Asthma (Dama) in Pakistan: Symptoms, Triggers and Why Inhalers Are Not Addictive

Asthma is one of those conditions where the honest answer to "how common is it in Pakistan?" is "it depends how you count." The Global Asthma Report 2022 states that approximately 4.3% of Pakistan's population is suspected to have asthma. But a rigorous population survey in Karachi — 1,629 adults across 75 randomly selected clusters, published in BMC Pulmonary Medicine — found prevalence of 1.8% by self-report, 6.6% when both symptoms and lung-function reversibility were required, and 11.3% by reversibility on spirometry alone.

That six-fold spread between the lowest and highest figure in the same city, in the same study, is the finding worth carrying away: far more people have measurable airway disease than have ever been told they have asthma. Undiagnosed asthma in Pakistan is likely much more common than diagnosed asthma.

At a glance

• Global Asthma Report 2022: ~4.3% of Pakistan's population suspected to have asthma
• Karachi adult survey: 1.8% self-reported, 6.6% symptoms + reversibility, 11.3% reversibility on spirometry
• The gap between self-report and lung testing suggests substantial under-diagnosis
• Asthma is controlled, not cured — and well-controlled asthma should not limit normal life
• Inhalers are not addictive; that belief is the single most common reason for avoidable attacks

Dama kya hai?

Dama (asthma) mein saans ki naliyan waqtan fawqtan sikur jati hain aur un mein sujan ho jati hai, jis se saans phoolta hai, seene mein jakran hoti hai, aur seene se seeti jaisi awaz aati hai. Yeh koi "kamzori" nahi — yeh phephron ki ek qabil-e-control bimari hai.

Sab se bara ghalat-fehmi: "inhaler ki aadat par jati hai." Yeh sach nahi hai. Inhaler dawai ko seedha saans ki naliyon tak pohnchata hai — isi liye khurak choti hoti hai aur jism par asar goliyon se kam hota hai. Log inhaler is liye roz istemal karte hain ke bimari roz mojood hai, is liye nahi ke inhaler ne "aadat" daal di. Inhaler se darr kar ilaj tarrk karna hi wo waja hai jis se attack hota hai aur mareez emergency mein pohnchta hai.

Symptoms

• Shortness of breath (saans phoolna), especially on exertion
• Wheezing — a whistling sound while breathing out (seene se seeti ki awaz)
• Chest tightness (seene mein jakran)
• A dry cough that is worse at night or in the early morning (raat ko khansi)
• Symptoms that come in episodes, triggered by something identifiable, and ease between attacks

A cough that is only nocturnal, with no fever, is a classic under-recognised presentation of asthma — particularly in children, where it is often treated as one chest infection after another.

Common triggers in Pakistan

• House dust and dust mites (ghar ki gard) — bedding, carpets, stuffed toys
• Winter smog in Lahore and much of upper Punjab, and vehicle exhaust in every large city
• Smoke — cigarettes, sheesha, mosquito coils, wood or coal cooking fires, and burning rubbish
• Cold air, and sudden weather changes
• Pollen, notably the spring pollen season in Islamabad and Rawalpindi
• Respiratory infections, which set off many attacks
• Strong perfumes, incense, agarbatti and cleaning fumes
• Exercise — which is a reason to optimise treatment, not to stop exercising

How it's diagnosed

Asthma is diagnosed from the pattern of symptoms plus, ideally, a breathing test. Spirometry measures how much air you can force out and whether that improves after a bronchodilator — the "reversibility" that separates asthma from fixed airway disease such as COPD. In practice many Pakistani patients are diagnosed clinically and started on treatment; if the diagnosis is uncertain, or if treatment isn't working, a general physician or chest specialist can arrange proper lung-function testing. A cough lasting more than two weeks should also raise the question of TB, which is common enough here that it needs excluding rather than assuming.

Treatment

Modern asthma care splits into two jobs, and confusing them is where most poor control comes from:

• Controller (preventer) inhaler — usually an inhaled steroid, taken daily whether or not you feel unwell. It reduces the underlying airway inflammation. This is the one people wrongly stop when they feel fine
• Reliever inhaler — opens the airways within minutes during symptoms. Needing it more than about twice a week is a signal that the controller regimen needs reviewing, not that you need more reliever
• Spacer device — a cheap plastic chamber that dramatically improves how much drug reaches the lungs, especially for children and anyone whose technique is imperfect
• Trigger control — bedding hygiene, avoiding smoke, masks on smog days
• Written action plan — what to do when symptoms escalate, and at what point to reach a hospital

Inhaler technique is worth checking at every visit: a large share of "medicine not working" turns out to be medicine not reaching the lungs.

When to see a doctor — and when to go to hospital

• Needing the reliever inhaler more than twice a week, or waking at night with symptoms
• Symptoms limiting work, school, prayer, walking or exercise
• Any first-time wheeze in an adult, which needs a proper diagnosis rather than a borrowed inhaler
• Emergency: breathlessness so severe that speaking in full sentences is difficult, lips or fingertips turning blue, the reliever not helping, or drowsiness and confusion — go to hospital immediately

Frequently asked questions

Kya inhaler ki aadat par jati hai?

Nahi. Inhaler nasha-aawar nahi hai. Dawai rozana is liye leni parti hai ke sujan rozana mojood hoti hai — bilkul waise jaise blood pressure ki goli roz leni parti hai. Inhaler chhorne se bimari nahi jati, sirf control jata hai.

Does asthma go away in children?

Symptoms improve or disappear with age in many children, though the underlying tendency can persist and return later. That is a reason for regular review, not for stopping treatment on a guess.

Is a nebuliser better than an inhaler?

Not inherently. An inhaler with a spacer delivers medication as effectively as a nebuliser for most situations and is far more practical. Nebulisers have a role in severe attacks and in patients who cannot use an inhaler.

Can someone with asthma exercise or fast?

Generally yes, when asthma is well controlled — and good control is exactly what makes both easier. Anyone whose asthma is currently unstable should plan this with their doctor rather than improvise.

Sources

• The Global Asthma Report 2022 — Pakistan
• "Epidemiology of asthma and associated factors in an urban Pakistani population: adult asthma study-Karachi," BMC Pulmonary Medicine (PMC)
• "Monthly and seasonal prevalence of asthma and COPD in District Dera Ismail Khan, Khyber Pakhtunkhwa, Pakistan" (PMC)

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