Sumi Gupta
In 2024, residents of Delhi experienced a series of disruptions due to hazardous air pollution—persistent coughing, reduced visibility from thick smog, school closures, halted construction activities, and restrictions on private vehicle movement.
In a troubling report released on January 6, 2025, the Centre for Science and Environment (CSE) in Delhi, highlights a sharp increase in Delhi’s air pollution levels. In 2024, the annual concentration of fine particulate matter (PM2.5), a major pollutant, rose by 3.4%, reaching 104.7 µg/m³ — more than double the national air quality standard. There is a stark contrast between national air quality standards and those set by the World Health Organization (WHO). The NAAQS permits a yearly PM2.5 concentration of up to 40 µg/m³, while WHO recommends no more than 5 µg/m³ annually — a standard far stricter than India’s.
This increase is particularly concerning given that the number of stubble fires in Delhi, Punjab, and Haryana dropped significantly in 2024. Total fire counts decreased by 37.5% from 63,721 in 2023 to 39,865 in 2024, with a staggering 71.2% reduction in seasonal farm fires between October and December. Despite the decline in stubble burning, the worsening air quality persists, challenging the prevailing notion that agriculture is the primary cause of pollution.
The CSE report points to local and regional sources, including vehicular emissions, open waste burning, and dust from construction, as major contributors to the crisis. This latest increase in pollution underscores the urgent need to address local pollution sources and push for stricter regulations to safeguard public health.
What are the common respiratory diseases across India?
Dr. Baibhav Kumar: “Respiratory diseases are a significant public health concern in India, with asthma, chronic obstructive pulmonary disease (COPD), and bronchitis among the most common. Asthma, particularly widespread in Delhi, is often triggered by allergens, infections, and pollution, with the city earning the unfortunate title of the “asthma capital” due to its poor air quality. COPD, primarily 
caused by long-term exposure to pollution and smoking, remains one of the leading causes of death across the country. Bronchitis, both acute and chronic, also presents a serious health risk. Additionally, conditions like pneumonia, tuberculosis (TB), bronchiectasis, pneumoconiosis, and pulmonary sarcoidosis continue to contribute to the growing burden of respiratory diseases in India.
Since the onset of the COVID-19 pandemic, respiratory issues have significantly worsened, largely due to post-COVID fibrosis, which has left many individuals with weakened lungs. Patients with pre-existing conditions such as COPD or asthma are now experiencing more severe symptoms, including increased difficulty in breathing and oxygen deprivation. People with heart or lung disease, older adults, children, individuals with diabetes, and those from lower socioeconomic backgrounds are particularly vulnerable to the health effects of particle pollution.
In managing these conditions, healthcare providers often rely on tools like flu PCR tests, nebulization, and oxygen support. For pneumonia cases, bronchoscopy and tailored antibiotic treatments are crucial. In more severe instances of respiratory failure, non-invasive ventilation is used to reduce carbon dioxide levels and relieve symptoms, offering critical relief to patients.”
What causes respiratory disease?
Dr. Baibhav Kumar: “Respiratory diseases can be triggered by infections, smoking, or the inhalation of harmful substances such as second-hand tobacco smoke, radon, asbestos, and air pollutants.
In India, air pollution has emerged as a significant contributor to the rising incidence of respiratory ailments. Key pollutants include particulate matter (PM), nitrogen oxides (NOx), and ozone (O3), which vary in concentration based on factors like location, climate, land use, and local regulations. Urban areas, in particular, suffer from elevated pollution levels due to transportation, industrial activities, and rapid urbanization.
Research has consistently shown a direct link between exposure to particulate pollution and a range of respiratory health issues, such as coughing, wheezing, reduced lung function, inflammation of the airways, and bronchial hyperreactivity. Over time, prolonged exposure can lead to chronic lung diseases, asthma, and even premature death, particularly among vulnerable groups such as children, the elderly, and those with existing heart or lung conditions.”
How does particle pollution affect the respiratory system?
