Breathing Between Attacks

On World Asthma Day, observed on May 5, focus once again turns to a persistent gap in respiratory care. Access to anti-inflammatory inhalers, the foundation of asthma treatment, remains uneven across the country. In many clinics, asthma management is still reactive, with patients seeking help only after symptoms become severe.

This year’s theme, centred on access, raises a simple question. If asthma is manageable, why are so many still struggling to control it?

The treatment exists. The access does not

Asthma is not an unknown disease. It is a chronic condition driven by airway inflammation, and its management is well established. “Anti-inflammatory inhalers, especially inhaled corticosteroids, are the foundation of treatment. They reduce symptoms, prevent flare-ups, and lower the risk of hospitalisation,” says Dr Vijay Kumar Chennamchetty, Senior Consultant Pulmonologist, Apollo Hospitals. Yet, access to these inhalers remains inconsistent. “Despite their proven benefits, these life-saving inhalers are often underused or inaccessible due to factors such as high costs, limited availability in rural areas, and lack of awareness,” says Dr Vijay Kumar.

Many patients rely on quick-relief inhalers instead. These provide immediate comfort but do not treat the underlying inflammation.

“In many cases, patients rely heavily on quick-relief inhalers, which provide temporary relief but do not address the underlying inflammation, a practice that can lead to worsening disease over time,” he adds.

A system built around emergencies

The pattern is familiar to pulmonologists. “Most patients reach me only after an attack. That itself is the problem,” says Dr Gangadhar, Pulmonologist, Medicover Hospitals. Preventive care is often delayed or discontinued. Patients stop medication once symptoms ease, assuming the condition is resolved. “The first thing patients ask when I prescribe a preventive inhaler is whether they can stop it once they feel better,” he says. “That misconception alone is responsible for a significant share of repeat emergency visits.”

This approach turns asthma into a cycle of crisis rather than control.

Under-prescribed, underused

The gap is not just patient behaviour. It begins earlier. “Inhaled corticosteroids remain under-prescribed at the GP level, partly due to unfamiliarity with asthma severity grading, and partly because patients resist the word ‘steroid’,” says Dr Gangadhar.

Many patients with mild or moderate asthma are treated only with reliever inhalers. Preventive therapy is never introduced. By the time they reach a specialist, the condition is already poorly managed.

Cost is only part of the story

Generic inhalers have improved affordability. But access is not only about price. “Generics have helped, but cost is not the only barrier,” Dr Gangadhar notes. Technique plays a role. So does perception. Inhalers are often seen as a sign of weakness or chronic illness. Children hesitate to use them at school. Adults avoid them in public. The idea of daily medication without visible symptoms also reduces adherence. “A patient who uses a reliever only when breathless will never achieve disease control. Consistent use of preventive therapy is what separates managed asthma from crisis-driven asthma,” he says.

The role of awareness

For Dr Vijay Kumar, improving access goes beyond affordability. “Improving access is not merely about affordability, but also about education and healthcare infrastructure. Early diagnosis, regular follow-ups, and patient awareness about correct inhaler use are equally vital.” Misconceptions remain widespread. Fear of dependency, concerns about side effects, and lack of understanding about how inhalers work continue to hold patients back.

In a country where pollution, seasonal changes, and urban living are increasing respiratory issues, the burden is only rising. “Children and the elderly remain particularly vulnerable,” he points out.

A preventable gap

Asthma is controllable. That is not the issue. The issue is consistency. Preventive treatment requires regular use, follow-up, and understanding. Without it, patients move from one episode to the next, never fully stabilising. “World Asthma Day serves as a reminder that no one should struggle to breathe due to lack of access to basic treatment,” says Dr Vijay Kumar.

What’s going wrong

l Preventive inhalers are under-prescribed at early stages

l Patients stop treatment once symptoms reduce. Reliever inhalers are overused

l Misconceptions about “steroids” reduce acceptance

l Social stigma affects adherence

What needs to change

l Early diagnosis and routine follow-up

l Wider availability of inhaled corticosteroids

l Clear patient education on long-term use

l Training on correct inhaler technique

l Integration of asthma care into primary health systems