Why COPD cases are rising sharply in India and why it’s no longer a smoker’s disease

COPD is no longer a smoker’s disease. Doctors explain why cases are rising across India (Image: Pexels)

Chronic obstructive pulmonary disease (COPD) was considered to be a condition that mostly affected older smokers. However, this is no longer the case. In several states across India, COPD is now emerging as a major cause of death, sometimes even surpassing heart disease in reported mortality.

Dr Shachi Dave, Consultant Pulmonologist, Narayana Hospital, Ahmedabad attributed the rise to a unique mix of environmental exposures, lifestyle patterns and gaps in healthcare access. She shared more about its causes and the ways to treat it  effectively.

Why COPD Is Rising Sharply

The reasons for the sharp rise in COPD cases can be attributed to a broad spectrum of factors from environmental to lifestyle, and even delayed diagnosis.

Also Read: World COPD Day 2025: Pulmonologist shares simple ways to protect your lungs from pollution if you have Asthma or COPD

Smoke from biomass fuels

Large parts of India still rely on biomass fuels such as wood, coal, charcoal and crop residue for daily cooking and heating. Many women cook inside small, poorly ventilated spaces. This creates continuous indoor smoke exposure which acts in the same way as cigarette smoke to harm the lungs.

Long term exposure causes persistent airway inflammation, and airway remodelling (structural changes that cause airway walls to thicken) that eventually leads to irreversible airflow limitation. Over time, this results in COPD in people who have never smoked.

Severe outdoor pollution

High levels of particulate matter, dust and smog, especially in the northern parts of India, prolonged exposure to traffic emissions, crop burning, industrial smoke and construction dust are some of the most significant causes that trigger COPD. These particles reach deep into the lungs, trigger oxidative stress and cause chronic inflammation that eventually causes COPD.

Tobacco exposure

Tobacco use in both smoked and smokeless forms is widespread in many states. Combined with high levels of passive smoke exposure inside households, this adds significantly to disease burden from both smokers and non-smokers.

The Role of Delayed Diagnosis

Along with environmental challenges, the availability of specialised lung care remains limited in many regions across the country. People in these areas still do not have access to pulmonologists, spirometry testing or good diagnostic facilities.  As a result, COPD is often detected late, only when breathlessness becomes severe.

Many cardiac conditions also remain undiagnosed and present suddenly as cardiac deaths. This makes COPD appear more dominant in mortality statistics in certain regions.

The Winter Surge: November to February is the most dangerous period for COPD patients. Every year, hospitals see a clear rise in acute attacks with exacerbations sometimes spiking by nearly 30 per cent.

Cold weather: Cold air irritates the airways, increases bronchospasm and makes mucus clearance more difficult. This leads to worsening breathlessness and chest tightness.

Seasonal viral infections: Respiratory viruses spread more easily in winter. These infections inflame the airways and rapidly worsen COPD symptoms.

Indoor crowding and pollution: People generally stay indoors with closed doors and windows to cut out the winter chill. If biomass fuels are used, the concentration of indoor smoke rises sharply. Even without smoke, poor ventilation increases the risk of infections.

Heavy outdoor pollution: Winter inversion traps pollutants close to the ground.

Combined with crop burning smoke and industrial emissions, this makes the air extremely toxic for vulnerable individuals.

COPD Is No Longer a Smoker’s Disease

Modern clinical evidence shows that COPD now affects many people who have never touched tobacco. The disease is linked to biomass smoke exposure, outdoor particulate pollution, industrial and construction dust, and chemical fumes from workplace industries, among environmental factors. The medical risk factors range from childhood pneumonia, to prematurity birth and low birth weight which result in underdeveloped lungs, post-tuberculosis lung damage, as well as genetic factors such as alpha one antitrypsin deficiency.

In India, post-tuberculosis lung damage alone contributes significantly to COPD cases, making the illness common among younger adults as well.

Also Read: Doctors explain why toxic air damages lungs, causes long-term breathing disorders

The Way Forward

FAQs on COPD

1. What is COPD?

COPD, or chronic obstructive pulmonary disease, is a long-term lung condition that causes breathing difficulties due to airflow obstruction.

2. What are the main causes of COPD?

The main causes include smoking, long-term exposure to harmful pollutants such as biomass smoke, industrial dust, and chemical fumes, as well as genetic factors.

3. Who is at risk of developing COPD?

Although traditionally associated with older smokers, COPD can affect non-smokers exposed to indoor and outdoor pollutants, individuals with a history of lung infections, and those with genetic predispositions.

4. How is COPD diagnosed?

COPD is diagnosed using spirometry, which measures lung function. Other tests may include chest X-rays and CT scans.

5. What are the symptoms of COPD?

Symptoms include persistent cough, shortness of breath, wheezing, and frequent respiratory infections.

Disclaimer: This article, including health and fitness advice, only provides generic information. Don’t treat it as a substitute for qualified medical opinion. Always consult a specialist for specific health diagnosis.