Dr. Baibhav Kumar: “Particles that settle in the respiratory tract can trigger inflammation, with the intensity depending on the type and concentration of particles involved. Combustion-related particles like organic carbon and transition metals provoke significant inflammatory responses. This inflammation increases sensitivity to irritants such as cold air, allergens, and pollutants, leading to bronchoconstriction and reduced lung function. Over time, it can cause long-term damage to lung tissue and the alveolar-capillary barrier, fostering chronic inflammation.
For those with asthma, particle pollution is especially harmful, rather detrimental. It aggravates existing airway inflammation, particularly in those with allergic asthma, as exposure to allergens combined with pollution intensifies symptoms. Numerous Epidemiological studies underline the link between prolonged exposure to particulate matter and worsened asthma symptoms, decreased lung function, and increased reliance on medication.”
What precautions can people in urban areas take to avoid respiratory diseases?
Dr. Baibhav Kumar: “To stay safe, it’s crucial to minimize exposure to pollution as much as possible, especially for the elderly. Wearing a mask can help, and my advice to everyone is to avoid smoking. Living in a city like Delhi, which often resembles a ‘gas chamber’ in terms of air quality, makes it all the more important to protect your lungs.
When it comes to diet, patients with comorbidities such as diabetes and hypertension should have a tailored plan. In general, I recommend a high-protein, calorie-rich diet that supports the body’s needs.
For those with respiratory issues, it’s vital to remove the stigma surrounding nebulization. Patients should continue their treatments as prescribed and follow up regularly with their doctor. Stopping treatment prematurely can cause setbacks, as nebulization is key in opening the airways.
Elderly patients must monitor their oxygen levels and breathing carefully. If you notice signs of labored breathing or a drop in oxygen saturation, seek immediate medical attention. X-rays and consultations with a respiratory specialist are necessary for appropriate care.
For school-going children, it’s important to understand that while outdoor play is vital, during high pollution levels, it’s safer to keep them indoors. Schools may close during such times, but children should focus on maintaining a balanced diet, staying hydrated, and engaging in practices like yoga and meditation. Teaching them these habits early can help boost their overall health.
To the youth: Managing your health means getting six to eight hours of sleep daily, incorporating yoga, pranayama, walking, or exercise into your routine, and staying active. However, avoid morning walks during high pollution. A healthy lifestyle is essential, as lack of exercise weakens lung capacity, especially in polluted environments. Modify your habits, stay active, eat well, and regular check-ups a part of your routine.”
Is vaping an alternative to smoking?
Dr. Baibhav Kumar: “Vaping is absolutely not a safe option, especially in India. Many people mistakenly believe it’s a safer alternative to 
smoking, but that’s simply not true. The chemicals found in vapes can cause acute lung injuries, potentially leading to respiratory distress syndrome (RDS) and other severe complications, in a matter of few days. In fact, vaping is just as harmful, if not more dangerous, than smoking—it can trigger immediate lung damage. Despite being illegal, vaping is widely available, and it’s crucial that people understand the risks it poses.
If you’re trying to quit smoking, nicotine patches or lozenges are much safer alternatives, but vaping should be completely avoided. For young people, I strongly discourage self-treatment through vaping. Proper counselling is vital when quitting smoking, and it’s important to seek medical advice. There are many ways to quit smoking with professional support—don’t attempt it on your own.”
While the respiratory system has natural defences against pollution, prolonged exposure to elevated levels of particulate matter can cause lasting harm, even to otherwise healthy individuals. To safeguard lung health and minimize the risk of chronic conditions, proactive measures to reduce exposure are essential. For vulnerable groups, including children and the elderly, limiting outdoor activities during high pollution episodes is crucial. Alongside minimizing exposure, maintaining a balanced diet, staying well-hydrated, and engaging in regular physical activities—such as yoga, exercise, and sports—can help mitigate the adverse effects of pollution. These steps are vital to fostering resilience and preserving health amidst an increasingly challenging environment.
