Asthma in seniors could be India’s next health crisis: Here's what you can do

In India, breathlessness in older adults is often dismissed as a natural part of ageing. Fatigue, wheezing or a persistent cough may be attributed to heart problems, seasonal allergies or simply a body slowing down but what frequently goes unnoticed, however, is that these symptoms could be indicative of asthma, a condition many still associate with childhood.

In an interview with HT Lifestyle, Dr Namita Mittal, Medical Superintendent - Antara Assisted Care Services Ltd at Antara Senior Care, shared, “Projections suggest that by 2050, over 25 million Indian seniors could be living with asthma, a number driven by the dual pressures of an aging population and worsening environmental conditions. This quiet oversight carries consequences, as asthma in seniors is both under-recognised and under-treated, despite carrying some of the highest health risks.”

She cautioned, “As the population ages and environmental challenges mount, India is poised to face a significant increase in asthma-related illness among its older citizens. It’s a trend that deserves more clinical attention and thoughtful, age-sensitive care.”

A distinct set of challenges

Asthma behaves differently in seniors. Dr Namita Mittal explained, “Ageing lungs naturally lose some of their elastic recoil, with respiratory muscles weakening over time. These changes affect how air moves in and out of the lungs, making older adults more susceptible to airway narrowing and breathlessness. Complicating this is the fact that symptoms like chest tightness or wheezing often overlap with other age-related health issues, including heart failure, chronic obstructive pulmonary disease (COPD), and acid reflux.”

Adding to the complexity is the issue of under-diagnosis. Dr Namita Mittal elaborated, “Many older adults may not report breathing difficulties, assuming it is normal for their age or misattributing it to other conditions. In clinical practice, it is not uncommon to encounter patients whose asthma went undetected for years, simply because no one thought to test for it. Spirometry, the standard test for asthma, poses its own challenges in the elderly. Physical frailty, cognitive limitations, and fatigue can affect a senior’s ability to perform the test reliably. However, with patient instruction and support, meaningful results are possible, and early detection remains crucial.”

The role of pollution and environment

India’s escalating air pollution problem significantly worsens respiratory health, especially for older adults. Dr Namita Mittal shared, “Cities like Delhi, Lucknow, and Kanpur routinely record air quality levels several times higher than World Health Organization standards. Beyond urban areas, the widespread use of biomass fuels in rural homes exposes seniors to prolonged indoor air pollution, a factor closely linked to asthma exacerbations.”

What often escapes public discourse is that older adults are especially vulnerable to the cumulative effects of air pollution. Dr Namita Mittal pointed out, “Years of exposure reduce lung resilience and aggravate pre-existing conditions. Emerging data also suggests that pollution-induced asthma in seniors tends to be more severe and less responsive to standard treatment, making preventive strategies even more important.”

Barriers to effective management

Managing asthma in older adults extends beyond prescribing inhalers. Dr Namita Mittal informed, “Comorbidities such as diabetes, hypertension and osteoarthritis often complicate treatment regimens. Many medications used for other chronic illnesses can interfere with asthma control, while long-term corticosteroid use raises additional concerns like bone loss, cataracts, and blood sugar fluctuations.”

Medication adherence is another frequent hurdle. Dr Namita Mittal said, “Seniors may struggle with inhaler technique due to arthritis, tremors, or visual impairment. Cognitive decline or memory lapses can lead to missed doses, while the financial burden of long-term inhaler use remains a deterrent for many, particularly in rural and lower-income households.”

Addressing these challenges calls for a patient-centric, simplified approach. Dr Namita Mittal said, “Using combination inhalers that reduce dosing frequency, incorporating spacers, or opting for nebulizer treatments where needed can make a meaningful difference. Supportive tools like home-use pulse oximeters and symptom trackers, available through elder care services and health platforms, can also aid in monitoring and early intervention.”

Correcting misconceptions

Asthma in India continues to be surrounded by misconceptions, some of which delay appropriate care. Dr Namita Mittal highlighted, “A prevailing belief persists that asthma is a condition of the young and that inhalers are addictive or only meant for severe cases. This often discourages older patients from seeking timely treatment or adhering to prescribed regimens.”

In clinical experience, simply addressing these beliefs through clear, patient-specific education improves outcomes considerably. Dr Namita Mittal asserted, “Involving family caregivers is equally essential, as they play a vital role in supervising medication use, recognising symptom escalation, and ensuring follow-ups.”

A broader, more compassionate approach

Asthma management for seniors must extend beyond pharmacotherapy. According to Dr Namita Mittal, environmental control remains key, thereby using air purifiers during peak pollution days, avoiding exposure to biomass smoke and minimising triggers like dust and allergens in the home.

The expert suggested, “Pulmonary rehabilitation programs, gentle physical activity and vaccination against respiratory infections further strengthen a senior’s ability to manage their asthma. An often overlooked but critical factor is social isolation. Loneliness and limited social engagement can negatively affect disease control by reducing motivation for self-care and exacerbating psychological stress, which in turn may worsen asthma symptoms. Regular social interaction, caregiver involvement and community-based health initiatives can help mitigate this risk.”

Asthma in older adults is a growing public health issue that cannot be ignored. Dr Namita Mittal concluded, “The combination of India’s ageing population, persistent environmental hazards and frequent gaps in geriatric care creates a perfect storm for underdiagnosed and undertreated asthma among seniors. Early recognition, accessible diagnostic services, and a commitment to age-appropriate, individualized care are vital. On this World Asthma Day, it is worth reflecting that effective geriatric asthma care is not just about managing symptoms but about preserving dignity, independence, and quality of life for India’s elders.”

Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.