There’s something in the air in India’s cities.

India is home to 15-20 million asthmatics, and, in light of the recent World Health Organization (WHO) report that lists New Delhi as the world’s most polluted city, this number is only likely to grow. Getting smart on asthma has never been more important. The condition can be debilitating—but with the right knowledge and treatment, it doesn’t have to be.

WHAT IS ASTHMA?

Asthma is a condition that constricts one’s airways. It can affect both children and adults, though onset is most common in childhood. Asthma is generally caused by allergies, an often genetic intolerance of a certain substance, or by environmental factors, like pollution, which trigger episodes, or ‘attacks’ of difficulty breathing.

“It’s often very difficult to pinpoint the exact reason why these attacks occur,” says Dr. Puneet Khanna, an asthma specialist at the BLK super specialty hospital in New Delhi. “But the increasing pollution levels in our cities, repeated exposure to dust, pollen, smoke, animal dander, cigarette fumes—all this can trigger an attack in those who are already predisposed to the condition.”

But outdoor allergens aren’t the only triggers. According to the WHO, the strongest risk factor for asthma, especially for infants, is exposure to indoor allergens.

“It’s a vicious cycle,” Dr. Khanna explains. “Pollution can drive us indoors, but even here, there’s dust from curtains, carpets, old furniture.”

Poor ventilation, recirculated air from A/C units, and exposure to cockroaches, pets and animal dander, can also contribute, he adds.

The solution, however, is not obsessive cleanliness, which can also cause people to develop asthma.

“Our obsession with hygiene and early and frequent use of antibiotics in children is one of the reasons why asthma is increasing in children in the last few decades,” says Dr. Vikram Jaggi, Medical Director of the Asthma Chest and Allergy Centre in New Delhi.

Earlier, he explains, children would often play outdoors, exposed to dust and grime, bacteria and worms, which challenged their immune systems and helped them develop natural defenses. But in today’s cloistered lifestyles, parents tend to be paranoid about what kids come into contact with, inhibiting such development. Now, with less hardy immune systems, children are bothered by particles as natural as house dust and pollen and are more prone to asthma.

Dr. Khanna says this kind of indoor living may also contribute to asthma in another way: By keeping kids out of the sunlight, parents might be fostering Vitamin D deficiencies, which have also been linked to asthma.

DIAGNOSIS AND MANAGEMENT

For adults and children alike, an attack always starts with heavy, laboured breathing. A raspy, wheezy, or whistling sound can accompany every rise and fall of the chest.  Asthma can be frequently misdiagnosed, as other symptoms mimic the common cold or flu: a stuffed or running nose, watering eyes, frequent cough (especially at night), an inflamed throat, and, occasionally, a fever. It’s not unusual to feel extreme drowsiness and even chest pain during an attack.

If you think your child may have this condition, you can request something called a peak flow monitoring test, which doctors use to assess lung capacity. Your child will blow into a tube that has a meter on the side—simple and not scary, like blowing up a balloon. For a more accurate diagnosis, meant for older children, a spirometry breathing test is best, says Dr. Jaggi. Your child will blow into a machine which measures lung capacity more accurately to confirm the condition and its severity. (The test runs anywhere from Rs. 1000-1500.)

Once diagnosed, asthma can be managed so that attacks are not as frequent or intense. First, try to keep track of what normally triggers an attack, so you can avoid exposure as much as possible. If it’s impossible to tell, consider a skin prick test, which can help identify severe allergies. The test presses a series of small, dulled needles dipped in common allergens into one’s back. Depending upon the resulting swelling or inflammation, doctors can determine one’s individual allergies.

Second, if prescribed an inhaler, learn how to use or help your child use it effectively. An inhaler is the cornerstone of asthma treatment. You may need a metered dose inhaler, which measures out the medication in small, structured doses inhaled in puffs. Or, for very bad attacks or for very young children, a nebulizer, which vaporizes liquid medicine that is breathed in through a mask over the lips and nose.

Regardless of type, these inhalers deliver varied doses of steroids that help open airways. While this may sound concerning, these types of steroids have no negative side-effects.

“Your child will not become obese, sluggish or suffer from high blood pressure, as is the case when oral steroids are abused,” says Dr. Khanna.

He does advise, however, a quick rinse of the mouth after using an inhaler, as the medicine can linger in the mouth and teeth, causing dental problems. Also, make sure the inhaler is cleaned after each use, to avoid contracting an infection from lingering germs.