The burden of respiratory disease. 95/3

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Introduction

Respiratory disease has a major effect on mortality and morbidity at all ages. Acute upper respiratory infections are among the commonest illnesses experienced at all ages and lead to absence from school and work, visits to GPs, and heavy use of "over the counter" medicines. Similarly, acute lower respiratory infections such as acute bronchitis, bronchiolitis and pneumonia account for substantial morbidity at all ages. In children, asthma is the most common chronic disease, and in adults, chronic lower respiratory diseases such as chronic bronchitis, emphysema, and chronic obstructive airways disease (COAD) are important contributors to sickness absence (LAIA factsheet 92/4), premature retirement, disability and mortality. Other major respiratory diseases include tuberculosis (LAIA factsheet 92/3), lung cancer (LAIA factsheet 93/1) and cystic fibrosis (LAIA factsheet 95/2).

Mortality

Diseases of the respiratory system accounted for 10.8% of all deaths in 1992. This compared with 45.6% attributed to diseases of the circulatory system (30.4% heart disease and 15.3% cerebrovascular disease), and 26.1% from cancers. Lung cancer accounted for 6% of all deaths.

Figure 1: Mortality, hospital admissions and consultations with GP by disease group

The pattern of mortality from respiratory disease varies with age. In children, lower respiratory diseases such as bronchitis, bronchiolitis and pneumonia account for about 3% of deaths. Although asthma has a high mortality profile, it accounted for only 0.3% of all deaths at ages 0-14. Deaths from cystic fibrosis currently occur among children and young adults, although life expectancy is increasing (LAIA factsheet 95/2). Lung cancer is an important cause of death up to the age of 70, after which pneumonia and obstructive lung diseases (chronic bronchitis, emphysema and COAD) account for a greater proportion of all deaths.

Figure 2: Percentage of deaths attributable to respiratory disease

Hospital admissions

In 1991/2, 6.5% of all hospital admissions were for respiratory diseases. Pregnancy and perinatal conditions were the commonest reasons for admission (13.6%), followed by diseases of the digestive system, the circulatory system, cancers and injury & poisoning.

The pattern of admissions varies with age. In children, respiratory diseases account for 11% of admissions in the 0-4 age-group, split evenly between upper and lower respiratory tract diseases. In those aged 5-14, they account for 17%, the majority of which are for upper respiratory tract complaints such as tonsillitis. Asthma, one of the commonest single causes for admission among children, accounts for 3% and 4% respectively in each age-group. Upper respiratory tract infections continue to be important in young adults. However, from age 45 onwards, lung cancer and lower respiratory diseases such as pneumonia assume greater importance.

Figure 3: Percentage of hospital admissions attributable to respiratory disease

Consultations with General Practitioners

More people consult their GP for respiratory disease than for any other group of diseases. In 1991/2, 30% of the population consulted their GP for respiratory disease, accounting for one in six of all consultations.

The most common respiratory complaints presenting to GPs are acute upper respiratory tract infections (8.6% of all consultations), acute bronchitis & bronchiolitis (3.1%) and asthma (2.6%). The pattern of consultations varies with age (figure 4). Among children, 33% of all consultations are for respiratory diseases, with upper respiratory tract diseases accounting for two thirds of these. In adults, respiratory diseases account for 13-14% of all consultations. Diseases of the upper respiratory tract are still important among young adults, whereas among the elderly, lower respiratory tract diseases account for a greater proportion of consultations.

Figure 4: Percentage of consultations with a GP attributable to respiratory disease

General morbidity

In the 1988 General Household Survey, 7% reported diseases of the respiratory system as a cause of long-standing illness, disability or infirmity. This was the third most common complaint, behind the musculoskeletal system (12.4%) and the heart & circulatory system (7.5%). Respiratory diseases were the most commonly reported group in children, whereas in adults, other diseases were more important. Within respiratory diseases, asthma was the commonest complaint, followed by bronchitis and emphysema.

Sickness benefit statistics relating to 1982/3 show that respiratory problems were the largest single reported cause of spells of certified absence, accounting for 33% of all spells. However, they were less important in terms of working days lost, with diseases of the circulatory system, the musculoskeletal system and mental disorders accounting for larger proportions of lost working time (LAIA factsheet 92/4).

Prescriptions

In 1991, 10% of all prescriptions were for the respiratory system. They were the fourth most commonly prescribed drugs, after drugs for the nervous system (18%), the cardiovascular system (17%) and infections (12%). Half of the respiratory prescriptions were for bronchodilators, and a further 15% for inhaled corticosteroids (LAIA factsheet 93/2).

Summary

• Respiratory diseases have a major effect on morbidity and mortality at all ages.

• Lower respiratory diseases account for 3% of deaths in children. In the middle-aged and elderly, lung cancer, chronic bronchitis, emphysema, pneumonia and COAD are among the principal certified causes of death.

• Respiratory conditions account for 13% of pediatric admissions; asthma is one of the commonest single causes of admission among children. Lower respiratory infections such as pneumonia account for 6.8% of all admissions in the elderly.

• Three in ten people who visit their GP consult for respiratory disease. The most common complaints are acute respiratory infections and COAD.

• Diseases of the respiratory system are reported by 7% of the population as a cause of long-standing illness, disability or infirmity. They are the single largest cause of spells of certified sickness absence; drugs for the respiratory system account for 10% of all prescriptions.

Footnote

Classification of health statistics
Health statistics described here are classified using the Ninth Revision of the International Classification of Diseases (ICD). Most respiratory diseases are now grouped together in ICD Chapter VIII, ICD codes 460-519. Within this there are sub-categories covering upper respiratory tract diseases (ICD 460-65, 470-78) and lower respiratory tract diseases (ICD 466, 480-519). Other respiratory diseases classified elsewhere include respiratory tuberculosis (ICD 10-12), whooping cough (ICD 33), lung cancer (ICD 162), and cystic fibrosis (ICD 277.0).