Global tobacco experts issue stark warning that the world is on brink of turning into an 'ashtray planet' that will significantly escalate chronic respiratory diseases

• Twenty leading tobacco-control experts contributed to first-of-its-kind report visualising possible 2040 futures around nicotine consumption impact on diseases like asthma and COPD
• Report warns world could steer towards doomsday 'ashtray planet' scenario shrouded in second-hand smoke smog, with healthcare systems stretched to limits
• It calls for immediate action from health decision makers to persevere with generational bans, restrict nicotine to prescription only, and ban vape flavours or attractive packaging

COPENHAGEN, Denmark, May 30, 2025 /PRNewswire/ -- The Copenhagen Institute for Futures Studies (CIFS), an independent non-profit think tank, gathered twenty tobacco-control specialists from Africa, Europe, the Middle East, North America, South America, and Southeast Asia, to explore four plausible futures to 2040 around nicotine use and the impact this will have on chronic respiratory diseases.

Findings from the experts have been published in a first-of-its-kind report to analyse how tobacco and nicotine use could intersect chronic respiratory diseases like chronic obstructive pulmonary disease (COPD) and asthma. The report highlights four possible scenarios for 2040 depending on actions government, health decision makers and individuals take now around nicotine use.

The experts were gathered to explore potential future scenarios and to highlight a course toward one 'endgame generation' scenario we must strive to significantly reduce nicotine use and improve chronic respiratory disease outcomes. At the same time, they also identified tipping points, which closely reflect the current geopolitical climate that risk steering the world to the worst-case scenario the experts deemed 'ashtray planet' by 2040.

In the 'ashtray planet' scenario, tobacco and nicotine use has become deeply entrenched across much of the world. Second-hand smoke and aerosol are common in public spaces with people smoking on public transport, outside hospitals, or even in parks where children play. People begin wearing masks again, not for viruses, but to cope with outdoor smoke and smog.

COPD and asthma become significantly more prevalent stretching health systems to the limit, not to mention the mental health burden on both patients and their caregivers. Health care professionals do little more than renew basic prescriptions, driving a revolving door of readmissions. A surge in undiagnosed asthma leads to attacks with often fatal consequences that could have been prevented among children, disproportionately affecting those in low and middle-income countries.

Aron Szpisjak, Head of Health and Futurist at CIFS said: "Chronic respiratory diseases like asthma and COPD affect 550 million adults yet they are almost invisible in global health discussions. Tobacco is the leading preventable risk factor for these conditions, contributing to 8.3 million deaths every year."

"With the risk of governments catering to corporate interests and economic survival dominating national agendas, what we saw as the doomsday scenario now feels dangerously close to being realised. We still have time to shape the future and steer us on the right course to an endgame where nicotine consumption is reduced significantly, and chronic respiratory diseases begin to decline. We already have the solutions to get us there and avert the ashtray planet scenario. But that can only happen if decision makers across the world commit to sustained, coordinated action."

The report describes early warning signals, policy shifts and trends which could indicate the 'ashtray planet' scenario is beginning to unfold and underscores the urgency for action. For example, when more immediate crises such as economic instability, authoritarian politics, worsening environmental disasters, and mounting inequality lead governments to prioritise economic survival over public health resulting in rollbacks of tobacco-control regulations. Another example is the rise of newer nicotine products such as e-cigarettes, which rapidly gain popularity through social media and celebrity influence, particularly among young people.

Chronic respiratory diseases impose a significant burden, particularly in low- and middle-income countries, where 90% of premature deaths occur due to underdiagnosis and limited access to care.

In the scenario most closely resembling a status quo where developed countries do enact strong tobacco-control policies and uptake of new nicotine products is limited, the report highlights that positive outcomes may remain uneven. This is particularly the case in underserved regions where public trust in government and health institutions is low and there are varying abilities to adapt policies to local realities.

Bogi Eliasen, CIFS Fellow and Futurist , said: "High smoking rates jeopardise our progress towards the Sustainable Development Goal of aiming to reduce premature mortality from non-communicable diseases. While smoking rates are dropping, progress is slow and insufficient. Delaying action further risks slowing progress, making tobacco use harder to reverse, and missing a critical opportunity to protect millions of people."

"We have seen positive signs with the recent approval of the Integrated Lung Health resolution at the World Health Assembly, but there is still work to be done to ensure chronic respiratory diseases maintain priority status. As world leaders gather at the United Nations General Assembly in September this year to adopt a new declaration on non-communicable diseases later this year, they must take strong action on tobacco control and ensure people living with chronic respiratory diseases are meaningfully included in the commitments."

The report includes strategic actions for policy makers, public health bodies, and patient and advocacy groups. Immediate priorities include strengthening tobacco control by persevering with action such as generational bans, restricting new nicotine products to prescription only access, and limiting appeal by banning flavours and attractive packaging.

The full report is available online: https://www.cifs.dk/read-listen/reports-knowledge/the-future-of-chronic-respiratory-diseases-and-nicotine-consumption

Notes to Editors

About the report

The Future of Chronic Respiratory Diseases (CRDs) and Nicotine Consumption: Beyond Smoke and Mirrors report was developed in a two-phase approach. The first phase combined desk research and expert interviews to generate the evidence base, complemented with an AI model built by the CIFS team which included 4,000 peer-reviewed articles and policy documents. To ensure the integrity of the evidence base, studies linked to the tobacco industry were excluded.

The second phase comprised two co-creation workshops that convened more than 20 tobacco-control specialists from Africa, Europe, the Middle East, North America, South America, and Southeast Asia. Participants were selected both for the relevance of their expertise and to ensure a diversity of viewpoints. In the first workshop, the experts identified critical uncertainties to structure the four future scenarios. In workshop two, participants revisited the four draft scenarios to explore early warning signs and tipping points suggesting that a particular trajectory is beginning to unfold, and the strategic trade-offs stakeholders may face.

This report was commissioned by Sanofi and Regeneron. CIFS independently conducted the research, expert interviews, workshop facilitation, and the development of all scenarios and recommendations. While Sanofi and Regeneron provided financial support, CIFS maintained full editorial independence.

Neither the Copenhagen Institute for Futures Studies nor Sanofi and Regeneron have any affiliation with the tobacco or nicotine industry.

About the Copenhagen Institute for Futures Studies (CIFS)

The Copenhagen Institute for Futures Studies is an independent, non-profit think tank established in 1969, on the initiative by former Danish Minister and OECD Secretary-General Professor Thorkil Kristensen.

Our purpose is to help people and organisations imagine, work with, and shape their future. We do this by applying our unique approach to futures studies and foresight, combined with more than 50 years of global experience and contributions to the field, working with organisations across the public, private, academic, and civic sectors, as well as with the general public. Being independent of commercial and political interests enables an objective approach and allows for all profits to go exclusively to fund further research and non-profit initiatives.

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