Breathing Battles: Air Pollution & COPD's Hidden Crisis In India
India bears a disproportionate burden, accounting for 17.8 per cent of global COPD cases and a staggering 27.3 per cent of related deaths
In the bustling Delhi/NCR region and many populous parts of India, a silent epidemic is tightening its grip—Chronic Obstructive Pulmonary Disease (COPD). This progressive lung disorder, characterised by persistent airflow limitation, is the second leading cause of death and disability in India, just behind only cardiovascular diseases. Despite its significant burden, COPD remains overshadowed by more visible health crises, neglected by both public awareness and healthcare policies. We hope that this year’s theme for World COPD Day 2024, observed on 20th November is seriously taken by all. The theme this year is "Know Your Lung Function." This theme emphasises the importance of “monitoring lung health, particularly through tests like spirometry, to detect early signs of COPD.
What is COPD?
It is a collection of respiratory disorders, mainly emphysema and chronic bronchitis, rather than a single illness. This is generally characterised by shortness of breath, wheezing, increased phlegm production, and a persistent cough are some of its defining signs. Although smoking is still the biggest risk factor, other major factors that have come to light are equally alarming including air pollution, genetic predisposition, and occupational hazards. According to a 2022 Lancet study, air pollution alarmingly raises the incidence of COPD, especially for people with genetic vulnerabilities and bad lifestyles.
Looking at the overall Health Burden, some facts are indeed alarming and need immediate attention. Globally, COPD affects 384 million individuals and contributes to over 3 million deaths annually. India bears a disproportionate burden, accounting for 17.8 per cent of global COPD cases and a staggering 27.3 per cent of related deaths.
Of late COPD instances have risen sharply in Delhi-NCR, where the air quality has deteriorated and reached life-threatening levels. States like Uttar Pradesh, Haryana, Punjab, and Rajasthan report the highest prevalence, exacerbated by the widespread use of biomass fuels for cooking and heating, poor healthcare access, and delayed diagnosis. Hospitalisations rise as a result of the toxic combination of pollution, industrial pollutants, and vehicle exhaust that exacerbates symptoms. With COPD patients fighting not only illness but also environmental neglect, breathing has become an endless struggle for the inhabitants.
COPD is often described as an "orphan disease," not because it is rare but because it fails to garner the attention it deserves. Unlike heart attacks or strokes, COPD kills slowly, eroding patients' quality of life over time. Its subtle onset, coupled with the absence of dramatic events, leads to under-diagnosis and inadequate treatment.
A critical gap lies in diagnostic tools. Spirometry, the gold standard for diagnosing COPD, is unavailable in most primary healthcare settings. Consequently, more than 50% of COPD cases remain undetected. Even when diagnosed, treatment options such as inhaled bronchodilators and corticosteroids are often out of reach for patients relying on public healthcare systems.
Over half of COPD cases in India are attributed to air pollution, both outdoors and indoors. One of the main causes of COPD in India is pollution. Despite initiatives like the Pradhan Mantri Ujjwala Yojana (PMUY), Indoor air pollution is still a major health concern in India and contributes directly to the rise of chronic obstructive pulmonary disease (COPD). To lessen reliance on biomass fuels, PMUY, which was introduced in 2016, has given subsidised LPG connections to more than 9 crore rural families. However, because of the low awareness, and long-standing cooking habits, many homes still use biomass. The 2021 report from the World Health Organization emphasises. Biomass fuels, still used by millions for cooking, release harmful particulates that severely damage lung tissues over time.
The issue is made worse by outdoor air pollution, which urban dwellers must deal with from industrial pollutants, seasonal crop burning, and vehicle emissions. Urban residents face additional risks from vehicular emissions and industrial pollutants, creating a public health emergency. Supreme Court on Monday has asked Delhi, Uttar Pradesh, Haryana, Punjab, and Rajasthan to strictly follow Stage IV, GRAP.
Combatting COPD requires a concerted effort involving healthcare providers, policymakers, and the public. Here’s how India can tackle this growing crisis:
Making spirometry widely available in primary healthcare centres is crucial. Regular screening for high-risk populations, such as smokers and those exposed to biomass smoke, can facilitate early diagnosis. Policemen, traffic police personnel, security guards etc are entirely exposed to high levels of pollution, their diagnosis should be prioritised too
Inhaled bronchodilators and other essential medications must be included in the public health system. Subsidized pricing and partnerships with pharmaceutical companies can make these treatments affordable.
Strict enforcement of environmental regulations, coupled with initiatives like promoting cleaner cooking fuels, is vital. Awareness campaigns must educate communities about the risks of biomass fuel use and alternatives like LPG and electric stoves.
Vaccines such as those for influenza, pneumococcal disease, and the newly introduced RSV vaccine for patients above 60, play a crucial role in preventing complications among COPD patients. Integrating these vaccines into public health programs will ensure broader coverage.
Public awareness campaigns must emphasise early symptoms and risk factors of COPD. Educational programs for healthcare professionals can improve diagnosis rates and ensure adherence to treatment protocols.
The progression of chronic obstructive pulmonary disease (COPD), characterised by severe harm, reduced lung function, and ongoing respiratory issues, is often silent but fatal. The combined burden of indoor and outdoor pollution requires immediate legislative adjustments, such as stricter emission restrictions, public awareness campaigns, and additional LPG refill subsidies. Until substantial action is taken, COPD will remain a significant barrier to improved public health outcomes in India. Despite being a preventable and treatable condition, COPD nonetheless kills millions of people globally and in India. It is a considerably more urgent problem in India due to the combination of socioeconomic hurdles, healthcare inadequacies, and environmental neglect. COPD treatment is not only a medical issue; it is also a social necessity. India can combat this silent killer by putting lung health first, enforcing strict environmental regulations, and bolstering its healthcare system.
Our lives are shaped by the air we breathe. Conditions like COPD will continue to take unnecessary lives until we all take action to make it safe and clean. Acting now will not only save millions of lives but also revitalise public health as a whole
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