes and an increasing variety of newer types of tobacco products. The impact of air pollution, both indoor and outdoor, on respiratory diseases is often considered inevitable at regional or population levels. There is accumulating evidence to support the association of ambient air pollution with increasing exacerbations of asthma and COPD. Some components of air pollutants, such as particulate matters (PM2.5), are believed to contribute to lung carcinogenesis. As a respiratory physician and the President of APSR and FIRS, I would urge respirologists and health care professionals be prepared for opportunities to counteract the health care burden of these big 5 respiratory diseases and the risk factors behind them, namely air pollution, tobacco smoking, poverty and climate change, through more collaborative research, education and advocacy. None declared.

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