Respiratory diseases represent a major global public health burden, contributing significantly to morbidity, mortality, and reduced quality of life. Obstructive and restrictive lung diseases form two major categories of chronic respiratory conditions that impose long-term health and socioeconomic challenges. According to the Global Burden of Disease (GBD) study, chronic respiratory diseases account for over 7% of global deaths annually, with chronic obstructive pulmonary disease (COPD) ranking as the third leading cause of death worldwide. Similarly, restrictive lung diseases such as pulmonary fibrosis and sequelae of tuberculosis contribute substantially to chronic disability and healthcare utilization. The World Health Organization (WHO) estimates that more than 300 million people globally suffer from asthma and nearly 400 million from COPD, while the prevalence of restrictive diseases is steadily rising due to post-infectious and occupational causes [1-6].

In India, the burden of both obstructive and restrictive lung diseases is disproportionately high, driven by widespread risk factors such as tobacco smoking, passive smoke exposure, household air pollution from biomass fuel, occupational dust and chemical exposures, and a high prevalence of post-tuberculosis sequelae. COPD alone affects more than 55 million Indians and is the second leading cause of death in the country. Restrictive lung diseases, often underdiagnosed, remain a growing concern in the wake of high tuberculosis incidence, increasing cases of interstitial lung disease, and continued occupational exposures in industries such as agriculture, construction, and textiles. The economic costs of these chronic conditions are also immense, arising from hospitalizations, long-term treatment, reduced productivity, and premature deaths [7,8].

Punjab, a northern Indian state, presents a unique epidemiological profile. The state faces a dual burden of communicable and non-communicable diseases, with respiratory disorders ranking among its top health concerns. High rates of tobacco use, alcohol consumption, exposure to industrial and agricultural dust, and continued reliance on biomass fuels in rural households contribute significantly to the prevalence of lung diseases. Furthermore, occupational exposures in farming, construction, and manufacturing are common in the region, amplifying risks for obstructive and restrictive conditions. Despite this high-risk environment, public awareness regarding the causes, symptoms, preventive strategies, and management of chronic lung diseases remains inadequate. Misconceptions, delayed health-seeking behavior, and limited knowledge about diagnostic tools such as spirometry or preventive measures such as smoking cessation and clean fuel adoption further exacerbate the burden [9-12].

Timely recognition and prevention of risk factors, along with early diagnosis and management, are critical in reducing the health and socioeconomic impacts of lung diseases. Awareness of key symptoms such as persistent cough, breathlessness, and wheezing, as well as knowledge of environmental and lifestyle-related risk factors, is essential to encourage early medical consultation and reduce complications. Previous studies conducted in India and other low- and middle-income countries have highlighted poor community-level knowledge regarding chronic respiratory conditions, with obstructive and restrictive diseases often confused or misattributed to other illnesses [11-14]. However, there is a paucity of region-specific data from Punjab, where cultural practices, occupational exposures, and healthcare-seeking behaviors may shape awareness levels differently compared to other states.

The present study was therefore undertaken to assess awareness regarding obstructive and restrictive lung diseases among the general public of Punjab. Specifically, it aimed to evaluate knowledge about risk factors, symptoms, preventive strategies, and diagnostic modalities, while examining the influence of socio-demographic determinants such as age, gender, residence, education, and occupation. By identifying knowledge gaps and vulnerable groups, the study seeks to provide evidence to guide targeted public health education campaigns and policy interventions, ultimately aiming to reduce the burden of chronic respiratory diseases in Punjab.

Study Design and Setting

A descriptive, cross-sectional study was conducted to assess the level of awareness regarding obstructive and restrictive lung diseases among the general public of Punjab. Data collection was carried out using a structured, self-administered questionnaire designed on Google Forms. The digital format enabled wide distribution, ensured uniformity in responses, and facilitated participation from both rural and urban populations across multiple districts of Punjab.

Study Population and Eligibility Criteria

The study included adults aged 18 years and above, residing in either urban or rural areas of Punjab. Both males and females from diverse educational and occupational backgrounds were eligible to participate, provided they gave voluntary informed consent. To minimize bias, the following groups were excluded: healthcare professionals, medical and paramedical students, individuals with severe cognitive or communication difficulties, and duplicate or incomplete submissions.

