Mumbai's Chronic Respiratory Stress: A Growing Concern for Asthma Patients

For years, I gave my asthma patients the same advice: Check the air quality index before stepping out, avoid peak traffic hours, stay indoors on bad pollution days. It is advice I no longer give. Not because it is medically inaccurate, but because for most people, it is meaningless. They cannot choose their commute. They cannot move away from the construction site outside their building. Telling a Mumbaikar to avoid pollution is telling them to avoid Mumbai.This World Asthma Day, the Global Initiative for Asthma has called access to anti-inflammatory inhalers an urgent unmet need. They are right. Approximately 34 million people in India live with asthma, around 13 per cent of the global burden, and yet this country suffers three times the global asthma mortality rate. Findings from the Lung Care Foundation’s research show that nearly one in three children in highly polluted settings had evidence of airflow obstruction, yet only about 3 per cent were using inhalers. This gap between disease and diagnosis reflects a deeper issue: Patients continue to rely on rescue inhalers or cough syrups / temporary tablets, while underusing inhaled corticosteroids that address the underlying inflammation.Those who depend only on reliever medication are far more likely to end up in emergency rooms or worse. The medicine exists. The knowledge exists. Closing that treatment gap is work worth doing and worth saying plainly on a day like today.But in a city like Mumbai, the treatment conversation cannot be the whole conversation. Because over the past decade, I have watched something change in my clinic that no inhaler adjustment can fully explain. Asthma exacerbations are coming more often, more severely, and across more of the year. And they are happening in patients who are doing everything right. The seasons have shifted. What was once an October-to-February phenomenon of worsening symptoms has become, for many, a year-round reality.The data now confirms what clinicians here have long observed. According to Central Pollution Control Board data, Mumbai recorded only seven ‘good’ air quality days across five winter seasons between 2021 and 2026, with most clustered in a single year. A coastal city that once relied on sea winds to clear its skies has quietly arrived at a condition of chronic respiratory stress for its residents.Fine particulate matter (PM2.5) does not behave like dust or pollen. It is small enough to bypass the nose and throat entirely and settle in the deepest airways, where it triggers the same inflammation that asthma medication works to suppress.The medicine and the environment are working against each other. Prescribing the right inhaler, to the right patient, at the right time saves lives and that message needs to reach every general practitioner in Maharashtra. Acknowledgement is where change begins. Not blame, not demand, simply the honest recognition, in clinical notes, in patient conversations, in public health messaging, that the air Mumbaikars breathe is part of their diagnosis.Dr Mehul Thakkar is a senior pulmonologist