Overview#
Asthma is a chronic inflammatory disease of the airways that causes recurring episodes of wheezing, breathlessness, chest tightness, and coughing. In India, an estimated 34 million people have asthma, making it one of the most common chronic respiratory conditions. Urban air pollution, dust, and allergens are major triggers. Despite effective treatments, asthma remains underdiagnosed and undertreated in India, partly due to the stigma associated with using inhalers.
Causes & Risk Factors#
- Allergic triggers – dust mites, cockroach allergens, pollen, mould, and pet dander are the most common triggers in Indian households.
- Air pollution – vehicular emissions, industrial pollution, crop burning (especially in North India), and indoor biomass fuel smoke.
- Genetic predisposition – family history of asthma, eczema, or allergic rhinitis (atopic triad).
- Occupational exposure – chemicals, flour dust, wood dust, and textile fibres.
- Respiratory infections in early childhood – viral bronchiolitis increases asthma risk later in life.
Signs & Symptoms#
- Wheezing (a whistling sound when breathing out)
- Shortness of breath, especially on exertion or at night
- Chest tightness or pressure
- Persistent dry cough, worse at night or early morning
- Symptoms triggered by cold air, exercise, dust, smoke, or strong odours
- Difficulty speaking in full sentences during severe attacks
- Using accessory muscles (neck, rib) to breathe during attacks
- Symptoms that improve with bronchodilator (inhaler) use
Diagnosis#
- Spirometry (Pulmonary Function Test) – measures FEV1 and FVC; a reduced FEV1/FVC ratio (< 0.7) with reversibility after bronchodilator confirms asthma.
- Peak Expiratory Flow Rate (PEFR) – simple, portable test; variability > 20 % over 2 weeks suggests asthma.
- Allergy testing – skin prick tests or specific IgE to identify triggers.
- Complete Blood Count – eosinophil count may be elevated in allergic asthma. Book CBC
- Chest X-ray – usually normal in asthma; helps rule out other causes like TB or pneumonia.
Treatment Options#
Inhalers (mainstay of treatment):
- Reliever (SABA) – salbutamol inhaler for quick relief during attacks.
- Controller (ICS) – inhaled corticosteroids (budesonide, fluticasone) taken daily to prevent attacks. This is the most important treatment for persistent asthma.
- Combination inhalers (ICS + LABA) – for moderate-severe asthma (budesonide-formoterol, fluticasone-salmeterol).
- LAMA – tiotropium added for severe uncontrolled asthma.
Important: Inhalers are safe, effective, and deliver medication directly to the lungs with minimal side effects. The common Indian belief that "inhalers are addictive" is a myth. Using inhalers is far safer than taking oral steroids.
Additional measures: Leukotriene receptor antagonists (montelukast), allergen avoidance, and immunotherapy for specific allergies.
Prevention#
- Identify and avoid personal triggers – keep a symptom diary.
- Use allergen-proof mattress and pillow covers to reduce dust mite exposure.
- Avoid smoking and exposure to secondhand smoke and biomass fuel (chulha) smoke.
- Get annual influenza vaccination – respiratory infections can trigger severe attacks.
- Keep rescue inhaler accessible at all times; have a written asthma action plan.
When to See a Doctor#
Consult a pulmonologist if you need your reliever inhaler more than twice a week, wake up at night due to coughing or wheezing, or if asthma limits your daily activities. Seek emergency care for severe breathlessness (unable to speak in sentences), blue lips or fingertips, PEFR below 50 % of personal best, or if the reliever inhaler provides no improvement.