The number of deaths due to Chronic Obstructive Pulmonary disease (COPD) has increased over the last 7-8 years. In 2022-23 alone, deaths due to COPD increased nine times as compared to the last seven years, a reply to an RTI filed by The Indian Express showed.
2022-2023 saw the highest number of deaths — 886 — while the numbers in the last seven years did not cross 150. In 2015-2016, there were 181 deaths, which reduced to 98 in 2016-2017. In 2017-2018, the number increased to 111 followed by a dip to 55, 98, 62, and 125 in the next four years.
COPD is a common lung disease causing restricted airflow and breathing problems; smoking and air pollution are the most common causes. In such patients, the lungs can get damaged or clogged with phlegm. Symptoms include cough, sometimes with phlegm, difficulty breathing, wheezing, and tiredness. People with COPD are at higher risk of other health problems. While it is not curable, symptoms can improve if one avoids smoking and exposure to air pollution and gets vaccines to prevent infections. It can also be treated with medicines, oxygen therapy, and pulmonary rehabilitation.
According to an official from the state health department, before Covid, they were not compiling data on COPD. “When the pandemic struck, there were specific guidelines to maintain data on various respiratory diseases so we do not miss any Covid deaths. Because of this, we managed to maintain data on COPD deaths as well,” the official added.
In its reply to the RTI, the Directorate General of Health Services said not all healthcare facilities in Delhi are represented in this data which was sourced from several private, public, and autonomous healthcare facilities. “The completeness and accuracy of the information depends on the voluntary participation and timely submission of data by the healthcare institutions. Furthermore, variations in data reporting practices among different healthcare institutions may impact the consistency and comparability of the information presented,” it said.
The pollution link
The data comes at a time when Delhi recorded the most polluted December month in four years in 2023. According to doctors, apart from smoking, there is a clear connection between COPD and long-term exposure to pollution (indoor and outdoor).
For years, studies worldwide have shown how air pollution is directly related to increased risk of COPD. A study published in Jama Network journals in 2019 said long-term exposure to ambient air pollutants was significantly associated with increasing emphysema, assessed quantitatively using CT imaging and lung function. Emphysema is one of the diseases that comprise COPD.
Another study published in Lancet in 2022 said long-term exposure to air pollution was associated with an increased risk of COPD, especially in those with high genetic risk and unfavourable lifestyles.
According to Dr Raj Kumar, Director, Vallabhbhai Patel Chest Institute: “There is data and published literature that if one is exposed to indoor (pollutants) such as biomass and coal (during cooking), women tend to develop COPD even without smoking. If we talk about outdoor pollution and COPD, it can happen when there is long-term exposure to toxic elements… people who are genetically inclined to develop bronchial asthma can develop symptoms.”
Dr Kumar added that people exposed to toxins like PM (Particulate Matter) 2.5 will show signs of damage to the bronchi and alveoli. “In COPD, there are two elements — chronic bronchitis and emphysema. So now there is evidence that even non-smokers can develop these conditions,” he said.
Are children at risk? Dr Kumar said no, but added that they can develop an exacerbation of the respiratory problem: “The symptoms will set in early. They may also be prone to develop bronchial asthma… when they are exposed to the pollution, they develop symptoms…”
At AIIMS Delhi, Dr Anant Mohan, Professor and Head of the Pulmonology department, said a causal connection to prove PM levels are linked to COPD deaths and worsening of symptoms is difficult but there are indirect connections. “… There have been instances of high (hospital) admissions on days with high pollution levels, but we cannot directly say a person died because of air pollution alone. The causes of COPD are many,” he said.
On the deaths mentioned in the RTI reply, Dr Nikhil Modi, Senior Consultant in Respiratory and Critical Care Medicine at Indraprastha Apollo Hospitals, Delhi, said it could be of chronic patients, those who were not on medication, as well as those whose exposure to smoking and pollution is non-stop.
He also said the number of deaths due to COPD could be more and pointed to the pandemic years where there was a lack of clarity on whether the aggravating factor was COPD or Covid among those who died. “We can’t rely on this completely.”
He stressed on the need for a central registry of such cases: “We haven’t got proper data. The central registry needs to be better so we know which disease is a major culprit and act in time.” Dr Anant Mohan concurred and said a central repository or a database would be helpful.
Dr Modi said if a patient with COPD contracts pneumonia and similar infections, the chances of them progressing towards severe illness and even death are higher. He said patients should protect themselves with regular immunisation, building up nutrition, and protecting themselves from pollution, smoking and crowded places.
At his institute’s OPD, Dr Kumar has been seeing referral patients and his observation is that the severity is higher in winter. For smokers exposed to indoor and outdoor air pollution, the obstructive phenomenon will be more and last longer, he said.
Dr Modi too said most cases are reported during winter and monsoon. “In winter, we see more patients when pollution levels are high. The ones who require admission are mostly patients above the age of 40.
