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India’s second biggest killer, a relative unknown?

Despite accounting for thirteen percent of all deaths in India in 2016, few could explain the risks or symptoms of the disease. Despite its common nature, many could not even call the condition by name.

Copyright: juangaertner / 123RF Stock PhotoChronic obstructive pulmonary disease (COPD) does not share the same public spotlight as other noncommunicable diseases (NCDs) such as cancer and heart disease. The extent to which it is overlooked amounts to a dangerous negligence, as COPD reaps a similar death toll.

In the west, the disease is primarily linked to smoking. COPD is a broad classification encompassing a number of lung conditions each caused by chronic exposure to lung irritants and toxins. In India, and much of the developing world, smoking is just one risk factor. Constant exposure to air pollution of the kind regularly witnessed in India’s metros also accounts for a considerable number of cases.

The number of cases of COPD in India increased from 28.1 million in 1990 to 55.3 million in 2016, according to a study published in The Lancet. Of the disability-adjusted life-years (DALYs) due to COPD in India in 2016, 53.7 percent were attributable to air pollution. 25.4 percent could be ascribed to tobacco use and 16.5 percent to occupational risks.

Sundeep Salvi, director of the Chest Research Foundation (CRF) in Pune, discusses with IndiaSpend why he believes the issue remains neglected. “India has faced the rampage of communicable diseases, such as tuberculosis, malaria and HIV-AIDS, for so long now that we feel we have somehow conquered communicable disease,” he said “Now, the incidence of noncommunicable diseases is on the rise. COPD is a good example of a noncommunicable disease that remains neglected.”

Salvi notes air pollution as being a major contributing factor. “Levels of air pollution have risen dramatically over the last two to three decades,” he notes. “That has had a major impact on COPD.”

While it is easy to view air pollution as an problem confined to urban environments, this does not give the full picture. Rural environments also suffer issues from pollution such as crop burning or pesticides and fertilisers used for farming, as well as indoor pollution due to cooking with unsafe biofuels. In fact, rural areas account for 75 percent of pollution deaths in India, challenging the misconception that pollution is solely an urban problem.

Salvi notes that “the number one risk factor is biomass fuel because over sixty percent of homes still use it”. A key concern with the burning of biofuels within the home is the level of ventilation. As the burning of the fuel will be an almost daily experience, inhalation of fumes will be a chronic issue, causing damage over an elongated period of time.

Change within India’s disease landscape is not a future issue. It has already occurred. Noncommunicable diseases, rather than infectious diseases, dominate India’s top ten causes of death. This is unlikely to reverse, as these conditions are becoming ever more common. India’s healthcare system must adjust accordingly or it will simply not cope with the change. In particular, the chronic nature of most NCDs has to be addressed. Making sure treatment is available to those who need it is of vital importance to mitigating India’s NCD burden and improving quality of life for those who stare down illness that will have to be managed over the course of their lifetime.

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