Anvi Jose was 19, midway through her first year of engineering at a college in Kottayam, when a particularly humid monsoon morning triggered the worst asthma attack she had experienced in years. Her rescue inhaler was in her hostel room. By the time her roommate fetched it, she was already in the poly clinic near the college, struggling to speak. What made the episode worse, her doctors later told her family, was not just that the inhaler was absent, it was that Anvi had been using it incorrectly all this while.
Her story is a common one, reflecting a broader public health challenge where misinformation often keeps the most effective treatment at arm’s length. Across India, millions of asthma patients carry inhalers they barely understand, use incorrectly, or avoid altogether out of embarrassment. The consequences range from poorly controlled symptoms to hospitalisation and, in the worst cases, death.
Inhalers remain the most effective and safest tool available for managing asthma. Unlike tablets, which are absorbed into the bloodstream and affect the entire body, inhaled medication travels directly to the airways. "The dose is minimal with lesser side effects," explains Dr PS Shajahan. "It is just like using ointments for skin conditions or eye drops for ophthalmic issues — targeted drug delivery, giving drugs only to areas where the disease is."
But the device only works when used properly, and that is where India faces a serious gap.
Dr Arjun P, senior consultant in pulmonology at KIMSHEALTH Thiruvananthapuram, says the scale of the problem is stark. Errors in technique are seen in over 50% of cases in the region, he notes, and the fallout is serious – poor inhaler use leads to uncontrolled asthma, frequent hospital visits, reduced lung function, and higher mortality.
When Anvi was first prescribed a daily preventive inhaler at 14, she quietly stopped using it after a few months. She worried her classmates would think she was chronically ill. Her parents fretted that she might become "dependent" on it. These are anxieties that doctors encounter constantly.
"Inhaler stigma is very common in India, even among highly educated patients," says Dr Shajahan. He draws an analogy that cuts through the fear most effectively: needing a long-term inhaler for asthma is no different from wearing spectacles to see clearly, or using insulin for diabetes. "No one says they are addicted to spectacles or insulin."
The prolonged need for inhalers, he emphasises, reflects the chronic nature of asthma, not any habit-forming quality of the medicine.
There are also patients who turn to unproven remedies, including the fish-swallowing practice still prevalent in parts of India, driven by a belief that modern medicines carry dangerous side effects. Dr Shajahan is direct – the treatment for asthma has vastly improved with inhaled medicines, and the safety profile of inhaled drugs is considerably better than oral alternatives.
Dr Arjun advocates for structured patient education programmes, led by doctors, nurses, or respiratory therapists, that go beyond simply handing a device to a patient. Patients need to learn correct technique, understand how to avoid triggers, manage humidity at home using dehumidifiers, and even dispose of used inhalers responsibly. Vaccination against influenza and pneumonia, he adds, is strongly recommended for all asthma patients.
Anvi’s inhaler now follows her everywhere in her bag. After a session with a respiratory therapist who walked her through her technique step by step, she realised she had been firing the spray a half-second too late, and never holding her breath long enough. A simple correction. A significant difference.