Global, regional, and national impacts of smoking on asthma burden among middle-aged and older adults: changing landscape from 1990 to 2021

Background Smoking exposure is a leading cause of asthma. This study used the Global Burden of Disease (GBD) database (1990–2021) to analyze the global, regional, and national burden of asthma induced by smoking exposure in middle-aged and older adults. Methods Data on deaths, Disability-Adjusted Life Years (DALYs), Age-Standardized Death Rate (ASDR), and Age-Standardized Mortality Rate (ASMR) from the Global Burden of Disease (GBD) database (1990–2021) were extracted. Multiple figures were created to illustrate the burden of smoking-related asthma. The Bayesian Age-Period-Cohort (BAPC) model and Estimated Annual Percentage Change (EAPC) were used to predict future trends. Results In 2021, smoking-related asthma caused 29,139 deaths (95% UI: 3,307–59,819) and 839,802 DALYs (95% UI: 94,016–1,635,936). The ASR peaked in the 70–74 age group. And men have higher ASR values than women in most regions. India had the highest number of deaths (13,121; 95% UI: 1,194–30,815) and DALYs (310,802; 95% UI: 29,822–690,977), while Nepal recorded the highest ASDR (13.58; 95% UI: 1.35–30.73). A negative correlation between Socio-Demographic Index (SDI) and EAPC was observed for deaths (ρ = -0.6, p < 2.2e-16) and DALYs (ρ = -0.46, p < 3.7e-12). Projections suggest that by 2040, ASMR and ASDR will decrease to 0.48 (95% UI: 0.43–0.52) and 19.58 (95% UI: 19.05–22.11), respectively. Conclusions Smoking exposure significantly impacts asthma, with varying effects by age, sex, and region. The burden of smoking-related asthma in middle-aged and elderly adults is expected to decline, underscoring the importance of promoting a smoke-free society.