Dr Sundeep Salvi, Chairman of Chest Research and Training Pvt Ltd, President of the Indian Chest Society, Director of the Pulmocare Research Foundation and Education (PURE) in Pune, and Distinguished Professor of Research at Symbiosis International University, recently engaged in an insightful discussion with Kalyani Sharma regarding the current state of respiratory diseases in India. During the conversation, he emphasised key issues, challenges, and the need for increased awareness and research in this crucial field
How critical is early detection in managing and preventing respiratory diseases?
Respiratory diseases are among the most common ailments for which patients visit doctors in India. Many years ago, we conducted a nationwide study across 880 cities and towns in all states and Union Territories. On a single day, we collected data from 205,000 patients. The study, which was later published in The Lancet Global Health, aimed to identify the primary ailments for doctor visits in India.
The findings were startling. We anticipated respiratory diseases to be significant, but the scale was unexpected—50 per cent of patients in India visit a doctor for a respiratory problem. When extrapolated, this means that out of the 40 million people who visit doctors daily, nearly 20 million do so for respiratory issues.
Within this, we categorised respiratory ailments into two segments: acute respiratory conditions, mostly infections, and chronic respiratory diseases such as asthma, COPD, and post-tuberculosis complications. Acute conditions account for about 50 per cent of all respiratory cases, while chronic respiratory diseases make up the remaining 50 per cent. In effect, one in four patients visiting a doctor in India is there for a chronic respiratory issue. This was an eye-opener, revealing that respiratory diseases are a much larger problem than previously recognised.
It was published in 2015-2016 and remains one of the largest studies of its kind in India. It was a one-day point prevalence study, and considering the rising pollution levels and climate change, the current figures are likely worse.
I have also had the privilege of serving as the Chairperson for the Chronic Respiratory Disease Section in the Global Burden of Disease (GBD) study. GBD is an authoritative source of health-related data that governments use to shape healthcare policies. Our research indicates that at least 100 million people in India suffer from chronic respiratory diseases. More concerning, India ranks number one globally in deaths and suffering due to chronic respiratory diseases, even after adjusting for population size.
Despite its prevalence, respiratory health seems neglected. Why is that?
It is neglected across the board by patients, healthcare providers, policymakers, and the healthcare system. Awareness is the first step toward addressing this crisis. Before COVID-19, respiratory health was even more overlooked. However, the pandemic did one positive thing: it underscored the importance of lung health.
COVID-19 taught us three key lessons:
- The lung is a vital organ and must be taken care of.
- SpO2 levels are crucial indicators of oxygen concentration in the blood.
- High-Resolution CT (HRCT) scans are essential for detecting lung complications like fibrosis and pneumonia.
Before the pandemic, lung health was taken for granted, but now, there is greater awareness and attention.
Infectious diseases like tuberculosis and HIV/AIDS have been long-standing concerns. How has India’s healthcare system addressed them?
The Ministry of Health has done commendable work in reducing the burden of tuberculosis. However, the exclusive focus on communicable diseases has led to the neglect of non-communicable diseases (NCDs), including chronic respiratory diseases. The consequence has been unnecessary suffering and deaths.
For instance, out of every 100 people who die from asthma worldwide, 46 are from India—meaning India accounts for 46 per cent of global asthma deaths. This is an alarming and unacceptable statistic, largely driven by pollution, underdiagnosis, undertreatment, and inappropriate treatment. Social stigma around asthma and inhaler use further exacerbates the problem.
Are there any recent research findings you’d like to highlight?
We have been pioneers in studying non-smoking COPD. COPD is the second leading cause of death in India, yet awareness is abysmally low. In a study conducted in Pune’s urban slums and rural areas, we found that 99 per cent of respondents had never heard of COPD. In contrast, nearly everyone was aware of tuberculosis (TB) and AIDS, thanks to extensive awareness campaigns.
COPD was traditionally thought to be caused solely by smoking. However, our research showed that in India and other low- and middle-income countries, 70 per cent of COPD cases arise from non-smoking causes, such as biomass fuel exposure. This was a groundbreaking revelation, and our findings were published internationally, bringing attention to the issue.
What are some of the most common but underestimated environmental triggers?
Biomass smoke exposure is the leading cause of COPD in India. In earlier years, 65 per cent of Indian households used biomass fuels (wood, dung, or crop residues) for cooking. While this has now reduced to 40 per cent, it remains a significant risk factor.
We also found that:
- Burning a single mosquito coil for six to seven hours produces as much smoke as smoking 100 cigarettes.
- A single dhoop or agarbatti stick, which burns for about 15-20 minutes, emits smoke equivalent to 500 cigarettes.
- Children lighting firecrackers, such as phuljhadi (sparklers) during Diwali, are exposed to smoke equivalent to 1,300 cigarettes.
India urgently needs more awareness campaigns about these harmful exposures to protect lung health.
What role do AI-driven predictive models play in early detection and prevention of respiratory diseases?
AI is transforming respiratory disease diagnosis and management. One promising development is the use of AI-driven cough analysis. A few years ago, I worked on a project that analysed cough sounds to diagnose respiratory conditions. We developed a digital stethoscope that captures cough sounds and, using AI, identifies patterns indicative of asthma, TB, COPD, and bronchitis.
This work, done in collaboration with the Massachusetts Institute of Technology (MIT), has paved the way for more advanced digital diagnostic tools. Today, digital stethoscopes equipped with AI are becoming widely available, offering a non-invasive and efficient way to detect respiratory diseases early.
Key takeaways
The key takeaway is that respiratory diseases are a massive yet overlooked public health issue in India. The PHC’s in India which serve the rural population with major Respiratory issues have substandard awareness in recent advancements. Awareness, early detection, and proper treatment can prevent suffering and deaths.
We need concerted efforts from policymakers, healthcare providers, and the public to tackle this growing crisis. Protecting our lungs must become a priority.