The Silent Epidemic: COPD and the 3.5 Million Deaths No One Talks About - José Luis Castro #105

We sit down with Dr. José Luis Castro, Director General Special Envoy for Chronic Respiratory Diseases at the WHO, to confront one of the most overlooked yet devastating health crises of our time: chronic respiratory diseases—specifically asthma and COPD. With over three decades of experience in global health leadership, he has dedicated his career to advancing sustainable health initiatives across developing countries and urban centres worldwide. The Central Question When a child can't breathe, everything else stops. But when an adult has COPD, the world kind of crosses the street. Why? COPD is the hidden respiratory crisis—often met with a shrug, silent judgement, or post-pandemic fear. We assume it's a consequence of lifestyle choices. We tell ourselves they brought it on themselves somehow, and in doing so, we give ourselves permission to look away. This judgement is a failure of empathy and a failure of society. Key Topics Discussed: The Scale of the Crisis: Over half a billion people affected. 3.5 million deaths every year. Yet only one article in the New York Times in 2024—an obituary. Why chronic respiratory diseases are the Cinderella of public health. The Stigma Problem: How COPD has been framed as a "smoker's disease"—and why that narrative is both scientifically wrong and morally dangerous. The role of air pollution, occupational exposure, and early-life lung injury in creating this invisible epidemic. What COPD Actually Looks Like: A visceral, unflinching picture of life with COPD—from three oxygen cylinders (one by the bed, one in the toilet, one in the living room) to the slow suffocation of social isolation, breathlessness, and the erosion of dignity. Why breathlessness is invisible—and why that invisibility is deadly. The Indoor Air Connection: Why the majority of our exposure to outdoor air pollution occurs indoors. How the built environment—our homes, schools, and workplaces—is either protecting us or slowly poisoning us. The fundamental contract we have with buildings is broken. Environmental Justice: Why this is not just a problem for "the poor" or "smokers"—it's a problem for all of us. Anyone who breathes is at risk. And we are only one diagnosis away from being vulnerable ourselves. GUEST: Dr. José Luis Castro - Director General Special Envoy for Chronic Respiratory Diseases, WHO https://www.linkedin.com/in/jose-luis-castro/ https://www.emro.who.int/health-topics/chronic-obstructive-pulmonary-disease-copd/ https://www.who.int/ The Air Quality Matters Podcast in Partnership with Farmwood (\"https://farmwood.co.uk/\") - Eurovent (\"https://www.eurovent.eu/\") - Aico (\"https://www.aico.co.uk/\") The One Take Podcast in Partnership with SafeTraces (\"https://www.safetraces.com/\") and Inbiot (\"https://www.inbiot.es/?utm_campaign=simon&utm_source=airqualitymatters&utm_medium=podcast\") Do check them out in the links and on the Air Quality Matters Website. (\"https://www.airqualitymatters.net/podcast\") If you haven't checked out the YouTube channel its here (\"https://www.youtube.com/@airqualitymatters-SimonJones\"). Do subscribe if you can, lots more content is coming soon. Chapters 00:00:00 Introduction: The Silent Crisis of Chronic Respiratory Disease 00:02:31 Meet Jose Luis Castro: The WHO's Mission on Respiratory Health 00:04:44 The Staggering Numbers: Half a Billion People Affected 00:08:01 The Stigma Problem: Why COPD Gets Ignored 00:11:20 Clean Air as a Human Right: The UN General Assembly Pledge 00:13:46 From Numbers to Action: Making Air Quality Personal 00:17:30 The Inequality of Exposure: Environmental Justice and Air Quality 00:26:41 The Tobacco Parallel: Lessons from Successful Policy Change 00:29:28 Agency and Action: Why Individual Power Matters 00:36:43 The Invisible Organ: Why We Don't Talk About Lungs 00:39:17 Childhood Exposure: Creating Glass Ceilings for Young Lungs 00:43:38 What COPD Really Looks Like: A Paramedic's Perspective 00:47:33 Living with COPD: The Oxygen Tank Reality 00:52:58 The Coughing Boy: Social Isolation and Respiratory Disease 00:58:41 Beyond Smoking: The Real Causes of COPD 01:03:22 Early Detection and Spirometry: The Diagnostic Challenge 01:07:00 The Economic Case: Healthcare Costs and Productivity Loss 01:07:59 Occupational Health: Construction, Welding, and Workplace Exposure 01:14:25 The 2025 Breakthrough: Political Recognition at Last 01:17:01 Breaking Down Silos: Why Doctors Must Ask About Buildings 01:19:27 The Built Environment is in Us: Rethinking Our Relationship with Buildings 01:24:42 Jose's Journey: From TB to COPD 01:27:41 The Universal Threat: Why This Affects Everyone 01:33:15 Closing Thoughts: Breathing as the Starting Point