NEW DELHI: India accounts for more than 43% of Asia’s chronic respiratory disease–related disability, the highest share in the region, according to a new analysis published in The Lancet Respiratory Medicine on Wednesday. The study identifies air pollution as a major factor behind India’s persistently high lung disease burden.The study, based on estimates from the Global Burden of Disease 2023, found that Asia as a whole contributed nearly 67% of global disability-adjusted life years (DALYs) due to chronic respiratory diseases in 2023. India alone accounted for 43.3% of Asia’s DALYs, while China contributed 27.8%, together making up over 70% of the regional burden, largely driven by population size and sustained exposure to risk factors.In 2023, India’s age-standardised DALY rate from chronic respiratory diseases remained above 2,040 per 100,000 population, among the highest in Asia, reflecting a substantial burden of disability and premature mortality linked to respiratory conditions, despite a gradual decline since 1990.Explaining what this translates to on the ground, Dr G.C. Khilnani, pulmonologist and Chairman, PSRI Institute of Pulmonary, Critical Care and Sleep Medicine, said respiratory illnesses such as pneumonia, asthma and COPD are now among the most common conditions seen in clinical practice, with children and the elderly particularly vulnerable. He said delayed diagnosis worsens outcomes, while air pollution has emerged as a major driver—accounting for nearly half of COPD cases and a growing share of lung cancers, including among non-smokers.South Asia, driven largely by India, recorded the highest age-standardised prevalence of chronic obstructive pulmonary disease (COPD) in Asia at 3,044 cases per 100,000 population. While prevalence across Asian regions was broadly similar, the analysis found that disability and deaths were significantly higher in lower-income regions, pointing to poorer outcomes rather than higher disease occurrence.Dr Ujjwal Parakh, Senior Consultant in Chest Medicine at Sir Ganga Ram Hospital, said chronic respiratory diseases—particularly COPD—are steadily increasing in India and are often diagnosed late due to low awareness and limited access to spirometry. With air pollution damaging lungs much like tobacco smoke, he said controlling pollution and improving early detection are critical.The study identified ambient particulate matter pollution and household air pollution from solid fuels as major contributors to India’s respiratory disease burden. Household air pollution in South Asia was associated with an age-standardised DALY rate of 658 per 100,000 population, among the highest globally.Researchers cautioned that although age-standardised DALY rates for most chronic respiratory diseases have declined across Asia over the past three decades, uneven progress, persistent pollution exposure and gaps in access to care threaten to slow or reverse gains. Without sustained improvements in air quality, cleaner household energy use and equitable respiratory care, the study warned, India’s lung disease burden is likely to remain high.