Asthma is a long-term condition in which the airways become inflamed and narrow, causing wheezing, coughing, chest tightness and breathlessness. It is controllable with the right inhalers.
Go to hospital immediately if you notice
- Being too breathless to complete a full sentence
- The reliever inhaler not helping, or wearing off within an hour or two
- Lips, tongue or fingertips looking blue or grey
- Struggling so hard to breathe that the skin sucks in between the ribs or at the neck
- Drowsiness, confusion or exhaustion during an attack
- These mean go to hospital immediately, or call 112
Overview
In asthma the airways are persistently inflamed and sensitive. When something irritates them, the muscles around them tighten and the lining swells and produces mucus, so less air gets through. That is what causes wheezing and breathlessness.
Symptoms come and go. Between episodes many people feel completely normal, which is exactly why treatment often gets abandoned.
Asthma cannot usually be cured, but it can be controlled well enough that most people live entirely normal lives — including playing sport at a high level.
Air pollution, dust and smoke make asthma considerably harder to control, which matters a great deal in Indian cities.
Symptoms of Asthma
- Wheezing — a whistling sound when breathing out
- Cough, often worse at night or in the early morning
- Breathlessness
- A tight feeling in the chest
- Symptoms triggered by dust, smoke, cold air, strong smells, exercise, pollen or a cold
- Waking at night because of coughing or breathlessness, which is an important sign that asthma is not controlled
What causes it
- Long-term inflammation of the airways, which makes them over-sensitive
- A combination of inherited tendency and environment rather than one single cause
- Common triggers include dust mites, smoke, air pollution, cold air, pollen, strong perfumes, exercise and viral infections
Who is at higher risk
- A family history of asthma, eczema or allergies
- Having eczema or allergic rhinitis yourself
- Smoking, or exposure to someone else's smoke — including in the womb
- Air pollution and burning of biomass or waste
- Certain workplace exposures such as dust, chemicals and flour
- Being significantly overweight
Tests and diagnosis
These are the tests doctors commonly use. Which ones you need depends on your symptoms.
- Your symptom pattern and history, which are the most important part
- Spirometry — a breathing test measuring how much air you can blow out and how fast
- Checking whether the breathing test improves after a reliever inhaler
- Peak flow readings, sometimes recorded at home over a couple of weeks
- Allergy testing in some people, to identify triggers
Treatment
- Asthma treatment comes in two kinds, and understanding the difference matters enormously.
- A reliever inhaler, usually salbutamol, opens the airways within minutes during symptoms. It does not treat the underlying inflammation.
- A preventer inhaler, usually containing a low-dose steroid, reduces the inflammation and is taken every day even when you feel completely well. This is what actually keeps asthma under control.
- If you need your reliever more than about twice a week, your asthma is not controlled and your treatment needs reviewing — do not simply use more reliever.
- Inhaler technique determines how much medicine reaches the lungs. Ask to be shown, and ask about a spacer, which improves delivery considerably.
- Ask your doctor for a written action plan describing what to do when symptoms worsen.
Prevention
- Take the preventer inhaler every day as prescribed, even when you feel fine
- Identify and reduce your triggers — bedding, dust, smoke, strong smells
- Do not smoke, and keep your home free of others' smoke
- Check air quality on bad-pollution days and limit outdoor exercise then
- Keep up with flu vaccination as your doctor advises
- Keep your reliever inhaler with you
When should you see a doctor?
See a doctor if you have a cough that will not settle, wheezing, or breathlessness on exertion — especially if symptoms wake you at night. Treat an attack as an emergency and go to hospital if you cannot speak a full sentence, if the reliever is not working, or if lips or fingertips look blue.
Frequently Asked Questions
Are asthma inhalers addictive?
No. This is one of the most damaging myths about asthma in India. Inhalers are not habit-forming. They deliver a very small dose directly to the lungs, which is why they cause far fewer side effects than tablets. People who avoid inhalers out of fear of addiction end up with worse-controlled asthma and more hospital visits.
What is the difference between a reliever and a preventer inhaler?
The reliever, often a blue inhaler, opens the airways within minutes when you have symptoms. The preventer, taken daily, reduces the underlying inflammation so symptoms happen less often. The reliever helps you today; the preventer is what keeps you well.
Can asthma be cured?
It usually cannot be cured, but it can be controlled so well that it barely affects daily life. Some children's asthma improves considerably as they grow, though it can return later.
Can I exercise with asthma?
Yes, and you should. Well-controlled asthma is compatible with all kinds of sport, including at professional level. If exercise reliably brings on symptoms, tell your doctor — that usually means the asthma needs better control, not that you should stop exercising.
Questions to ask your doctor about Asthma
Pick the three that matter most to you and write them down before your appointment. Consultations are short, and almost everyone forgets at least one.
- Which of my inhalers is the reliever and which is the preventer?
- Can you watch me use my inhaler and check my technique?
- Should I be using a spacer?
- How often is it normal to need the reliever?
- Can I have a written action plan for when symptoms get worse?
- What are my triggers likely to be, and what can I do about them?
- At what point should I go to hospital rather than wait?
What this costs, and what is free
Government hospitals and health and wellness centres provide screening and treatment for blood pressure, diabetes and common long-term conditions at little or no cost.
Eligible families are covered up to ₹5 lakh per year for hospitalisation under Ayushman Bharat PM-JAY. Day-to-day medicines are not covered by PM-JAY, but Jan Aushadhi Kendras sell them at much lower prices.
Generic versions are sold at Jan Aushadhi Kendras at substantially lower prices than branded packs of the same medicine.
The main long-term cost is medicines taken daily for years, not the consultation. Asking your doctor to write generic names, and buying at a Jan Aushadhi Kendra, is usually the single biggest saving available.
Source: Ayushman Bharat PM-JAY, National Health Authority, Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP)
Prices and scheme rules change. Confirm current details with the hospital or Kendra before you rely on them.