No Longer A Smoker's Illness: The Hidden Lung Disease Epidemic Behind India's Winter Death Spike

For years, chronic obstructive pulmonary disease (COPD) was seen as a condition that mainly affected older smokers. That picture has changed completely now. In several states across India, COPD is now emerging as a major cause of death, sometimes even surpassing heart disease in reported mortality. The rise is not because the illness has suddenly become more dangerous but because India continues to face a unique mix of environmental exposures, lifestyle patterns and gaps in healthcare access.

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.

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.

The Way Forward

There is an urgent need to strengthen air pollution control, improve access to specialised lung care and create wider awareness about early symptoms. Timely diagnosis through spirometry, prompt treatment and avoidance of smoke exposure can slow disease progression dramatically.

Chronic obstructive pulmonary disease may be creeping up silently, but with better prevention, early detection and cleaner air, this burden can be reduced. The biggest shift required is recognising that this is no longer a disease of elderly smokers but a widespread public health problem driven by the air that millions breathe every day.

(By Dr Shachi Dave, Consultant Pulmonologist, Narayana Hospital, Ahmedabad)

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