5 Primary Causes of Chronic Obstructive Pulmonary Disease (COPD)

We've all experienced a dry cough, occasional shortness of breath, fatigue, or episodes of breathlessness at some point. While these symptoms may seem minor or commonplace, they can be indicative of more serious underlying conditions, especially in an era where respiratory illnesses are increasingly prevalent. It's essential not to overlook these warning signs and to seek timely medical evaluation when they persist or worsen.

COPD is a progressive and debilitating respiratory condition that affects over 55 million Indians, primarily due to preventable causes. Understanding the etiological factors is vital for primary prevention. This article outlines five major causes of COPD, highlighting India-specific data and clinical insights into the pathophysiology.

1. Tobacco Smoking

Tobacco smoking is the most significant risk factor for COPD globally and in India.

● Cigarette, bidi, and hookah use all contribute.

● Bidi smoke contains higher concentrations of tar, nicotine, and carbon monoxide compared to cigarettes.

● Smoking damages airway epithelium, causes chronic inflammation, and leads to mucus hypersecretion and airway narrowing.

● In India, nearly 80% of male COPD cases are linked to smoking.

● Long-term exposure results in emphysema and chronic bronchitis—two key components of COPD.

2. Indoor Air Pollution

Indoor air pollution from biomass fuel combustion is a major cause of COPD in rural India.

● 60% of households still use cow dung, firewood, and crop residue for cooking.

● Poorly ventilated kitchens lead to chronic inhalation of particulate matter (PM2.5), carbon monoxide, and volatile organic compounds.

● Women involved in cooking and children playing nearby are particularly vulnerable.

● Inhaled pollutants induce oxidative stress, inflammatory cell recruitment, and airway remodelling.

3. Outdoor Air Pollution

Ambient air pollution contributes significantly to COPD in urban India.

● Vehicular emissions, industrial effluents, and construction dust are primary sources of PM2.5 and PM10.

● India has 14 of the world’s 20 most polluted cities (WHO data, 2023).

● Chronic exposure causes alveolar damage, fibrosis, and airflow limitation.

● Despite lower smoking rates, urban areas show high COPD incidence due to poor air quality.

4. Occupational Exposure

Several Indian occupational sectors are high-risk environments for respiratory health.

● Construction workers inhale cement dust and silica.

● Textile workers are exposed to cotton dust and chemicals.

● Farmers inhale agrochemicals, pesticides, and organic dust.

● Chronic exposure causes persistent inflammation, chronic bronchitis, and restrictive/obstructive spirometry patterns.

● Employers often lack adequate workplace respiratory protection.

5. Post-Tuberculosis Sequelae

India bears the highest global burden of tuberculosis (TB).

● Pulmonary TB leads to permanent damage to the lung architecture.

● Common sequelae include fibrosis, bronchiectasis, and cavitations.

● These changes create airflow obstruction consistent with COPD.

● Nearly 15–20% of COPD patients in India have a prior TB history.

● Such patients may be non-smokers but still exhibit irreversible airway obstruction.

Conclusion

Chronic Obstructive Pulmonary Disease is a multifactorial condition largely driven by preventable exposures. While tobacco smoking remains a primary cause, indoor air pollution, occupational hazards, and post-TB damage significantly contribute to India’s burden. Policymakers, healthcare professionals, and the public must collaborate to improve air quality, promote clean fuel usage, enforce occupational safety, and ensure early diagnosis and treatment to curb this escalating public health concern.

_SE