Market evolution: Respiratory therapy apparatus (CN 901920) — 2015–2025

Introduction

This report examines the evolution of EU trade in respiratory therapy apparatus — classified under customs code 901920 and encompassing ozone therapy, oxygen therapy, aerosol therapy, artificial respiration and other therapeutic respiration apparatus, including parts and accessories — over the period 2015 to 2025. The decade was shaped by two major forces: the long-term structural reconfiguration of EU production and trade relationships, and the extraordinary demand shock triggered by the COVID-19 pandemic in 2020–2021. While EU trade in this product category grew substantially over the period — exports rose by 66.8% and imports by 58.7% in value terms — the trajectory was far from linear. A massive pandemic-era surge in both import and export volumes and values was followed by a partial normalisation, leaving behind a fundamentally altered market landscape characterised by declining domestic production, growing import dependence, and shifting geographic partnerships. The following sections unpack these dynamics in detail.

1. A Decade of Growth Disrupted by an Unprecedented Pandemic Spike

Overall trade expanded significantly despite volatile swings

Between 2015 and 2025, EU extra-EU trade in respiratory therapy apparatus grew markedly. Export values rose from €817.7 million to €1,363.7 million, representing a cumulative increase of 66.8%. Import values grew from €951.8 million to €1,510.8 million, an increase of 58.7%. In volume terms, export quantities grew by 51.3% (from 10,641 tonnes to 16,102 tonnes) while import quantities expanded by 60.6% (from 23,983 tonnes to 38,525 tonnes).

The COVID-19 pandemic produced a dramatic but temporary demand shock

The most striking feature of the decade was the explosive growth in 2020–2021, driven by the global demand for ventilators and respiratory support equipment during the COVID-19 crisis. Total EU imports peaked at approximately €2,981.0 million — more than triple the 2015 baseline — while exports surged to €2,111.9 million. The price dynamics during this period were equally remarkable: export unit prices spiked to a maximum of €137,797 per tonne, nearly double the 2015 level of €76,837/t, before subsiding to €84,670/t by 2025. Import prices also surged to a peak of €92,983/t before falling back to €39,212/t — essentially returning to their 2015 starting point. The trade balance swung dramatically during this period, ranging from a deficit of €869.1 million at its worst to a surplus of €204.3 million at its best, before settling back to a modest deficit of €147.1 million in 2025.

The post-pandemic normalisation brought volumes and prices back toward structural trends

By 2025, both trade flows had retreated substantially from their pandemic peaks. Import values were roughly half of their maximum, and export values had fallen by about 35% from their peak. However, both remained significantly above pre-pandemic levels — imports were 58.7% higher and exports 66.8% higher than in 2015. This suggests that while the acute crisis demand subsided, the pandemic left a lasting structural impact on the market, likely through expanded installed bases of respiratory equipment, increased awareness of respiratory health, and permanently altered supply chain relationships.

2. Geographic Reorientation: Shifting Partners and Diverging Destinations

China emerged as the dominant import source during the pandemic, then partially retreated

The most dramatic geographic shift occurred in EU imports from China. Chinese imports surged from €110.1 million in 2015 to a peak of €1,521.2 million — a staggering 14-fold increase driven by emergency procurement of ventilators and respiratory equipment in 2020. By 2025, Chinese imports had normalised to €269.0 million, still 144.2% above 2015 levels. This pattern — an enormous spike followed by a partial retreat — reflects the shift from emergency purchasing to more routine commercial relationships, but also likely reflects the growing capacity of Chinese manufacturers in this segment.

New import partnerships grew rapidly while traditional suppliers lost ground

Several emerging suppliers saw remarkable growth over the period. Singapore grew from €96.7 million to €299.8 million (+209.9%), Mexico from €37.6 million to €114.8 million (+205.5%), and Malaysia from €4.4 million to €20.5 million (+370.8%). These shifts point to a broader diversification of EU respiratory equipment supply chains toward Asia-Pacific and Latin American manufacturing hubs. By contrast, the United States — the second-largest import partner — saw its share decline by 17.3%, falling from €212.4 million to €175.6 million.

EU export destinations shifted toward advanced economies, while some traditional markets weakened

On the export side, the United States remained the largest destination, growing from €161.2 million to €348.3 million (+116.1%), followed by the United Kingdom at €257.6 million (+143.3%) and Switzerland at €109.9 million (+100.7%). Notably, exports to Russia declined by 26.1% (from €38.1 million to €28.1 million), and exports to China fell by 46.3% (from €66.2 million to €35.6 million) — the latter reflecting China's growing self-sufficiency in this product category. The export concentration index (HHI) rose by 47.8% from 802 to 1,186, indicating that EU exports became more concentrated on fewer destination markets over the decade.

