It has been said that India accounts for about 13 per cent of the global asthma burden, but “reports three times higher mortality and more than two times higher disability-adjusted life years (DALYs) than the global proportion of asthma burden.”  The same study also highlighted that the earlier Asia Pacific Asthma Insight and Management study “found that dust and air pollution caused asthma in nearly half of the asthmatic patients” in India.

With this clear link between air pollution and asthma, and the air quality index in many Indian cities frequently breaching hazardous levels, it has become more important than ever to understand the disease, how air pollution affects it, and what can be done to manage it.

What is Asthma?

Asthma is a major noncommunicable disease (NCD) affecting both children and adults and is the most common chronic disease among children globally, in which the airways in the lungs become inflamed, swollen, and narrowed. These changes can produce excess mucus, making breathing difficult and often triggering coughing, chest tightness, wheezing, or shortness of breath. While some people experience mild symptoms, for others, asthma can be a serious problem, interfering with daily life and potentially causing life-threatening attacks.

According to the World Health Organisation, asthma affected an estimated 26.2 crore people in 2019 and caused 4.55 lakh deaths worldwide. In India, the problem is particularly severe, because while the prevalence of the disease has marginally reduced between 1990 and 2021, the number of deaths due to asthma has risen. In fact, India now accounts for approximately 46 per cent of all asthma-related deaths in the world.

Although asthma cannot be cured, its symptoms can be effectively controlled with proper medication, lifestyle adjustments, and regular medical monitoring. Asthma varies widely between individuals. Some may have only occasional attacks or symptoms triggered by specific circumstances, such as exercise, while others may face persistent difficulties.

Asthma can be triggered by several factors. Respiratory infections, exposure to airborne allergens like pollen, dust, mould spores, or pet dander, as well as air pollutants, smoke, and cold air, are common triggers. Occupational exposure to chemical irritants and strong emotional stress may also worsen symptoms.

Certain medications, including aspirin and other nonsteroidal anti-inflammatory drugs, and conditions like acid reflux can exacerbate asthma. Risk factors that increase susceptibility include a family history of asthma, other allergic conditions such as hay fever or atopic dermatitis, obesity, smoking, exposure to second-hand smoke, and environmental pollution.

The complications of uncontrolled asthma are significant. They include chronic interference with sleep and work, frequent hospitalisations, permanent narrowing of airways, and side effects from long-term medication use. Thus, proper management is critical to prevent both short-term attacks and long-term damage.

How does air pollution worsen the asthma crisis?

Asthma prevalence in India has been steadily rising over the years, and multiple studies point to a combination of lifestyle, genetic and environmental factors. A 2016 study highlighted a link between sedentary lifestyles and asthma, while others have shown the association between obesity and asthma. However, doctors underline the impact of allergens and pollution on asthma.

Dr Harish Chafle, Senior Consultant Chest Physician and Bronchoscopist at Gleneagles Hospitals, explained that the major cause of asthma is primarily allergic in nature. He noted that seasonal changes, such as the transition from rainy to winter or winter to summer, significantly affect the prevalence of allergens in the environment. “Nowadays, prolonged rains, even into late November, combined with temperature changes, contribute to increased air pollution in cities like Delhi and Mumbai,” he said.

Dr Chafle also highlighted the role of indoor air pollution. He pointed out that habits such as burning incense or mosquito coils indoors can drastically worsen air quality. “One mosquito coil burnt is equivalent to smoking hundreds of cigarettes,” he noted, emphasising the hidden dangers inside homes. He further explained that construction and demolition activities across urban areas add to dust and allergen exposure, increasing the overall antigenicity of the air.

Regarding rural areas, he observed that children exposed to smoke from traditional chulhas or burning wood at home are at higher risk of developing asthma or chronic obstructive pulmonary disease.

On the role of air pollution in triggering asthma, Dr Chafle explained, “Air pollution increases the presence of allergens, viruses, and bacteria in the air. When inhaled, these can trigger a hyper-response in the airways, leading to bronchospasm and inflammation. This reduces the airway diameter, making breathing difficult and causing classic asthma symptoms.” He stressed that both indoor and outdoor pollutants play a critical role in this process, particularly in densely polluted cities.

A 2023 study examining women aged 15–49 years used satellite data on particulate matter (PM2.5) alongside the National Family Health Survey (NFHS-4) to assess the impact of outdoor air pollution on asthma prevalence. The researchers reported that “both indoor pollution as well as outdoor air pollution are important risk factors for asthma in women as both independently increase the probability of asthma among this group.” The study also highlighted that smoking, second-hand smoke exposure, diet, and obesity were additional contributors to asthma risk.

