Pollution, poor awareness, delayed diagnosis driving India’s rising asthma burden: Experts

India’s asthma burden is rising steadily as worsening air pollution, rapid urbanisation, indoor smoke exposure and poor awareness continue to fuel respiratory illnesses across the country, according to pulmonologists.

According to the Global Asthma Report and World Health Organisation estimates, India accounts for nearly 13% of global asthma cases, with experts warning that a large number of patients remain undiagnosed or inadequately treated.

Doctors say the problem is no longer confined to severe breathlessness alone, as asthma is increasingly presenting through subtle and atypical symptoms that are often ignored.

Experts warn many asthma symptoms continue to be overlooked

Pulmonologists say delayed diagnosis remains one of the biggest concerns, particularly because asthma symptoms are frequently mistaken for common cough, allergies or seasonal infections.

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Dr. Vikas Mittal, Director - Pulmonologist at CK Birla Hospital (Delhi), said symptoms such as persistent coughing, especially at night, wheezing, chest tightness, shortness of breath and fatigue during physical activity can all indicate underlying asthma.

“At times, symptoms may seem unusual, especially in children and older adults, resulting in delays in diagnosis and treatment,” he said, adding that timely medical intervention can significantly improve long-term quality of life.

Dr. Amit Kumar Mandal, Senior Director - Pulmonology at Paras Health (Panchkula), said asthma is increasingly appearing through symptoms that patients do not immediately associate with respiratory disease.

“Asthma today is increasingly presenting with symptoms that are often overlooked or misinterpreted, such as a persistent cough, throat irritation, fatigue, or disturbed sleep, rather than just classic breathlessness,” he said.

According to Dr. Murali Mohan BV, Senior Consultant, Pulmonologist at Narayana Health City (Bengaluru), many asthma patients are missed because symptoms develop gradually over months.

“A child who coughs only at night, a young professional who feels unusually fatigued, a grandmother with a persistently itchy throat and runny nose in winter — these are some of the asthma patients that we are missing out on,” he said.

Dr. Obul Reddy, Consultant Pulmonologist at Gleneagles Hospitals, added that asthma symptoms can include wheezing, chest tightness, persistent cough, fatigue, itchy throat and runny nose, especially at night, making early recognition critical for timely treatment.

Air pollution remains one of the biggest asthma triggers

Doctors said worsening air quality in Indian cities continues to aggravate asthma attacks and respiratory complications, particularly during winter months when pollution levels spike sharply.

Dr. Obul Reddy said urban centres such as Delhi and Bengaluru face a particularly high asthma burden because of deteriorating air quality, while rural regions continue to struggle with biomass fuel exposure.

“High Air Quality Index (AQI), especially above 300, significantly inflames airways, reduces lung function, and increases hospitalisations,” he said.

Dr. Vikas Mittal said that winter smog and monsoon-related humidity and mould growth often trigger seasonal spikes in asthma episodes.

Similarly, Dr. Murali Mohan BV said pollution spikes directly translate into increased emergency admissions and worsening chronic respiratory disease.

“The lung is not designed for what we are putting it through. Every spike in PM2.5 is a spike in hospital admissions,” he said.

Doctors also pointed out that active smoking and second-hand smoke exposure significantly worsen airway inflammation and increase the frequency of asthma attacks.

Childhood asthma becoming a growing concern in cities

Pulmonologists warned that asthma among children is rising rapidly in urban India because of increased exposure to pollutants, indoor allergens, infections and poor air quality.

Dr. Vikas Mittal said asthma prevalence in some Indian cities has reached nearly 30%, particularly among children exposed to pollutants, dust and indoor allergens.

He advised parents to watch for recurring cough, breathing difficulty and reduced physical activity in children, which may indicate underlying respiratory disease.

Dr. Sanchit Mohan, Consultant Pulmonologist at Kailash Hospital (Noida), said changing environmental conditions and pollution are making asthma management increasingly difficult in children.

“Triggers such as dust, smoke, weather fluctuations, and pollution can aggravate the airways and lead to frequent asthma attacks,” he said.

He stressed that asthma can be controlled effectively through regular medication, early identification of warning signs and reducing exposure to triggers.

“Simple preventive measures such as maintaining a clean, dust-free home, avoiding smoke exposure, using masks in high pollution, and ensuring good indoor ventilation can significantly reduce flare-ups,” he added.

Dr. Murali Mohan BV said allergens from dust mites, cockroaches and mould, combined with outdoor pollution and recurrent infections, are creating “perfect conditions” for early-onset asthma in children.

Doctors seek to dispel myths around inhaler use

Experts said misconceptions surrounding inhalers continue to prevent many asthma patients from seeking proper treatment or following prescribed therapy consistently.

Dr. Manisha Mendiratta, Director & Head - Pulmonology at Sarvodaya Hospital (Faridabad), said asthma management requires more than medication alone and depends heavily on awareness and trigger prevention.

“Recognising early warning signs, identifying personal triggers, and ensuring correct inhaler technique can go a long way in achieving better disease control and improving quality of life,” she said.

She added that women may also experience worsening symptoms due to hormonal changes during different life stages.

Dr. Amit Kumar Mandal said myths around inhalers remain a major barrier to effective asthma care.

“Addressing common myths around inhaler use is equally critical, as these misconceptions often prevent patients from seeking timely and effective care,” he said.

Dr. Sanchit Mohan said many parents continue to wrongly believe inhalers are addictive for children.

“One of the most common myths is that once a child starts using inhalers, they become addicted to them. This is completely untrue,” he said.

“Inhalers are not habit-forming; they are essential for controlling airway inflammation.”

Early diagnosis and cleaner air key to reducing asthma burden

Doctors said asthma can be effectively managed when diagnosed early, treated consistently and supported by cleaner environmental conditions.

Experts stressed that improving air quality, creating smoke-free environments, encouraging early medical consultation and increasing awareness around atypical symptoms are all critical to reducing asthma-related complications in India.

“The good news is that asthma is manageable when caught early, treated properly, and supported by cleaner air,” Dr. Murali Mohan BV said.

Pulmonologists added that stronger public awareness and timely intervention could help prevent severe attacks, emergency hospitalisations and long-term lung damage for millions of asthma patients across the country.