India has made steady and commendable progress in addressing non-communicable diseases by improving screening for diabetes and hypertension, strengthening cardiovascular care, and expanding access to chronic treatments. Yet asthma, one of the most common respiratory conditions in the country, continues to be poorly controlled at scale.
World Asthma Day serves as a timely reminder of the ongoing and urgent need particularly in India—for universal access to anti-inflammatory inhalers, which remain the cornerstone of effective asthma care.
Asthma is a chronic inflammatory condition with symptoms that change over time. Because the underlying airway inflammation is ongoing, consistent and structured management leads to far better outcomes than occasional or reaction based treatment.
The reality check: India’s asthma burden
India is home to nearly 35 million asthma patients, accounting for around 13 per cent of the global burden, and over 40 per cent of Asia’s chronic respiratory disability, with air pollution as a major cause. Urbanisation, occupational exposures, and a cultural tendency to attribute breathlessness or wheezing to seasonal changes or aging often delay clinical recognition.
Asthma prevalence among children is estimated at around 7.9 per cent, affecting school attendance, physical development, and family finances. About 82 per cent of patients with early symptoms and 70 per cent with severe asthma remain clinically underdiagnosed in India. Despite having one of the highest asthma burdens globally, India faces a striking paradox: highly effective, evidence based therapies exist, yet a large proportion of patients remain underdiagnosed and undertreated.
Delayed diagnosis leads to worsening conditions, with repeated exacerbations, and affects both patients and health systems.
The adherence gap: the silent barrier
Even when patients receive a diagnosis and are prescribed inhalers, outcomes remain poor due to a lack of ongoing treatment. Globally, only 30–70 per cent of patients adhere to inhaler therapy, and in India, non-adherence may be as high as 75 per cent.
Many patients stop treatment once symptoms improve, unaware that asthma requires sustained anti-inflammatory control. The consequences of this underuse are entirely avoidable—frequent exacerbations, repeated hospitalisations, emergency care visits, missed school and work days, and a significantly reduced quality of life. There is also a challenge of invisibility. Many patients perceive themselves as “well” until a severe episode forces medical attention, often when the disease has already progressed.
The way forward: A decade of opportunity
Anti-inflammatory inhalers are the foundation stone of asthma management. However, improving access is not just about making inhalers available; it is equally about ensuring sustained usage, correct technique, and long-term adherence. Managing asthma requires an integrated care model that brings together preventive strategies, chronic disease management, clinical intervention, and sustained follow-up, aligning primary care with specialist services, behavioral support, and technology-enabled programs that keep patients engaged over the long term.
Stronger primary care screening, wider access to spirometry, and digital diagnostics can identify patients earlier, so that when treatment begins, it is continuous, personalized, and responsive to how the condition actually evolves.
In India, asthma care is increasingly getting personalized, prioritizing anti-inflammatory reliever therapy using inhaled corticosteroids with fast acting bronchodilators over quick-relief monotherapy to reduce the risk of severe exacerbations.
The standard of care prioritises anti-inflammatory relievers or Maintenance and Reliever Therapy (MART), in which a single combination inhaler such as budesonide-formoterol is used daily for maintenance and as needed for symptom relief. For patients whose asthma remains severe or poorly controlled despite optimal treatment, targeted biologic therapies such as monoclonal antibodies are increasingly used.
Patient support programs are a core component of effective care. Personalized coaching, digital follow-ups, inhaler technique reminders, and peer networks improve adherence and address the social and behavioral barriers that clinical encounters alone cannot resolve. These programs are especially valuable in asthma, where longterm success depends not on one-time intervention but on consistent behavior over months and years.
Reframing the future of asthma care
Medical science is reshaping what management can look like in practice. AI-powered platforms, digital smart inhalers, and wearable sensors now enable real-time monitoring of physiological and environmental triggers, automate adherence tracking, detect early signs of airway deterioration, and enable remote, data-driven treatment adjustments.
The shift in these technologies is the transition from preventive to predictive care — and it changes what the clinician’s role looks like. Rather than waiting until health concerns become more advanced, the system focuses on identifying risk early—understanding who may need support, when, and why—so care can be delivered in a timely and targeted manner.
However, technology alone is not the answer. The larger goal is to to build a respiratory ecosystem where access to essential therapy is universal, adherence is actively supported, and no patient is left behind due to preventable gaps in awareness or care delivery.
India has the clinical expertise, manufacturing capability, and digital infrastructure to lead this transformation. World Asthma Day reminds us that access cannot merely be defined by treatment; lasting impact can only be achieved if it’s followed by adoption and sustained adherence. The next decade, therefore, must focus on execution—aligning policy, primary care, industry, and patient engagement to not merely to improve treatment—but to redesign the continuum of care.