Hawaiʻi Health Data Warehouse

Asthma / Respiratory

Asthma is a chronic condition of the lungs in which the air passages become inflamed. During an asthma attack, narrowing of the airways causes breathing difficulty. Symptoms include coughing, wheezing or chest tightness. Asthma cannot be cured but it can be managed.

Chronic Obstructive Pulmonary Disease (COPD) refers to a group of lung diseases that cause airflow blockages and breathing problems. Symptoms include frequent coughing or wheezing, excess phlegm, mucus or sputum production, and shortness of breath. COPD increases one’s risk of developing respiratory infections. There is no cure for COPD, but it can be treated.

Why It’s Important


The CDC National Asthma Control Program reports that 1 in 13 Americans (over 25 million people) have asthma. Nationally, there were 1.8 million emergency department visits and 169,300 hospitalizations for asthma in 2019 and over 4,100 deaths in 2020.1 A 2018 CDC study estimates that asthma costs the US economy more than $80 billion annually in medical expenses, days missed from work and school, and deaths.


Chronic lower respiratory disease, primarily COPD, was the fourth leading cause of death and disability in the US in 2018. Almost 15.7 million Americans (6.45%) reported being diagnosed with COPD, and millions more have it but don’t know it.2 Treatment can include medicine, surgery, and oxygen therapy. The projected annual cost of COPD patient-related care was $49 billion in 2020.2

What Is Known


In 2020, 8.6% of Hawaiʻi adults reported currently being diagnosed with asthma. Nationally, 9.6% of adults reported current asthma (BRFSS).

  • In Hawaiʻi, women were twice as likely as men to report current asthma (11.7% vs 5.9%).
  • 8.9% of adults with current asthma reported also being diagnosed with diabetes.
  • Native Hawaiians were the most likely to report current asthma (14.3%) and Other Asian were the least likely at 4.9%.


In 2020, 3.7% of all Hawaiʻi adults and 5.9% of adults 45+ had ever been diagnosed with COPD, emphysema or chronic bronchitis (BRFSS). COPD was more prevalent among:

  • Adults 75+ years (10.4%)
  • Current cigarette smokers (7.4%)
  • Native Hawaiians (5.3%)

Most COPD cases are preventable since 8 in 10 COPD deaths are caused by smoking.2

Who Is at Risk


There are many factors that influence the risk of developing asthma. Some risk factors include:

  • Sex: Males are more likely to have asthma as children; however, females are more likely to have asthma as adults.
  • Age: Young adults ages 18-24 are more likely to have asthma when compared with older adults.
  • Race and ethnicity: Native Hawaiians are twice as likely to have asthma as Caucasians. Native Alaskans/American Indians and Others are also at increased risk.
  • Education: Adults who did not graduate high school have a higher risk than adults who did graduate high school or college.
  • Income: People with incomes below $50,000 per year are more likely to have asthma than those who have greater incomes.
  • Behavior: Smoking increases the risk of asthma as does obesity.


Risk factors for COPD include the following:

  • Smoking: Tobacco smoke is the greatest risk factor in developing COPD. Secondhand smoke can also increase the risk of COPD.
  • Asthma: People with asthma, or who have had asthma, may have an increased risk of developing COPD.
  • Genetics: Some people may have a rare genetic mutation called alpha-1-antitrypsin deficiency, which may cause COPD.
  • Workplace exposure: People who work in certain settings may be exposed more frequently to chemicals, dust, or other irritants that can harm the lungs.

How To Reduce Risk

The risk of severe complications of asthma can be reduced by properly taking prescribed medication and knowing possible triggers. Healthcare providers can advise on proper management after an asthma diagnosis. Effective management includes reducing exposure to triggers, using medicine as prescribed, and patient education in asthma care. People who work in school-based health centers may be able to help children manage their asthma. This includes helping reduce exposures to environmental asthma triggers, education, case management, improving indoor air quality, improving students’ home environments, and improving outdoor air quality around the school and community.

COPD is largely preventable by doing the following:

  • The best way to prevent COPD is to quit smoking. Even if you have already been diagnosed with COPD, quitting smoking can improve symptoms and possibly avoid worse complications.
  • Avoid secondhand smoke.
  • Avoid other air pollutants and irritants. Use personal protective gear at work to limit your exposure to lung irritants and chemicals.
  • Prevent and treat lung infections. Certain vaccines, like the flu vaccine and pneumonia immunizations, are important in preventing chronic lung infections. Current respiratory infections should be treated with antibiotics if possible.

If COPD can be caught and diagnosed early, treatment can begin earlier before progression worsens.

Page last updated July 29, 2022

Indicator Reports


A health indicator is a measure designed to summarize information about a given topic in population health or health systems performance.  Indicator reports provide numeric data for a health indicator as well as public health context (such as why it is important and what is being done to improve it).


1 Centers for Disease Control and Prevention. Most recent national asthma data. Asthma. https://www.cdc.gov/asthma/most_recent_national_asthma_data.htm Published May 25, 2022. Accessed July 29, 2022.
2 Centers for Disease Control and Prevention. Basics About COPD. https://www.cdc.gov/copd/basics-about.html Updated June 9, 2021. Accessed July 21, 2022.