Introduction: Respiratory syncytial virus (RSV) is a well-known pathogen in infants but less recognized as a cause of lower respiratory tract infections (LRTI) in older adults. However, RSV remains underdiagnosed in this population due to nonspecific symptoms and low clinical suspicion. This study analyses the clinical presentation, management, and outcomes of RSV infection in adults at a tertiary respiratory care centre in Western India. Methods: A retrospective study was conducted at a tertiary respiratory care centre in Western India, focusing on adult patients hospitalized with LRTI from June to September 2023. Nasopharyngeal swabs were collected from 29 patients and tested for respiratory viruses using nested polymerase chain reaction (PCR). Records of patients who had tested positive for RSV were reviewed and comprehensive clinical data, chest X-ray, high-resolution computed tomography (HRCT) and laboratory parameters were recorded. Data on RSV prevalence among patients who underwent PCR for diagnosis of LRTI, their demographics, clinical presentation, management, and outcomes were analysed. Ethical approval was obtained, and patient confidentiality was maintained. Statistical analysis was performed to assess associations between variables. Results: Of the 29 patients, 11 (37.9%) tested positive for RSV, with most aged 51–75 years. Common symptoms included breathlessness (100%), cough (72.72%), and fever (54.54%). Most patients required oxygen support, with an average hospital stay of 15.9 days. Radiological findings varied and often did not correlate with clinical severity. Treatment involved supportive care, including oxygen therapy, bronchodilators, and corticosteroids. No fatalities were reported among RSV-positive patients. Discussion: RSV is a significant but under recognized cause of LRTI in older adults. Despite nonspecific symptoms and inconsistent radiological findings. Increased clinical awareness and early diagnostic efforts are essential, particularly for older adults with chronic respiratory conditions. Conclusion: This study shows high prevalence of RSV in adults with LRTI and highlights the importance of early diagnosis and management. Enhanced clinical awareness among physicians could significantly improve outcomes and reduce unnecessary polypharmacy among these patients.