PNS|HYDERABAD
In India’s bustling cities, where traffic fumes and construction dust often steal the spotlight in air pollution debates, a quieter yet equally menacing threat lingers within our homes. Urban asthma is on the rise, not just due to outdoor smog, but because of hidden indoor pollutants that escape everyday scrutiny. Dr Nalini Nagalla, HOD & Senior Consultant – Pulmonology and Sleep Disorders at Arete Hospitals, emphasises that what we breathe indoors—often assumed to be safe—can significantly worsen or even trigger asthma. In this in-depth conversation, she unpacks the overlooked role of indoor air quality, modern lifestyle choices and mental health in shaping respiratory health and offers practical insights for reducing asthma risks within our living spaces.
“While the smog and visible pollution outside get most of the attention, it’s what’s inside our homes that’s quietly contributing to a lot of the respiratory issues we’re seeing,” says Dr Nalini adding, “Indoor pollution is often underestimated because it isn’t visible. But it’s very real — and in many urban homes, it can be just as harmful, if not worse, than what’s outside.”
From dust mites and mold to synthetic fragrances and smoke from incense or mosquito coils, the indoor environment is filled with triggers. Poor ventilation and cooking-related pollutants only add to the toxic mix.
The Sedentary Trap: A Modern Health Crisis
Even individuals who spend most of their time indoors — such as professionals and students — aren’t safe from asthma. In fact, their lifestyle may be exacerbating it.
“It’s ironic, but the more time we spend indoors, thinking we’re avoiding pollution, the more we’re exposed to these hidden irritants,” she explains. “A sedentary lifestyle, poor diet, lack of fresh air, and chronic stress all combine to weaken respiratory health.”
Homes today, she notes, are often designed to be too “sealed” — cutting off cross-ventilation and natural sunlight. “That creates an environment where allergens thrive. Add to that long hours of screen time, minimal movement, and poor posture — and suddenly, your lungs aren’t getting the workout they need to stay healthy.”
Design Flaws: A Breeding Ground for Asthma
The modern urban home, built for style and comfort, may unknowingly worsen asthma risk.
“These days, homes are designed to look good and feel comfortable, but health often takes a backseat. When there’s little or no ventilation, all sorts of things—like cooking smoke or fumes from furniture—just linger in the air with nowhere to go.”
She points out that air conditioning, if not properly maintained, can harbor mold and dust mites. Synthetic furnishings — from vinyl flooring to foam-based upholstery — slowly emit harmful volatile compounds. “We don’t smell them after a while, but they’re still in the air,” she warns.
Everyday Products: Hidden Offenders
Items we use without a second thought — mosquito coils, incense sticks, cleaning sprays, and room fresheners — can be potent triggers.
“They may seem harmless, but they release fine particles and fumes. When you’re in a closed room, those pollutants don’t just vanish; they hang around and build up quickly.”
The problem? We’ve normalised their use. “Those everyday cleaning sprays — especially the ones with bleach or strong perfumes — can be tough on the lungs. Same goes for room fresheners. They might make your home smell fresh, but for someone with asthma, they can actually trigger symptoms.”
Stress and Stillness: A Double Whammy
Asthma isn’t just physical — it’s emotional too.
“Stress can tighten the chest, increase inflammation in the body, and even make the airways more reactive. In students and professionals, I often see asthma flares around exam times or work deadlines.”
Additionally, inactivity reduces lung capacity. “Movement is medicine — especially for the lungs. Even simple things like walking or stretching can make a difference,” she says.
Poor Adherence: A Silent Aggravator
Asthma requires consistent management. Yet, many patients falter.
“Unfortunately, adherence is a big issue in asthma care. Some patients stop their controller medications once they feel better. Others worry about long-term side effects, especially with steroids, even though the doses in inhalers are quite minimal and safe.”
Cost, inconvenience and forgetfulness also play a role. But at the heart of it is a lack of awareness: “Many patients don’t realise that asthma is a chronic condition — not something that goes away completely.”
Misuse of Rescue Inhalers: A Red Flag
Relying too heavily on rescue inhalers is a serious concern.
“If someone finds themselves reaching for their rescue inhaler all the time, it usually means their asthma isn’t under control. These inhalers give quick relief, but they don’t treat the underlying inflammation.”
She compares it to “putting out fires over and over without fixing what’s actually causing them.” Without controller medicines, patients risk worsening symptoms, more ER visits and potentially severe attacks.
The Inhaler Stigma: Still a Roadblock
Although awareness has improved, misconceptions remain.
“I still meet patients who hesitate to start inhalers because they think it means their condition is serious or permanent. Some feel embarrassed to use them in public. Others are influenced by myths — that inhalers are addictive or weaken the lungs, none of which is true.”
Encouragingly, modern inhalers are smarter, easier to use, and more effective.
“We now have access to next-generation inhalers that are smart, breath-activated and designed for ease of use with targeted drug delivery systems.”
The Need for Parental Vigilance
Children often exhibit asthma differently — and indoor allergens play a major role.
“Many parents dismiss persistent coughing as ‘just a cold’ or ‘weather change,’ especially when there’s no wheezing. But coughing at night, after play, or early in the morning can all be signs of asthma.”
She advises parents to watch for persistent sneezing, congestion, or eye irritation — and not to delay evaluation. “Asthma in children can be well-managed if caught early.”
The New Asthma Demographic
Asthma is no longer limited to known “at-risk” groups.
“We’re seeing more people who never had asthma before beginning to experience symptoms. Working professionals, students, even homemakers — everyone’s spending more time indoors with windows closed and AC on. Dust, mold and chemicals build up and that takes a real toll on lungs.”
Breathing and Mental Health
Burnout, anxiety and chronic stress can all worsen asthma.
“Stress and anxiety can directly influence asthma by increasing inflammation and airway sensitivity. They also have an indirect effect — people under stress are more likely to skip medications, sleep poorly and eat unhealthily.”
Some patients, she notes, have seen improvement in asthma symptoms simply by addressing their mental well-being. “When we feel overwhelmed, it literally feels harder to breathe.”
Simple, Effective Steps for a Healthier Home
Not all solutions need to be high-tech or expensive. “Make sure your home gets fresh air—just a few minutes with windows open each day can help a lot. Skip cleaning products with strong smells or sprays; simple things like vinegar and baking soda work well instead.”
Regularly cleaning fans, AC filters, and curtains also helps. She adds: “Cutting back on mosquito coils, agarbatti, and incense is important. Instead, try mosquito nets or electric vaporisers. And easy-care indoor plants like spider plants or peace lilies can also improve air quality.”
Take Charge Early
Asthma doesn’t have to hold you back. With awareness, timely intervention, and some thoughtful changes at home, managing it is absolutely possible. “Asthma might be a chronic condition, but it doesn’t have to be a life-limiting one. If your breathing feels off, don’t wait it out. See a specialist, get evaluated, and take charge early — your lungs will thank you.”