A broader 2025 study, covering over 1.27 lakh participants across nine sites in India, including children, adolescents, and adults, examined genetic, environmental, personal health, and dietary risk factors. It found that parental history of asthma increased the risk in adults, while hay fever was a strong predictor in children and adolescents. Environmental triggers such as damp spots at home, use of coal, kerosene, or cow dung as cooking fuel, and exposure to truck traffic significantly increased the likelihood of asthma. Dietary factors, including consumption of bananas, curd, ice creams, and use of mosquito repellents, also emerged as risk factors. The study identified “genetic, environmental, personal health, and dietary risk factors for asthma in India, underscoring the need for public health measures to improve air quality, promote dietary awareness, and reduce indoor hazards.”

Regional variations were also noted. Jaipur, with its dry, arid climate and frequent sandstorms, showed a high prevalence of asthma among adolescents and adults. Conversely, Bikaner, another desert city with extreme climatic conditions and sandstorms, exhibited relatively lower asthma prevalence, potentially due to “lower urban air pollution levels.”

These insights are particularly concerning when you account for the fact that many of the cities with the most toxic air are in India. At about 3 pm on November 13, 52 of the top cities with the most polluted air were in India, with the worst of the lot having AQI levels “49x above standard.”

What is India doing to curb the asthma crisis?

The Government of India has implemented several measures under the National Health Mission (NHM). According to a 2023 Lok Sabha reply, the Department of Health and Family Welfare provides technical and financial support to states and Union Territories under the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS). The program aims to strengthen healthcare infrastructure, develop human resources, promote awareness, enable early diagnosis, and provide treatment and referral services for NCDs, including asthma and Chronic Obstructive Pulmonary Disease (COPD).

Under this program, 708 NCD clinics have been established at the district level and 5,671 at the Community Health Centre level to provide localised care for respiratory diseases. Patients with acute respiratory infections, COPD, and asthma are treated at tertiary care facilities, including medical colleges, central institutes like AIIMS, central government hospitals, and private sector hospitals under PMJAY and state-based health schemes.

On the preventive front, the government has promoted wellness and awareness programs through Ayushman Bharat – Health and Wellness Centres, aiming to encourage healthier lifestyles and environmental awareness at the community level. The National Centre for Disease Control has developed Information, Education, and Communication materials emphasising air pollution as a major risk factor for respiratory diseases, which have been shared with all states and Union Territories.

Most recently, the Centre issued an updated advisory to all states and Union Territories under its National Programme on Climate Change and Human Health (NPCCHH) to tackle air pollution-related diseases. It emphasised that children under five, the elderly, pregnant women, asthma and heart patients, and outdoor workers are at the highest risk. Healthcare facilities are advised to ensure adequate medicines, oxygen, nebulisers, ventilators, beds, and proper referral systems.

What experts say 

Dr Chafle emphasised that government measures for asthma and related respiratory conditions are effective in principle, but significant gaps remain in their implementation. “The biggest challenges are inadequate infrastructure and resources,” he noted.

He explained that only a small percentage of public health facilities have the necessary infrastructure, and there are persistent shortages of trained medical officers and specialists, particularly in rural areas. Existing staff often lack the training to manage the heavy workload of non-communicable diseases, while low community awareness, limited behavioural interventions, and data management issues further reduce program effectiveness.

On practical steps to reduce asthma risks, Dr Chafle stressed the importance of improving indoor air quality. “Avoid burning anything inside your home—no camphor, mosquito coils, paper, or wood,” he said. He also recommended maintaining greenery indoors, although he cautioned that plants must be watered carefully every 48 hours to prevent mosquito breeding.

Regarding outdoor exposure, Dr Chafle advised monitoring air quality. “If the AQI is very high, avoid going out, especially for children and the elderly, who are more prone to respiratory infections and asthma exacerbations. Morning hours with fog and smog are particularly risky, and sunlight later in the day can improve air quality somewhat.” He suggested using N95 masks when exposure is unavoidable.

Dr Chafle also highlighted the role of diet and immunity. “Stay hydrated, eat a balanced diet rich in protein, vitamin C, nuts, and foods with antioxidant properties. These help the body handle allergens or microorganisms more effectively.” He stressed the importance of timely medical intervention for those with underlying respiratory conditions: “If symptoms worsen, contact your chest physician immediately. Delaying care can lead to pneumonia and ICU admission, making recovery much harder.”

He also recommended vaccinations for high-risk groups. “Elderly patients or those with pre-existing respiratory conditions should consider vaccines like Influvac Tetra, Prevnar 20, under the guidance of a healthcare professional. Vaccination is a crucial preventive measure.”