Sample Size Determination

The minimum sample size was calculated using the single population proportion formula, assuming a 50% prevalence of adequate awareness (as no state-specific baseline data were available), with a 95% confidence interval and a 5% margin of error. The estimated sample size was 384, which was rounded up to 400 participants to account for potential non-responses and exclusions.

Sampling Technique

A purposive-cum-snowball sampling technique was used. The survey link was disseminated through social media platforms such as WhatsApp, Facebook, and email. Village health workers and community volunteers were engaged to share the survey among rural households, while participants were encouraged to forward the link within their networks to maximize coverage across socio-demographic groups.

Study Tool (Questionnaire Design)

The questionnaire was designed after reviewing existing literature, WHO guidelines, and validated tools from prior respiratory health awareness studies. It was divided into four sections:

• Socio-demographic details – age, gender, residence (urban/rural), education, occupation, and monthly household income

• Exposure history and risk factors – including history of lung disease diagnosis, smoking/second-hand smoke, occupational dust, household air pollution, family history, and respiratory symptoms

• Knowledge questions – 20 multiple-choice questions on obstructive and restrictive lung diseases, covering risk factors, symptoms, diagnostic tests, and preventive strategies. Each correct answer was scored as 1, and incorrect/don’t know responses as 0

• Knowledge score categorization – total scores (0–20) were categorized as excellent (16–20), good (12–15), fair (8–11), and poor (0–7)

Validation and Pilot Testing

The draft questionnaire was reviewed by experts in pulmonology, community medicine, and public health to ensure face and content validity. A pilot test was conducted among 30 individuals (urban and rural) to check for clarity, cultural appropriateness, and ease of understanding. Based on feedback, minor modifications were made. The tool demonstrated good internal consistency, with a Cronbach’s alpha value of 0.82.

Data Collection Procedure

Participation was voluntary. The Google Form began with an informed consent statement, and only those who consented could proceed. All items were mandatory, minimizing missing responses. The average completion time was 10–12 minutes. Data were automatically recorded in a secure Google Sheet, accessible only to the research team.

Data Analysis

Data were exported to IBM SPSS Statistics version 25 for analysis. Descriptive statistics (frequency, percentages) were used to summarize socio-demographic details, exposure history, and awareness levels. The Chi-square test (χ²) was applied to assess associations between knowledge levels (excellent, good, fair, poor) and socio-demographic variables (age, gender, residence, education, and occupation). A p-value <0.05 was considered statistically significant.

Ethical Considerations

The study adhered to the principles of the Declaration of Helsinki (2013 revision). Confidentiality was maintained by not collecting personally identifiable information, and responses were used solely for academic and research purposes.

The study included 400 participants, with the largest proportion belonging to the 30–44-year age group (37.0%), followed by 18–29 years (25.5%) and 45–59 years (24.0%), while only 13.5% were aged 60 years and above. Gender distribution was balanced, with 49.5% males and 50.5% females. More than half of the participants were from urban areas (53.5%), while 46.5% belonged to rural regions, ensuring a diverse representation. Educational status varied, with 37.5% having secondary education, 37.0% being graduates, 17.0% postgraduates, and 8.5% without formal schooling. Occupation-wise, skilled or unskilled workers (29.0%) and homemakers (26.5%) formed the largest groups, followed by service professionals (23.5%), students (14.0%), and retired individuals (7.0%). Monthly household income showed that most respondents earned between ₹10,001–25,000 (36.0%), while 29.5% had incomes below ₹10,000, 23.0% between ₹25,001–50,000, and 11.5% above ₹50,000. This distribution reflects a socio-demographically diverse sample across Punjab (Table 1).

Table 1: Socio-Demographic Characteristics of Participants (n = 400)

Among the respondents, Table 2 shows 21.0% reported a prior diagnosis of lung disease, with obstructive diseases such as asthma and COPD being more common (61.9%) than restrictive conditions (38.1%). Tobacco exposure was widespread, with 23.0% being active smokers and 29.5% reporting passive exposure, while nearly half (47.5%) had no tobacco-related exposure. Occupational dust or industrial exposure was reported by 26.5% of participants, whereas 30.5% reported household air pollution due to biomass fuel use. Family history of lung disease was noted in 17.0% of respondents. Regarding symptoms, 23.5% reported chronic cough, 18.0% breathlessness, and 14.5% wheezing or chest tightness, while 44.0% were asymptomatic. These findings highlight significant environmental and lifestyle exposures that predispose the population to obstructive and restrictive lung diseases.