Within the EU, France and Czechia emerged as major new exporters

The top EU exporting member states also experienced significant shifts. Germany remained the largest exporter (€416.8 million in 2025), but France's exports grew by an extraordinary 315.9% — from €50.2 million to €208.7 million — making it the fourth-largest EU exporter. Czechia's exports grew by 363.4% (from €11.9 million to €55.1 million), reflecting Central Europe's growing role in medical device manufacturing. Ireland, conversely, saw exports decline by 17.0%, from €130.4 million to €108.2 million. On the import side, the Netherlands dominated with €676.3 million in imports (+107.8%), reflecting its role as a major logistics and distribution hub.

3. Structural Erosion of EU Production and Growing Import Dependence

EU domestic production declined steadily over the period

Perhaps the most consequential long-term trend was the decline in EU production of respiratory therapy apparatus. Production volumes fell from 695.8 million items to 464.3 million items, a decline of 33.3%, while production values fell from €1,592.5 million to €1,334.3 million, a decline of 16.2%. The gap between the decline in volume (−33.3%) and the decline in value (−16.2%) indicates that EU manufacturers shifted toward higher-value products even as overall volumes contracted — consistent with a specialisation strategy focused on premium, technology-intensive respiratory equipment.

The EU flipped from a net exporter to a net importer of respiratory apparatus

The combination of declining production and growing imports fundamentally altered the EU's trade position. Net import reliance shifted from −14.7% in 2015 to +6.0% in 2025, peaking at +12.3% during the pandemic. In 2015, the EU was a net exporter in value-added terms; by 2025, it had become a net importer. Trade intensity remained extremely high throughout, hovering around 99–100%, indicating that this is a deeply integrated global market with very little autarky. Export propensity similarly remained near 100%, confirming the sector's outward orientation.

Product segment analysis reveals a widening price gap between EU exports and imports

The breakdown by sub-product from 2021 to 2025 reveals important structural differences. In imports, the broad category (90192090 — excluding mechanical ventilation) dominated at 33,237 tonnes and €1,195.8 million in 2025, while non-invasive ventilation (90192020) and invasive ventilation (90192010) volumes both declined significantly over this sub-period. In exports, by contrast, the EU shipped high-value invasive ventilation apparatus at supplementary unit prices averaging €791 per item in 2025, compared to just €14 per item for imports of the same category — a price differential of more than 50× that highlights the EU's position at the premium end of the value chain. This pattern is consistent with the broader structural story: the EU increasingly specialises in high-end, technologically sophisticated respiratory equipment (where Ireland, the Netherlands, and Sweden show the strongest revealed comparative advantages) while importing more commoditised, volume-driven products from lower-cost manufacturing centres.

Pandemic-era supply shocks exposed vulnerabilities concentrated in specific supplier relationships

The volatility analysis reveals that the largest supply shock occurred in 2020, when EU import prices from China surged by 675.2% with an abnormality score of 291.8, reflecting the emergency scramble for ventilators. Two further notable shocks were identified: an export price shock to Israel in 2020 (+356.0%) and an import price shock from Australia in 2023 (+563.3%). Australia and Malaysia showed the highest coefficient of variation in import flows (1.10 and 1.02 respectively), while EU exports to China exhibited the highest volatility (CV of 1.44). The import-side HHI declined modestly from 1,358 to 1,277 (−6.0%), suggesting a slight diversification of import sources — a likely response to the supply chain vulnerabilities exposed during the pandemic.

Conclusion

The EU market for respiratory therapy apparatus (CN 901920) underwent profound transformation between 2015 and 2025. While headline trade figures show robust growth — exports up 66.8% and imports up 58.7% — the underlying story is one of structural change accelerated by crisis. The COVID-19 pandemic generated an extraordinary but temporary demand surge that temporarily repositioned China as the EU's dominant respiratory equipment supplier and briefly pushed the EU into trade surplus, before normalisation restored a modest deficit. More consequential for the long term is the steady erosion of EU domestic production (−33.3% in volume) and the flip from net export status to net import dependence. The EU increasingly occupies a specialised niche in high-value, premium respiratory equipment — with unit export prices many multiples of import prices — while ceding volume production to lower-cost manufacturers in Asia and Latin America. The growing concentration of EU exports on fewer destination markets, combined with persistently high trade intensity, underscores the sector's vulnerability to geopolitical disruption. Policymakers seeking to ensure supply security in this critical medical equipment category will need to weigh the efficiency gains of global sourcing against the strategic risks exposed by the pandemic experience.