Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death in the world. According to WHO, at least 2.7 million deaths occur every year due to COPD, and 0.6 million of these are in India. The ministry of health has estimated that around 28 million people suffer from asthma and 17 million from COPD. City–based Chest Research Foundation (CRF), which recently completed 10 years, has been making dedicated efforts to control this silent epidemic. CRF director Dr Sundeep Salvi talks to SHASHWAT GUPTA RAY about the rising threat of COPD and asthma.

Among all the non–communicable diseases, obstructive airway diseases such as asthma and COPD affect the largest number of people in India. And these numbers are increasing rapidly, largely because of rapid urbanisation, overcrowding, increased motor vehicular traffic and changing lifestyles.

Many people who suffer from asthma and COPD remain undiagnosed, wrongly diagnosed, and poorly or wrongly treated. There is hardly any research that takes place in the field, and the knowledge we have is all imported from the West, which may not necessarily be relevant to Indian conditions.

There is very less awareness among health care providers, policy makers and the common man. It was to overcome these gross deficiencies that the CRF was founded in November 2002. The main objective was to provide relief to people suffering from chronic respiratory diseases through research and education.

The CRF conducts research on respiratory diseases with an emphasis on airway diseases, and organises update programmes and educational events for the community. We work with corporate, educational and research institutions in India and other countries, to improve understanding of the disease, its diagnosis and its management. Till now, the journey has been steady. Now, at least there is an acknowledgement of the hazards posed by respiratory disorders. However, a lot of work still has to be done.

Pollutants emitted from smoke are a major cause of COPD in India. Indoor smoke from biogas cooking stoves is the main culprit. In addition, burning of incense (agarbattis) sticks, emissions from diesel vehicles, dust from rampant construction activity, burning of mosquito coils – all these are major triggers of COPD and asthma in India. We were able to show that exposure to biomass fuel smoke due to indoor burning of wood, crop residue and animal dung is the most common risk factor for COPD in India.

The most common myth is that only smokers are susceptible to asthma and COPD. But our research, conducted over the years, has shown that non–smokers are equally at risk. We have also realised that there are more important risk factors than tobacco smoking for COPD.

Burning one mosquito coil is equivalent to smoking 100 cigarettes a day. But people are not aware of this. The smoke emitted from diesel vehicles releases 1,400 times more particulate matter than petrol vehicles. In fact, this matter is so fine that it gets into your lungs and wreaks havoc. Firecrackers also emit harmful smoke, which is 200 times above the safety limits prescribed by the WHO. Children are affected the most by this.

In Maharashtra, COPD is a leading cause of death and this is despite the fact that only 17 per cent of men and 0.1 per cent women smoke. This clearly indicates that other risk factors are responsible for COPD deaths.

The country is spending Rs 45,000 crore annually in terms of expenditure on treatment, while a lot of money is lost by working professionals as their productivity goes down due to asthma and COPD. According to the National Commission on Macroeconomics and Health (NCMH), in 2005, the prevalence of Obstructive Air Diseases (OADs) was about 45 million. It is expected to exceed 57 million by 2016. NCMH statistics reveal that almost Rs 25,209 crore was spent on the management of COPD in 2005, while the figure would have been just Rs 2,941 crore had the cases been managed according to guidelines.

For asthma, these figures are Rs 7,641 crore and Rs 2,200 crore respectively. In the annual budget, Rs 30,000 crore is the amount allotted to health. It is clear that asthma and COPD together take up almost the entire national budget earmarked for health.

Our doctors need to constantly update their knowledge and people must be made more aware. We endeavour to come up with more informative research work and use those results to update the knowledge and practice of respiratory disease management through certificate courses for physicians, training programmes for technicians and paramedical personnel, and patient education programmes. This will improve the diagnosis and management of airway diseases, while also helping patients overcome the stigma associated with these problems.

Diseases like TB and malaria are still being tackled on a war footing and have been in focus for several years, leading to their decline. OADs have been claiming more lives and threaten to be a greater danger in future. The government must formulate a national programme to control COPD.

Guidelines should be made on the usage of diesel, manufacturing of firecrackers, providing clean cooking fuel and stoves in urban slums and rural households. Reducing the sulphur dioxide (a major pollutant) content in firecrackers, discouraging diesel–driven vehicles, use of latest technology in vehicles to filter pollutants and provision for greenery in cities should be made a part of the national policy.