Integrating tuberculosis and lung health services in India: Opportunities and challenges

India bears one of the highest global burdens of tuberculosis (TB) and chronic respiratory diseases (CRDs), including chronic obstructive pulmonary disease (COPD), asthma, bronchiectasis, and post-tuberculosis lung disease (PTLD). Traditionally, TB and chronic respiratory diseases have been managed through vertical and fragmented healthcare programmes, leading to inefficiencies, delayed diagnosis, and poor continuity of care. Increasing evidence demonstrates strong epidemiological, biological, environmental, and socioeconomic intersections between TB and other lung diseases. Shared risk factors such as tobacco smoking, biomass fuel exposure, ambient air pollution, occupational hazards, poverty, malnutrition, and overcrowding amplify the burden of respiratory illness in India. Recent WHO policy frameworks advocate a transition from disease-specific programmes toward integrated, people-centred lung health services. This review examines the rationale, evidence, opportunities, and challenges for integrating TB and lung disease services in India. It discusses the role of primary healthcare strengthening, diagnostic integration, pulmonary rehabilitation, digital health innovations, workforce development, and multisectoral interventions. Lessons from the Practical Approach to Lung Health (PAL) and Indian pilot initiatives are also explored. An integrated TB-lung health strategy offers a pragmatic pathway to improve respiratory outcomes, optimize healthcare resources, strengthen health systems, and accelerate progress toward universal health coverage in India.