Asthma affects over 300 million people globally, yet it is still one of the most overlooked chronic conditions. It goes beyond the wheezing; is a constant fight against elusive triggers, sudden exacerbations, long lasting misconceptions, and prevailing myths. Understanding asthma means knowing the reasons, identifying the symptoms, and knowing how to manage it. Because every single breath is vital.
Asthma is a syndrome characterized by airflow obstruction affecting people of all ages. It is caused by inflammation and muscle tightening around the airways, which makes it harder to breathe. According to the 2019 Global Burden of Disease (GBD) report, India contributes to an estimated 12.9% of global asthma cases (34.3 million). The country’s unique mix of a distinct combination of pollen, seasonal dust, indoor smoke from biomass fuels, and outdoor pollution, asthma is both prevalent and challenging to manage.
Because of stigma, low awareness, and restricted access in rural areas, more than 70% of cases go undiagnosed, and only a small percentage of patients use inhalers correctly. If prevention, early diagnosis, and affordable treatment—particularly the availability of inhalers—are not prioritized nationally, the prevalence of asthma is predicted to increase in India, which is home to many of the most polluted cities in the world.
Asthma is associated with a specific chronic inflammation of the mucosa of the lower airways. The airway mucosa is infiltrated with activated eosinophil and T lymphocytes, and there is activation of mucosa mast cells. In asthma, the airways become hyper-reactive—like an overly sensitive alarm system. When exposed to triggers such as dust, pollen, smoke, or cold air, the airway muscles tighten, the lining swells, and thick mucus floods in. This triple assault narrows the bronchial tubes, making every breath a struggle. The result is the hallmark wheeze, chest tightness, and shortness of breath. Left unchecked, repeated inflammation can remodel the airway, making attacks more frequent and harder to control over time.
Asthma is characterized by episodic and reversible symptoms resulting from airway hyper responsiveness and inflammation. The cardinal features include:
- Wheezing– a high-pitched, musical sound, most prominent during expiration.
- Cough – often nonproductive, worse at night or in the early morning, and sometimes the sole presenting symptom.
- Dyspnea- breathlessness.
- Chest tightness– making it difficult to breathe deeply, typically intermittent.
Symptoms often vary over time and in intensity, are precipitated by specific triggers (e.g., allergens, exercise, cold air, respiratory infections, irritants), and are relieved—at least partially—by bronchodilators.
Many factors have been linked to an increased risk of developing asthma, although it is often difficult to find a single, direct cause. Asthma is a heterogeneous disease with interplay between genetic and environmental factors.
Risk Factors
- Endogenous– Genetic Predisposition, Atopy, Airway Hyper responsiveness, Gender, Ethnicity, obesity, early viral infections.
- Environmental– Indoor and Outdoor Allergens, occupational sensitizers, Passive Smoking, Respiratory Infections, air pollution, Diet( diets low in antioxidants such as Vit C and Vit A, magnesium, selenium, omega-3, are associated with increased risk of asthma. Vitamin D deficiency may also predispose to the development of asthma), Dampness and mold exposure.
- Triggers- Allergens, Upper Respiratory Tract viral infections(like Rhinovirus, RSV, Coronavirus), Exercise and hyperventilation, Cold Air, Drugs like Beta Blockers, aspirin, Stress, irritants( household sprays , paint, fumes etc).
When it comes to asthma, misinformation can choke the truth — let’s clear the air with research-backed facts.
Myths vs Facts:
Myth: Inhalers are addictive.
Fact: GINA 2024 – Inhalers are safe, non-addictive, and life-saving.
Myth: Only kids get asthma, and they outgrow it.
Fact: Global Asthma Report 2022 – Asthma can start at any age; many adults have relapses.
Myth: Asthma patients should avoid exercise.
Fact: Regular, controlled exercise improves lung health.
Myth: Asthma is caused only by allergies.
Fact: Pollution, infections, and occupational exposures are major triggers too.
Myth: You can stop medicines when you feel fine.
Fact: Stopping inhalers causes loss of control in up to 80% of patients.
Myth: Asthma is contagious.
Fact: WHO 2023 – It’s not infectious; it’s an inflammatory airway condition.
Myth: If I feel fine. I do not need my inhaler.
Fact: Asthma can still cause silent inflammation even without symptoms.
Myth: Steroids used in asthma are harmful like bodybuilder steroids.
Fact: Inhaled corticosteroids are low-dose, targeted medicines with minimal side effects.
Myth: Herbal or alternative remedies can cure asthma.
Fact: There is no cure. Only scientifically proven medicines can control it effectively.
Myth: Inhalers are only for severe asthma.
Fact: Inhalers are essential even for mild asthma to prevent worsening.
Myth: Certain “cold” foods like bananas, yogurt, citrus fruits and ice cream cause asthma.
Fact: These foods do not cause asthma.
Asthma is diagnosed through a combination of clinical history, physical examination, and objective lung function testing.
Clinical history like symptom pattern, variability, triggers, reversibility (relief with bronchodilator use). Physical examination, Objective tests like Spirometry – Demonstrates airflow limitation (reduced FEV₁/FVC ratio) and reversibility (increase in FEV₁ ≥12% and ≥200 mL after inhaled bronchodilator). Peak Expiratory Flow (PEF) – Shows diurnal variation >10% (adults) or >13% (children). Bronchoprovocation Tests, Allergy tests- Skin prick or IgE levels to identify triggers. Ruling out Differentials like COPD, bronchiectasis, heart failure, vocal cord dysfunction, and hyperventilation syndrome.
According to GINA 2024, both symptoms and objective evidence of variable airflow limitation are essential for a definitive diagnosis — symptoms alone are not enough. Recent developments in asthma management go well beyond “rescue inhalers”. Current asthma management guidelines (like GINA 2024) have placed inhaled corticosteroids (ICS), often in combination with long-acting beta-agonists (LABA), as the cornerstone of asthma therapy, with ICS-LABA fixed combinations becoming the new standard. Low-dose ICS-formoterol, delivered as needed, is now encouraged as first-line therapy for even mild asthma, largely differentiating itself from the traditional use of short-acting, speedy relief inhalers.
In cases of severe asthma, asthma therapy can include biologic agents -specific to certain inflammatory pathways -such as omalizumab, mepolizumab, and dupilumab that can improve management with dramatic impacts on everyday life. Smart inhalers, dose counters and educational tools or personalized action plans are utilized to assist management. Addressing triggers for asthma (and control) as well other factors such as allergens or environmental pollutants, is important as is continuing follow-up to allow for adjustment in therapy.
Asthma may be a lifelong condition, but research shows that the right lifestyle choices can turn the tide in a patient’s favor. Beyond inhalers and prescriptions, everyday habits — from the air we breathe to the food we eat — play a powerful role in controlling symptoms and preventing flare-ups. Preventing asthma flare-ups isn’t just about avoiding triggers. It’s also about strengthening your lungs through control, awareness, and early intervention.
The future of asthma care is moving towards precision medicine — where treatment is tailored to your genes, triggers, and lifestyle, not just your symptoms. Asthma teaches us that every breath counts; let us ensure each one is worth taking.
(Author is a medical doctor and health columnist. Feedback: [email protected])
