Air pollution is emerging as one of India’s most serious public health challenges since the Covid-19 pandemic and is set to worsen annually unless urgent corrective steps are taken, a UK-based Indian-origin pulmonologist has warned, cautioning that a growing wave of airway disease remains largely undetected and untreated.

In an interaction with PTI, several senior doctors practising in the UK said a substantial and largely invisible burden of undiagnosed airway disease is “building beneath the surface”, with its impact expected to place sustained pressure on both citizens and the healthcare system in India.

They also linked the global rise in cardiovascular diseases over the past decade to increased exposure to toxic emissions from urban transport, including automobiles and aircraft, especially in major cities in India, the UK and elsewhere, rather than attributing it solely to obesity.

Union transport minister Nitin Gadkari earlier this week acknowledged that nearly 40 per cent of Delhi’s pollution originates from the transport sector due to heavy reliance on fossil fuels, while stressing the need for cleaner alternatives and promoting the use of biofuels.

During the recently concluded winter session of Parliament, the government stated that there is no conclusive data establishing a direct correlation between higher Air Quality Index (AQI) levels and lung diseases, even as it accepted that air pollution is among the triggering factors for respiratory ailments and related conditions.

“The Indian government's renewed focus on controlling air pollution is necessary and overdue. However, it is time to confront an uncomfortable truth: for millions living in North India, the damage has already been done. What is currently being managed represents only the tip of the iceberg. A vast, hidden burden of undiagnosed airway disease is building beneath the surface,” Consultant Pulmonologist in Liverpool and former Covid-19 Advisory Committee member of India’s health ministry, Manish Gautam, told PTI.

Gautam warned that prolonged exposure has already set in motion a lung health emergency and urged policymakers to prioritise early diagnosis and treatment of airway diseases, including the creation of a rapid “lung health task group”.

Doctors noted that Delhi hospitals alone saw a 20 to 30 per cent rise in respiratory patients in December, with many first-time cases and young adults among those affected.

With more than two decades of experience in the UK’s National Health Service, Gautam added that while pollution control and preventive strategies remain essential, they are no longer sufficient in isolation.

“India has shown before that large-scale public health interventions are possible. Government initiatives have significantly reduced the impact of tuberculosis through early diagnosis, and structured treatment programmes. A similar level of urgency and investment is now required for airway diseases,” the Liverpool-based pulmonologist told PTI.

The government has reiterated in Parliament that there is no conclusive data establishing a direct causal link between air pollution and mortality or disease.

However, according to Rajay Narain, Honorary Cardiologist at St George's University Hospital in London, there is “overwhelming scientific evidence” connecting air pollution to cardiovascular, respiratory, neurological and systemic diseases, and any delay in action would further increase both health and economic costs.

He emphasised that while short-term measures may help reduce immediate exposure, long-term, science-based policies focused on clean air, protection of vulnerable groups and accountability across sectors are critical.

“Many early symptoms, such as headaches, fatigue, mild cough, throat irritation, digestive discomfort, eye dryness, skin rashes and recurrent infections, are often dismissed as minor issues but may represent early warning signs of serious chronic disease,” Narain told PTI.

Health ministry data presented during the winter session of Parliament showed that more than two lakh cases of acute respiratory illness were recorded in Delhi over the past three years, with around 30,000 patients requiring hospitalisation.

Drawing attention to less obvious risks, Professor Derek Connolly, a consultant cardiologist at Midland Metropolitan University Hospital in Birmingham, said people living in polluted cities face invisible cardiovascular dangers even on days when air quality appears acceptable.

“People do not realise that cardiovascular disease is an extremely slow process, with episodes of rapid deterioration. This is a silent killer. Most people are unaware of their exposure because particulate matter is invisible and cannot be measured as easily as blood pressure or cholesterol levels. We are all exposed to it, even on days when pollution does not seem too bad,” Connolly told PTI.

The Birmingham-based cardiologist added that although the rise in cardiovascular disease over the past decade has often been attributed to obesity, he believes a significant share is linked to the growing presence of automobiles and aircraft releasing toxic substances into the air.

According to the ‘2025 Report of The Lancet Countdown on Health and Climate Change’, PM2.5 pollution caused over 17 lakh deaths in India in 2022, with petrol use in road transport alone accounting for 2.69 lakh of those deaths.

In May, a global study by the International Council on Clean Transportation found that policies aimed at reducing road transport emissions could save 1.9 million lives and prevent 1.4 million new cases of childhood asthma worldwide by 2040.

Healthcare professionals have repeatedly highlighted the widespread public health impact of air pollution over the years, underscoring the growing urgency for decisive intervention.