Indoor air pollution and not smoking cheap cigarettes is the most important cause of chronic obstructive pulmonary disease (COPD) in India, reported a prevalence study conducted by Pune-based Chest Research Foundation (CRF) in collaboration with the KEM Hospital, Pune, and the Imperial College, London. In the West and other wealthier countries, smoking is the single most important causative factor of COPD.

The CRF study found that the prevalence of the respiratory disease was 6.9 per cent in the Indian population. Among those identified with COPD, only 7 per cent were tobacco smokers while the remaining 93 per cent were non-smokers.

Almost 700 million people in India suffer from high levels of indoor air pollution affecting women and young children as 75 per cent homes use biomass fuel like wood, crop residue and dung cakes.

Other research declared that exposure to wood smoke through home heating and cooking or through ambient neighborhood pollution may further increase the risk of COPD and related pulmonary problems in smokers.

The age factor was particularly disturbing. "Approximately 23 per cent of COPDs occurred in people less than 40 years of age. It was believed that COPD starts after 40 in people who have been smoking for over 15-20 years. In India, where the exposure to indoor air pollution begins from childhood, it occurs in younger people," said chest physician Sundeep Salvi, director of the CRF.

Statistics show that on March 2010 were found 10 causes of deaths in Maharashtra, and COPD was the main cause of these deaths.

What can help at this moment is a national COPD control program. "We have such programmes for malaria, filariasis, tuberculosis and AIDS. The mortality is far too high in COPD than any of these diseases. Policy makers should take up the issue and act fast, "said Salvi.

"Even though there is no similar report from other states in India, it seems likely that COPD may be one of the leading causes of death in other states too. The WHO had compiled a nationwide analysis in 2002, and reported that deaths due to chronic respiratory diseases accounted for the second largest cause of death, with COPD as the main cause of respiratory deaths," said Salvi.

He spearheaded the study along with social scientist Sanjay Juvekar from KEM Hospital and Peter Barnes, an eminent professor of respiratory medicine at Imperial College, London (UK).

The study was conducted in 22 rural villages in Pune district with a population of over 1 lakh. As many as 3,000 adults over the age of 25 years were randomly selected for the study which used a standardized respiratory health questionnaire and spirometry (lung function test for determining COPD).

In the western, tobacco smoking is believed to be the most important risk factor for COPD. However, recent evidence refutes this. "Exposure to biomass fuel smoke is the biggest risk factor, not only for India, but even globally. Compared to 1.1 billion smokers, more than 3 billion people use biomass fuel for cooking and heating purposes worldwide," Salvi concluded.

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