Table 2: Exposure History and Risk Factors Related to Obstructive and Restrictive Lung Diseases (n = 400)

Assessment of knowledge revealed considerable variability across domains. A majority correctly identified asthma and COPD as obstructive diseases (61.5%) and recognized their main symptom as shortness of breath with wheezing (68.0%). Similarly, cigarette smoking was widely acknowledged as a major risk factor (71.5%), and passive smoking was also recognized by 66.0% of respondents. Knowledge regarding environmental and occupational risks was moderate, with 60.5% linking dust exposure to silicosis/asbestosis and 69.0% linking biomass smoke with COPD and asthma. Diagnostic awareness was fair, with 63.5% identifying spirometry and 67.0% recognizing chest X-ray/HRCT as key tests. Awareness of preventive strategies was encouraging, as 78.0% recognized measures such as avoiding smoking, using clean fuels, and protective masks. Overall, 72.0% identified asthma triggers, and 76.5% acknowledged red-flag symptoms requiring medical help. However, misconceptions persisted regarding the reversibility of diseases, with only 61.5% correctly differentiating obstructive and restrictive conditions (Table 3).

Table 3: Knowledge Questions on Obstructive and Restrictive Lung Diseases (n = 400)

The overall knowledge distribution showed that only 18.5% of participants demonstrated excellent awareness, while 32.0% had good knowledge. A significant proportion (33.0%) had fair knowledge, and 16.5% fell into the poor category. This indicates that although nearly half the population had good to excellent awareness, more than half still had only fair or poor understanding, suggesting substantial gaps in public knowledge about obstructive and restrictive lung diseases (Table 4).

Table 4: Overall, Knowledge Score Distribution on Obstructive and Restrictive Lung Diseases (n = 400)

Analysis of socio-demographic determinants in Table 5 revealed that education, residence, and occupation were significantly associated with knowledge levels, while age and gender were not. Urban respondents showed higher proportions of excellent and good awareness compared to rural participants (p=0.002). Education emerged as the strongest predictor (p<0.001), with postgraduates showing the highest excellent knowledge (30.1%), compared to only 6.2% among those with no formal schooling. Occupational differences were also significant (p=0.008), with service professionals reporting the highest excellent knowledge (27.6%), while homemakers and unskilled workers had comparatively lower awareness. These findings highlight structural inequalities in knowledge distribution, emphasizing the influence of education, occupation, and place of residence in shaping awareness about lung diseases.

Table 5: Association Between Knowledge Level and Socio-Demographic Variables (n = 400)

This study provides valuable insights into the level of awareness regarding obstructive and restrictive lung diseases among the general public of Punjab. The findings highlight both encouraging aspects of knowledge and critical gaps that could significantly impact prevention, early detection, and timely management of chronic respiratory diseases.

The socio-demographic profile of respondents indicated a balanced representation across age, gender, and urban–rural distribution, which enhances the relevance of the findings to the general population of Punjab. The exposure history showed that a considerable proportion of participants were either active smokers (23.0%) or exposed to passive smoking (29.5%), while nearly one-third (30.5%) reported exposure to household biomass fuel smoke. These results are consistent with earlier studies in India where tobacco and household air pollution were identified as the most significant contributors to respiratory disease burden. Additionally, 26.5% of respondents reported occupational exposure to dust, reflecting the high prevalence of agriculture and industrial work in Punjab. Such widespread risk factors underscore the heightened vulnerability of the state’s population to chronic respiratory conditions.

