Lung diseases cost EU nations €400bn/yr
9 September 2013
A report from the European Respiratory Society (ERS) shows that
lung conditions cause 1 in 10 deaths across Europe and cost an
estimated €390bn for the 28 EU countries.
The European Lung White Book  provides burden, cost
and risk factor information for a range of respiratory diseases, to
provide a resource aimed at healthcare professionals, politicians,
and the public.
The White Book estimates that direct and indirect costs due to
lung conditions total at least a staggering €390 billion per year;
even this sum is an underestimate due to there being limited or no
data available on costs for some lung conditions.
The proportion of deaths due to respiratory disease is higher
among the 28 countries of the European Union (EU28) — representing 1
in 8 of all deaths (12.5% of total deaths, 661 000 deaths annually)
— than among the remainder of the WHO-defined European Region
countries (that include the countries of central Europe closer to
Asia), where it is 7.5% (292 000 deaths annually).
Each year in the EU28 countries, lung diseases cause:
- two-thirds of a million deaths, and
- at least 6 million hospital admissions, accounting for over
43m inpatient bed-days.
Four respiratory disease categories appear in the global top 10
causes of mortality, together accounting for one in six deaths as
well as one in 10 disability-adjusted life-years lost. These are
lung cancer, COPD, lower respiratory tract infections (including
pneumonia), and tuberculosis. Smoking and respiratory infections are
major causes of the burden of lung disease in Europe, and are
Among the wealthy countries of Western/Northern/Southern Europe,
Belgium and Denmark have the highest mortality from respiratory
diseases, at 117 deaths per 100,000 population followed by Ireland
(114) and the UK (112). However, the proportion of total deaths
attributed to a lung condition is highest in the UK and Ireland.
The White Book shows that while tobacco smoking rates in these
high-death rate countries such as Denmark and the UK have fallen
substantially since the 1970s, the long-term effects of those high
smoking rates from years gone by continue to manifest in cases of
lung cancer and COPD today.
By contrast Finland, with its highly active programme targeting
respiratory illness, has the lowest death rate from respiratory
conditions (54 per 100,000). Other countries with low mortality
include Sweden (56) and Cyprus (57). The attached spreadsheet shows
combined mortality rates for all lung conditions across countries in
Europe. Around half of respiratory disease deaths across all
European countries are due to lung cancer or COPD, with others
caused by a variety of conditions including pneumonia, lung
fibrosis, tuberculosis and influenza.
In European countries where detailed data are available, 7% of
hospital admissions result from respiratory causes. The pattern of
hospital admissions does not, however, exactly match the pattern of
mortality. Thus, while some high-mortality countries (such as
Belgium, Hungary, Ireland and Romania) also have relatively high
respiratory admission rates, there are countries with high mortality
but below-average admission rates (such as the UK), and others with
low or average mortality rates but high admission rates (for
example, Austria and Lithuania).
This variation could reflect a variety of issues including
reporting differences, and differences in quality of community care
preventing some hospital admissions (there are many cases of COPD,
for example, that are almost exclusively cared for in the community
and never reach hospital).
A chapter of the White Book dedicated to the economic burden of
respiratory diseases explains that the total average health and
societal cost per case of lung cancer is €364,213 while for
tuberculosis it is €86,217 (averaged across all forms of the disease
including multi-drug resistant and extensively drug resistant
forms). On the other hand, the costs of COPD, at €6,147 per case per
year, and asthma, at €7,443 per year, accrue over many years, and
represent an even greater socioeconomic burden because they are so
common. The data also shows that at least half the total
socioeconomic costs of respiratory disease can be attributed to
The White Book concludes that the burden of lung disease in
Europe remains as large today as it was at the turn of the
millennium, and is likely to remain so for at least the next 20
years. In the next two decades, the proportion of deaths caused by
respiratory disease in Europe is likely to remain stable, with
variations in different diseases balancing out the overall effect on
mortality. A decrease in deaths from lung infections will be
accompanied by a rise in lung cancer and COPD mortality.
Prof. Francesco Blasi, ERS President, says: “By 2030, the WHO
estimates that the four major potentially fatal respiratory diseases
(pneumonia, tuberculosis, lung cancer and COPD) will account for
about one in five deaths worldwide, compared to one-sixth of all
deaths globally in 2008. Within the WHO European Region, the
proportion is expected to remain stable at about one-tenth of all
deaths, with an increase in COPD and lung cancer deaths balancing a
decline in deaths from lower respiratory infections and
However, trends in conditions such as asthma are more difficult
to predict. Prof. Blasi says: “Although asthma causes few deaths, it
is an important cause of disability. There are no well-informed
projections of the future burden of asthma, but in many European
countries the prevalence of childhood wheezing increased between the
late 1990s and the early 2000s, and asthma is likely to remain a
major burden on European societies for decades to come.”
The increase has been attributed to ill-understood factors in the
“western” lifestyle and improving socioeconomic conditions in many
eastern European countries may be accompanied by an increase in the
prevalence of asthma.
He concludes: “Both the prevention and treatment of lung diseases
will need to be improved if their impact on longevity, quality of
life of individuals and economic burden on society, are to be
reduced in Europe and worldwide.”
Preventive measures are available for many respiratory conditions
but they need to be employed more effectively and more widely. The
most obvious preventable cause is smoking.
To combat its effects the World Health Organization in 2005
launched the wide ranging Framework Convention for Tobacco Control
(FCTC). Although most European countries and the EU have ratified
the convention, a minority still have to do so and in several others
implementation by government has been inadequate due to commercial,
fiscal and other pressures.
Another important contributor to respiratory disease and
disability is poor air quality and in many countries the standards
for both outdoor and indoor air fall short of those recommended by
Finally, more attention should be given to preventing and
controlling respiratory infections: by more effective immunisation
programmes for those conditions in which effective vaccines are
available, by more careful use of antibiotics and by Europe-wide
monitoring of the resistance patterns to antibiotics used in
treatment of tuberculosis, pneumonia and other respiratory
The White Book also underlines a critical lack of national
capacity to collect, interpret and use comparable data accurately
and transparently across different sectors and between countries.
“Since formulation of optimal policy demands accurate and up to date
information, it is of paramount importance that all European
governments improve and standardise surveillance and data collection
relating to respiratory diseases as a top priority and a matter of
urgency,” concludes Prof. Blasi.
1. Gibson GJ, et al. European Lung White Book.
Respiratory Health and Disease in Europe. European Respiratory
Society, September 2013.
The White Book is available at: