The Underexplored Patterns of Respiratory Risks Associated With Climate Disasters

Tropical cyclones (TCs), also known as hurricanes, typhoons and storms depending on the region and intensities, are among the most destructive climate disasters and have caused dramatic societal and economic impacts 1. Recently, Typhoon Fung-wong made landfall in the Philippines on November 9, 2025, causing widespread structural damage that included over 4100 houses, 312 heavily damaged schools, and numerous impassable roads and bridges. At least 1.4 million people were displaced. This catastrophe occurred while the country was still recovering from the destruction caused just a week earlier by Typhoon Kalmaegi. Each year, TCs affect an average of 20.4 million people and have caused mean direct economic losses of 51.5 billion United States dollars (USD) over the past decade, ranking among the costliest climate disasters 2. Yet the ledger of economic loss fails to capture the full human cost. Compared to the well-characterized physical attributes and tracking patterns of TCs, the health impacts remain relatively understudied. Epidemiological studies of TC-related health impacts have generally focused on all-cause mortality and mental health outcomes, consistently demonstrating elevated mortality risks associated with TC exposure 3. Understanding of cause-specific mortality and morbidity impacts remains limited, with a particularly notable gap in evidence regarding the respiratory health impacts. Respiratory health may represent one of the most sensitive and complex pathways linking climate disasters to population vulnerability. The mechanisms through which TCs may affect respiratory health are multifaceted and closely interconnected (Figure 1). Directly, TCs can create conditions (e.g., damaged housing, generation or resuspension of dust and other particulates, and disruption to electricity supplies) that exacerbate respiratory diseases. A review on power outages and community health reported increased hospitalizations and mortality for respiratory conditions during prolonged outages, particularly among people relying on electricity-dependent medical equipment (e.g., oxygen concentrators, ventilators) 4. In addition, increased outage days were associated with higher rates of emergency visits and hospital admissions for chronic obstructive pulmonary diseases (COPD), highlighting the potential contribution of frequent TC-related electricity disruptions to acute respiratory exacerbations 5. High winds and storm surges during TCs may also stir up sediments and overwhelm sewage systems, aerosolizing pathogens and particulates and exacerbating chronic respiratory diseases 4. Indirectly, factors such as displacement to crowded shelters and increased transmission of infectious diseases; mould growth, microbial proliferation and aerosolization of irritants; and high particulate exposure from cleanup and reconstruction activities, together with enduring physical, financial, and psychological stress, can further exacerbate respiratory risks that often manifest over the long term 3. In our previous systematic review of epidemiological studies quantifying the health risks of TCs, we observed that evidence regarding respiratory impacts was fragmentary and highly inconsistent in terms of the study settings, exposure assessments, and modelling strategies 3. These relatively limited studies largely focused on single, high-amplitude TC events (e.g., Hurricanes Katrina or Sandy) in the United States. After the review and particularly since 2022, a new wave of large-scale, multi-event studies has emerged to provide more conclusive findings, beginning to bridge the gaps by covering broader geographies and TC attributes (i.e., including multiple TC events across decades with varying characteristics). A multi-country time-series analysis, which included 32 cities across four countries and territories in East Asia (1972–2010), found an overall increase in respiratory mortality following TCs 6. Risks peaked on the day of exposure and subsided after the second day, with the strongest associations observed among those aged ≥ 65 years and driven largely by pneumonia and COPD. Similarly, a time-series study utilizing data from 153 Chinese cities (2013–2018) focused on risks within the first week post-TC, observing short-term increases in mortality from COPD and lower respiratory infections 7. By contrast, two other multi-country time-series studies with broader spatial coverage reported a relatively longer persistence of risk, extending through and largely concentrated within the first 2 weeks following exposure 8, 9. However, a multi-TC study focusing on long-term mortality changes in the United States suggested no association between TCs and respiratory mortality, despite finding persistently elevated all-cause mortality risks over 15 years for each event 10. Overall, short-term increases in respiratory mortality have generally been well established by recent large-scale, multi-TC epidemiological studies. However, despite these advances, the precise timing and duration of adverse effects remain heterogeneous and uncertain, which should be highly dependent on the specific TC event, affected region, and population demographics. In addition, a significant morbidity gap remains. The vast majority of current literature relies on mortality data, which represents a relatively extreme health outcome and reflects only the tip of the iceberg regarding the respiratory burden following climate disasters. Furthermore, there is a critical scarcity of evidence from Low- and Middle-Income Countries (LMICs). Most time-series studies originate from developed nations or regions with established mortality registration systems. Epidemiological data and evidence remain sparse for LMICs, especially those small island developing states, where respiratory vulnerability is compounded by high exposure intensity, infrastructure fragility, and limited healthcare accessibility. Under a changing climate, TCs of higher intensity are expected, while the global TC frequency may decrease or stay roughly stable 11. Continued warming is projected to yield TCs with higher maximum wind speeds and particularly, substantially heavier rainfall 12. A recent population-based study suggests that TC-related rainfall may be a more important respiratory mortality indicator than wind speed 8. For example, while Typhoon Fung-wong had already passed, its trailing rains continued to pose lingering hazards in some areas (e.g., northern Luzon). The TC-related rainfall could extend the window of risk well beyond the TC's passage by intensifying the dampness and mould proliferation that drive respiratory distress. Furthermore, TCs are expected to become longer-lived and capable of migrating to regions that have historically seen few such events 13. Recent evidence suggests that regions with historically fewer TCs can experience substantially higher mortality risks once exposed 8. These considerations highlight that TCs remain an important public health concern and a key driver of climate-related hazards, especially in the context of expanding coastal populations and rapidly aging societies that are particularly vulnerable to respiratory impacts. In response, more granular epidemiological evidence is needed, and such evidence should be integrated into the design and refinement of disaster risk management and health system preparedness for climate disasters like TCs. W.H. was supported by China Scholarship Council funds (numbers 202006380055). S.L. by an Emerging Leader Fellowship (GNT2009866) of the Australian National Health and Medical Research Council; Y.G. by Leader Fellowship (GNT2008813) of the Australian National Health and Medical Research Council. Open access publishing facilitated by Monash University, as part of the Wiley - Monash University agreement via the Council of Australasian University Librarians. This work was supported by Australian National Health and Medical Research Council (NHMRC), (GNT2008813 and GNT2009866); China Scholarship Council, 202006380055; and Emerging Leader Fellowship, GNT2009866. The authors declare no conflicts of interest.