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The number of deaths from chronic obstructive pulmonary disease (COPD) has increased in the last 7-8 years. In 2022-23 alone, COPD deaths increased nine times compared to the last seven years, a response to an RTI filed by The Indian Express showed.
In 2022-2023, the highest number of deaths was recorded (886), while the figures for the last seven years did not exceed 150. In 2015-2016, there were 181 deaths, which decreased to 98 in 2016-2017. In 2017-2018, the number increased to 111, followed by a drop to 55, 98, 62 and 125 in the following four years.
COPD is a common lung disease that causes airflow restriction and breathing problems; Smoking and air pollution are the most common causes. In these patients, the lungs may become damaged or clogged with phlegm. Symptoms include coughing, sometimes with phlegm, difficulty breathing, wheezing and tiredness. People with COPD are at increased risk for other health problems. Although it is not curable, symptoms may improve by avoiding smoking and exposure to air pollution and by getting vaccinated to prevent infections. It can also be treated with medications, oxygen therapy, and pulmonary rehabilitation.
According to a state health department official, before Covid they did not collect data on COPD. “When the pandemic hit, there were specific guidelines for maintaining data on various respiratory diseases so as not to miss any Covid deaths. Thanks to this, we also managed to maintain data on deaths from COPD,” the official added.
In its response to the RTI, the Directorate General of Health Services said that not all health centers in Delhi are represented in this data which comes from various private, public and autonomous health centres. “The integrity and accuracy of the information depends on the voluntary participation and timely presentation of data by health institutions. Additionally, variations in data presentation practices between different healthcare institutions may affect the consistency and comparability of the information presented,” he said.
The link with pollution
The data comes at a time when Delhi recorded the most polluted December in four years in 2023. According to doctors, in addition to smoking, there is a clear connection between COPD and prolonged exposure to pollution (indoors and outdoors).
For years, studies around the world have shown how air pollution is directly linked to an increased risk of COPD. A study published in Jama Network journals in 2019 said that long-term exposure to ambient air pollutants was significantly associated with increased emphysema, assessed quantitatively using CT imaging and lung function. Emphysema is one of the diseases that make up COPD.
Another study published in Lancet in 2022 said that long-term exposure to air pollution was associated with an increased risk of COPD, especially in people with high genetic risk and unfavorable lifestyles.
According to Dr. Raj Kumar, director of the Vallabhbhai Patel Chest Institute: “There is data and published literature that indicates that if one is exposed to indoor (pollutants) like biomass and charcoal (during cooking), women tend to develop COPD even without smoke. If we talk about outdoor pollution and COPD, it can happen when there is prolonged exposure to toxic elements… people who are genetically inclined to develop bronchial asthma can develop symptoms.”
Dr. Kumar added that people exposed to toxins such as 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 stated.
Are children at risk? Dr. Kumar said no, but added that they may develop an exacerbation of the respiratory problem: “Symptoms will appear early. They may also be prone to developing bronchial asthma… when they are exposed to pollution, they develop symptoms…”
At AIIMS Delhi, Dr Anant Mohan, professor and head of the department of Pulmonology, said it is difficult to find a causal connection to prove that PM levels are linked to COPD deaths and worsening symptoms, but there are connections. indirect. “…There have been cases of high (hospital) admissions on days with high levels of pollution, but we cannot directly say that a person died from air pollution alone. The causes of COPD are many,” he said.
On the deaths mentioned in the RTI response, Dr Nikhil Modi, senior consultant in respiratory and critical care medicine at Delhi’s Indraprastha Apollo Hospitals, said they could be chronic patients, those who were not taking medicines, as well as those whose exposure to smoking and pollution does not stop.
He also said the number of deaths from COPD could be higher and pointed to years of the pandemic in which there was no clarity about whether the aggravating factor was COPD or Covid among those who died. “We can’t completely rely on this.”
He emphasized the need for a central registry of these cases: “We do not have adequate data. “The central registry needs to be improved so that we know which disease is the main culprit and act in time.” Dr Anant Mohan agreed and said that a central repository or database would be helpful.
Dr Modi said that if a COPD patient contracts pneumonia and similar infections, the chances of it progressing to severe illness and even death are higher. He said patients should protect themselves with regular immunizations, improve their nutrition and protect themselves from pollution, smoking and crowded places.
At his institute’s OPD, Dr Kumar has been treating referred 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 greater and last longer, he said.
Dr Modi also said that most cases are reported during winter and monsoons. “In winter we see more patients when pollution levels are high. Those who require admission are mostly patients over 40 years of age.