Air pollution is arguably the biggest public health crisis India has faced since the pandemic and will continue to worsen each year unless urgent action is taken, a UK-based Indian-origin pulmonologist warned, noting that a looming tsunami of airway disease remains largely underdiagnosed and untreated.
Multiple senior doctors practising in the UK asserted that a vast, hidden burden of undiagnosed airway disease is "building beneath the surface" and its incoming wave will exact a heavy, lasting toll on Indian citizens and its healthcare system.
They linked the global rise in cardiovascular diseases over the past decade to increasing exposure to toxic emissions from urban transport, including automobiles and aircraft, particularly in cities across India, the UK and beyond, rather than obesity alone.
Union transport minister Nitin Gadkari on Tuesday admitted that nearly 40 per cent of the pollution in Delhi is caused by the transport sector due to dependence on fossil fuels, while emphasising the urgent need for cleaner alternatives, and pushing for the adoption of biofuels.
During the recently concluded winter session of Parliament, the government said that there is no conclusive data establishing a direct correlation between higher Air Quality Index (AQI) levels and lung diseases, despite acknowledging that air pollution is one of the triggering factors for respiratory ailments and associated diseases.
"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 a former Covid-19 Advisory Committee Member of India's Health, Manish Gautam, told PTI.
He cautioned that years of exposure mean that a lung health emergency is unfolding, while urging the policymakers to focus on early detection and treatment of airway diseases, and consider establishing a rapid "lung health task group".
In December, Delhi hospitals alone witnessed 20 to 30 per cent spike in respiratory patients, including many first-time cases and young adults, according to doctors.
Gautam, who holds over 20 years of experience at the UK's National Health Service, further noted that while pollution control and prevention measures remain critical, they are no longer sufficient on their own.
"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 said.
The government reiterated in Parliament recently that there is no conclusive data establishing a direct causal link between air pollution and mortality or disease.
According to Rajay Narain, Honorary Cardiologist at St George's University Hospital in London, there is "overwhelming scientific evidence" linking air pollution to a range of diseases, including cardiovascular, respiratory, neurological and systemic, and any delay in addressing the issue will add to the health and economic burden.
He underscored that while short-term measures may reduce immediate exposure, the real solution lies in sustained, science-driven policies that prioritise clean air, protect vulnerable populations and hold all stakeholders accountable.
"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 said.
Data presented by the health ministry in Parliament's winter session stated that over 2 lakh cases of acute respiratory illness were recorded in Delhi over the past three years, with around 30,000 patients requiring hospitalisation.
Highlighting the factors that often go unnoticed, Professor Derek Connolly, a consultant cardiologist at the Midland Metropolitan University hospital in Birmingham, said that even on seemingly clean days, residents in polluted cities are exposed to invisible cardiovascular risks.
"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 said.
The Birmingham-based cardiologist said that whilst the increase in cardiovascular disease over the last decade has been ascribed to obesity, he suspects that a large portion of it is due to the rise of automobiles and airplanes filling the air with toxic substances.
PM2.5 pollution led to over 17 lakh deaths in India in 2022, of which the use of petrol for road transport contributed to 2.69 lakh deaths, the '2025 Report of The Lancet Countdown on Health and Climate Change' said.
In May, a global study by International Council on Clean Transportation revealed that policies targeting road transport emissions could save 1.9 million lives and prevent 1.4 million new children's asthma cases worldwide by 2040.
Over the years, healthcare professionals have repeatedly flagged the widespread impact of air pollution on public health, highlighting the urgency for intervention.