OBJECTIVE: To compare age standardised death rates for respiratory disease mortality between the United Kingdom and other countries with similar health system performance. DESIGN: Observational study. SETTING: World Health Organization Mortality Database, 1985-2015. PARTICIPANTS: Residents of the UK, Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, the Netherlands, Portugal, Spain, Sweden, Australia, Canada, the United States, and Norway (also known as EU15+ countries). MAIN OUTCOME MEASURES: Mortality from all respiratory disease and infectious, neoplastic, interstitial, obstructive, and other respiratory disease. Differences between countries were tested over time by mixed effect regression models, and trends in subcategories of respiratory related diseases assessed by a locally weighted scatter plot smoother. RESULTS: Between 1985 and 2015, overall mortality from respiratory disease in the UK and EU15+ countries decreased for men and remained static for women. In the UK, the age standardised death rate (deaths per 100 000 people) for respiratory disease mortality in the UK fell from 151 to 89 for men and changed from 67 to 68 for women. In EU15+ countries, the corresponding changes were from 108 to 69 for men and from 35 to 37 in women. The UK had higher mortality than most EU15+ countries for obstructive, interstitial, and infectious subcategories of respiratory disease in both men and women. CONCLUSION: Mortality from overall respiratory disease was higher in the UK than in EU15+ countries between 1985 and 2015. Mortality was reduced in men, but remained the same in women. Mortality from obstructive, interstitial, and infectious respiratory disease was higher in the UK than in EU15+ countries.