Every year on World Lung Day (September 25), the spotlight turns to the silent yet escalating burden of chronic respiratory diseases. Among them, Chronic Obstructive Pulmonary Disease (COPD) is one of the leading causes of morbidity and mortality worldwide. Often dismissed as a “smoker’s disease,” COPD is now being increasingly diagnosed in people who have never touched a cigarette.
In India, the situation is particularly stark. Indoor air pollution from biomass stoves, toxic urban air, poorly managed asthma, and occupational hazards are placing non-smokers especially women and workers in polluted industries at serious risk. Yet, awareness remains low, and many patients normalise breathlessness as “a part of ageing,” only seeking medical help when the disease has already advanced.
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To understand the hidden dimensions of COPD among non-smokers, The Week spoke with pulmonologist Dr Shahid Patel, consultant pulmonologist at Navi Mumbai's Medicover Hospitals, who shared insights into causes, risks, misconceptions, and why timely intervention can change lives.
Traditionally, COPD has been associated with smoking. But why do non-smokers also develop it?
Traditionally, yes, COPD was linked almost exclusively with smoking. But newer research has identified a clear entity of non-smoking COPD. In India, one of the earliest explanations was household chulha exposure, especially among women. Many rural households still use firewood stoves, and prolonged exposure to this smoke has caused COPD in women. Beyond that, air pollution, occupational exposure—like in construction or heavily polluted work environments—are also significant contributors. Additionally, individuals with poorly controlled asthma since childhood or young adulthood can develop COPD-like symptoms later in life.
What role does passive smoking play in COPD?
Passive smoking is in fact more dangerous at times. The smoker inhales through a filter, but the people around them inhale the unfiltered smoke being exhaled. Families with a smoker often see higher rates of COPD in non-smoking relatives, although symptoms may appear later in life because younger lungs initially compensate better.
As a pulmonologist, how do you distinguish between active and passive smoking when diagnosing COPD?
Clinically, there isn’t much difference—the symptoms and spirometry findings are similar. The main difference lies in exposure history. But whether active or passive, reducing exposure is crucial. I recall a patient who had been smoking for nearly 40 years and reached an advanced stage of COPD. Despite heavy medication, his condition worsened—until he stopped smoking completely, due to being bedridden from depression. Within four months, his lungs had improved more than any medicine had ever managed. That was a humbling reminder: quitting smoking, even late in life, makes a huge difference.
Can third-hand smoke—the residual particles on clothes, furniture, and walls—also damage the lungs?
It can play a role, yes, but it’s not as significant as first-hand or second-hand smoke. Still, prolonged exposure is not ideal.
How serious is COPD in India right now?
Quite serious. People often take organs like the heart or kidney seriously, but tend to ignore the lungs. Breathlessness in old age is often dismissed as “normal,” when in fact it may be COPD—something preventable and treatable. COPD is not curable; it’s like diabetes or hypertension—it must be managed lifelong. Unfortunately, late diagnosis, frequent exacerbations, and repeated hospital admissions make it a heavy financial burden on families.
Roughly what proportion of your patients are COPD cases?
In my practice, about 30% of patients are COPD cases. Many of them relapse because they stop using inhalers due to stigma around steroids or switch to alternative therapies, which worsens their condition. What they don’t realise is that COPD treatment is mainly preventive—it aims to stop further lung damage.
Besides medication, what helps patients manage COPD better?
Pulmonary rehabilitation and physiotherapy are hugely important, but underutilised in India. Patients often think, “I’m breathless, how can I exercise?” But those who do regular lung exercises and physiotherapy have fewer symptoms, fewer hospital visits, and better quality of life. Medicines are important, but physiotherapy is equally critical in managing COPD.