Global, regional, and national burden of chronic obstructive pulmonary disease and asthma from 1990 to present: risk attributions and projections to 2050.

Background Chronic obstructive pulmonary disease (COPD) and asthma constitute two major global public health challenges with substantial societal and health system impacts. However, large-scale, long-term comparative studies on their epidemiological patterns and risk factor contributions remain scarce. This study aimed to systematically evaluate the global, regional, and national burden and temporal trends of COPD and asthma from 1990 to 2021, with further projections to 2050. Methods Data from 21 regions and 204 countries and territories were obtained from the Global Burden of Disease and Risk Factors Study 2021, covering the period 1990-2021. We quantified prevalence, mortality, disability-adjusted life years (DALYs), and risk factor attribution for COPD and asthma. Burden trends were subsequently projected through 2050 using predictive modeling. Results From 1990 to 2021, the global epidemiological trajectories of COPD and asthma diverged markedly. While the absolute number of prevalent COPD cases more than doubled (from 100.54 to 213.38 million), its age-standardized prevalence rate remained stable, and both age-standardized mortality and DALY rates fell substantially (by 37.45% and 37.0%, respectively). In contrast, asthma exhibited declines across all metrics: incident cases decreased by 8.90%, and age-standardized prevalence, mortality, and DALY rates dropped by 40.01%, 46.06%, and 44.46%, respectively. The burden was inequitably distributed: COPD incidence and prevalence were highest in low-middle Socio-demographic Index (SDI) regions, whereas asthma prevalence peaked in high-SDI regions, with its highest mortality in low SDI settings. Smoking remained the leading global risk factor for COPD DALYs, but household air pollution dominated in low SDI regions. For asthma, high body mass index emerged as the primary risk factor. Sex disparities were clear: COPD burden was higher in males, while asthma predominantly affected females in adulthood. Projections to 2050 indicate a continued rise in absolute COPD case numbers alongside declining age-standardized rates, whereas asthma burdens are forecast to decline in both absolute and rate terms. Conclusions Despite significant improvements in age-standardized rates of mortality and disability, the absolute burden of COPD has grown tremendously, driven by demographic forces. Asthma shows more favorable trends. The stark disparities in burden and risk factors underscore the need for dual strategies: global efforts to control risk factors (tobacco, air pollution, obesity) must be coupled with targeted measures to strengthen healthcare access in under-resourced settings and advance precision medicine for complex disease phenotypes.