Knowledge assessment revealed moderate awareness overall, with notable variation across different domains. A majority of respondents correctly identified obstructive diseases such as asthma and COPD (61.5%) and recognized cigarette smoking as a major cause (71.5%). Awareness of passive smoking (66.0%), biomass exposure (69.0%), and occupational dust exposure (60.5%) was encouraging, indicating some level of community understanding about environmental and lifestyle-related risk factors. However, knowledge of restrictive lung diseases and their implications remained limited, with only 57.0% identifying their primary effect on alveoli and lung expansion and 56.0% acknowledging their often-irreversible nature. These findings reflect a global trend where obstructive diseases, particularly asthma and COPD, receive more public and policy attention compared to restrictive diseases, which remain underrecognized and underdiagnosed.

Symptom recognition was also variable. While common features such as shortness of breath, wheezing, and morning cough were reasonably well identified, knowledge about the progression of breathlessness in restrictive diseases and the importance of early spirometry and imaging investigations was moderate. Encouragingly, preventive measures such as smoking cessation, use of clean fuels, protective masks, and vaccinations were widely acknowledged by the majority, suggesting a positive foundation on which to build more comprehensive health education initiatives.

The overall knowledge score distribution revealed that less than one-fifth of participants (18.5%) demonstrated excellent knowledge, while one-third had only fair knowledge and 16.5% fell into the poor category. This pattern indicates that despite some awareness of common risk factors and symptoms, a substantial portion of the population lacks adequate understanding, potentially leading to delays in seeking care or adopting preventive measures. Such findings are in line with earlier community-based studies in India and other low- and middle-income countries, where poor awareness of chronic lung diseases remains a persistent challenge.

Socio-demographic analysis further demonstrated that education, occupation, and residence significantly influenced knowledge levels, while age and gender did not. Participants with higher education, service/professional occupations, and urban residence had better awareness, likely due to greater access to health information and healthcare facilities. Conversely, rural residents, homemakers, and unskilled workers were disproportionately represented in the fair and poor knowledge categories, reflecting structural disparities in health literacy. These findings highlight the need for tailored interventions targeting vulnerable subgroups to bridge the knowledge gap.

Taken together, the results underscore the pressing need for enhanced community education programs in Punjab, focusing not only on well-known conditions such as asthma and COPD but also on restrictive diseases that are often neglected. Public health campaigns should prioritize awareness of environmental and occupational exposures, clarify misconceptions regarding disease reversibility, and emphasize early recognition of symptoms requiring medical attention. Strengthening primary healthcare services and integrating respiratory health education into ongoing non-communicable disease control programs may also help reduce the burden of chronic lung diseases in the state [9,12-14].

Strengths and Limitations

A key strength of this study lies in its large and socio-demographically diverse sample, which included participants from both urban and rural areas of Punjab, thereby providing a more representative picture of community-level awareness. The use of a structured, validated questionnaire with good internal consistency (Cronbach’s alpha 0.82) further enhances the reliability of the findings. Additionally, the inclusion of exposure history, knowledge domains, and socio-demographic determinants provides a holistic understanding of the factors influencing awareness. However, certain limitations should be acknowledged. The online, self-reported nature of the survey may have excluded populations with limited digital access, particularly older adults and lower-income groups, potentially introducing selection bias. Self-reported responses are also prone to recall and social desirability bias. Furthermore, the cross-sectional design limits the ability to establish causal relationships between socio-demographic factors and awareness levels. Finally, while the sample size was adequate, the use of purposive-cum-snowball sampling restricts the generalizability of results to the entire population of Punjab.

This study highlights that awareness regarding obstructive and restrictive lung diseases among the general public of Punjab remains moderate, with significant gaps in recognizing restrictive conditions, environmental risk factors, and disease irreversibility. While participants demonstrated reasonable knowledge of asthma, COPD, smoking, and biomass fuel exposure, awareness of restrictive diseases such as pulmonary fibrosis and post-tuberculosis sequelae was limited. Socio-demographic factors, particularly education, occupation, and place of residence, emerged as significant determinants of knowledge, underscoring inequalities in health literacy. These findings emphasize the urgent need for targeted health education campaigns, especially in rural communities and among less educated populations, to improve recognition of risk factors, symptoms, and preventive strategies. Integrating respiratory health awareness into existing non-communicable disease programs and strengthening primary healthcare outreach could play a pivotal role in reducing the burden of chronic respiratory diseases in Punjab.

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