According to the 2017 Global Burden of Disease Report, India is among the countries with the highest burden of chronic respiratory diseases, accounting for 15.69% of global cases and 30.28% of global deaths from these diseases. COPD With 55.23 million people affected, COPD-related deaths are second at around 0.85 million. Additionally, India leads in asthma-related mortality, accounting for 43% of global deaths.
Despite the significant health and economic impact, awareness is low among both healthcare professionals and the general public. Addressing the root causes, improving early diagnosis, promoting treatment compliance and implementing effective public health policies are critical to managing this growing burden.
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Air Pollution, Air pollution contributes significantly to India's respiratory health crisis. Millions of people are exposed daily to harmful particulate matter (PM 2.5 and PM 10) from vehicle emissions, industrial pollutants, construction dust and agricultural waste burning. These conditions are further aggravated by poor air quality Asthma and an increased risk of COPD, pneumonia and lung cancer. In cities with an Air Quality Index (AQI) above 500, breathing the air is equivalent to smoking 25-30 cigarettes a day. For example, an AQI of 300-350 can be equivalent to smoking 15-20 cigarettes a day, underscoring the serious health risks associated with toxic air in India.
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Smoking and Vaping: Tobacco use remains a major health problem in India, where there are over 267 million users. Smoking is the main cause of respiratory diseases such as lung cancer, COPD and chronic bronchitis. The chemicals in tobacco smoke damage the airways and impair lung function, causing around 1.2 to 1.3 million deaths in India each year. Secondhand smoke is equally harmful, often even more so due to lack of filtration. Vaping, marketed as a “safer” alternative, brings its own risks. Although e-cigarettes may contain fewer harmful chemicals than tobacco, they are not risk-free. Studies suggest that vaping can cause respiratory damage within 5 to 10 years, raising concerns about long-term health effects.
indoor air pollution, Indoor air pollution is a significant issue in rural areas, where many households use traditional biomass fuels such as wood, coal and dung for cooking and heating. This results in very high levels of smoke and particulate matter indoors, causing respiratory problems, especially in women and children who spend more time indoors. Chronic exposure can lead to asthma, COPD and acute respiratory infections.
Occupational Hazards and Industrial Emissions: Workers in industries such as mining, construction and manufacturing are at increased risk for respiratory diseases due to their exposure to dust, chemicals and fumes. This occupational exposure contributes to conditions such as silicosis, asbestosis and COPD. Additionally, industrial emissions deteriorate air quality, impacting both workers and surrounding communities.
Managing the burden of respiratory disease in India
To effectively manage and reduce the rising incidence of respiratory diseases in India, a comprehensive approach is required, focusing on prevention, early diagnosis, and long-term treatment. First and foremost, it is important to address air pollution. Coordinated efforts are needed between the government, industries, and the public to tackle this issue. Although initiatives such as the National Clean Air Programme (NCAP) aim to reduce particulate matter levels, strict regulations and enforcement are necessary. Measures such as controlling emissions from vehicles and industries, promoting clean fuels, and encouraging sustainable farming practices to cut down on crop burning are important. Additionally, increasing public transport, adopting electric vehicles, and increasing urban greenery can help reduce pollution in cities.
At the same time, it is also important to control tobacco and vaping. Accessible tobacco cessation programmes that provide both counselling and pharmacological support are essential for effective interventions. Public health campaigns should focus on educating the youth population about the risks of smoking and vaping, while strict regulation on the sale and marketing of vaping products is needed to prevent their use. Schools and colleges should play a key role in these efforts, ensuring that students are well informed about the dangers associated with smoking and vaping.
In addition, improving indoor air quality, especially in rural areas, is vital. Promoting clean cooking methods such as LPG, electric stoves or solar cookers can significantly reduce indoor air pollution. Although government programmes such as the Pradhan Mantri Ujjwala Yojana have made great progress in providing free LPG connections to low-income households, more efforts are needed for widespread adoption. Educating rural populations about the health risks of traditional cooking methods can promote behaviour change.
Early identification and adherence to treatment are equally important. Increasing awareness about the symptoms of chronic respiratory diseases such as asthma, COPD and lung cancer is crucial for timely diagnosis. Screening programmes targeting high-risk groups, including smokers and people exposed to indoor air pollution, can facilitate early identification. Once diagnosed, adherence to treatment is essential for managing symptoms and preventing disease progression. Emphasising the importance of regular medication use, with subsidised drugs and patient education, can improve compliance and long-term outcomes.
Finally, public health campaigns and education play a key role in reducing stigma and encouraging early medical intervention. Community-driven awareness initiatives should target both rural and urban populations, highlighting the risks associated with smoking, vaping, and air pollution. By integrating these efforts, India can better manage and reduce the growing burden of respiratory diseases.
(Author: Dr. Arvind Kumar, Chairman, Chest Surgery, Robotic Chest Surgery & Lung Transplant Program, Medanta, Gurugram)