An asthma attack can begin quietly. A little tightness in the chest. Breathlessness while climbing stairs. A cough that lingers longer than expected. But for many people, the real struggle starts much later, when the doctor prescribes an inhaler.
Across India, inhalers are still treated with suspicion. Some patients hide them inside bags. Others stop using them the moment they feel better. Many refuse them altogether because someone in the family once said, “Once you start using inhalers, you can never stop.”
That fear continues to cost patients their health. According to the Global Asthma Report, India carries one of the highest asthma burdens in the world, yet daily controller therapy remains underused among patients who need it most. Dr Mihir Gangakhedkar, Consultant - Pulmonology at Fortis Hospital Mulund, says the problem is not just medical, but deeply social.
“There still exists a significant gap between evidence-based care and the patient when it comes to managing asthma, resulting from a combination of stigma, lack of resources and myths associated with inhaler use.” And while science has repeatedly proven the benefits of inhaled therapy, myths continue to travel faster than facts.
“Inhalers are addictive”: Perhaps the oldest myth
This is the sentence pulmonologists hear almost every day. Many patients believe inhalers create dependency, and that once started, they become impossible to stop. But doctors say this belief misunderstands how asthma itself works.
Asthma is a chronic disease. Much like diabetes or high blood pressure, it often needs regular treatment to stay controlled. The inhaler is not creating dependence; it is managing inflammation in the lungs. What makes inhalers different is their delivery method. Instead of flooding the entire body with medication, inhalers send small doses directly to the lungs where the problem exists. That means faster relief and fewer overall side effects.
Research published in medical journals has repeatedly shown that patients who avoid inhalers due to fear often end up needing more emergency treatment later. The irony is difficult to ignore: fear of inhalers sometimes pushes patients toward more aggressive treatment later in life.
The steroid panic that continues to scare families
Few medical words create as much anxiety as “steroid.” For many families, the word immediately brings thoughts of weight gain, weakness, or long-term harm. But experts stress that inhaled corticosteroids are very different from oral or injectable steroids. The doses are much smaller. The medicine is targeted. And most of it acts directly inside the lungs rather than circulating heavily through the body.
The National Heart, Lung, and Blood Institute in the United States continues to recommend inhaled corticosteroids as a key long-term asthma treatment because they help prevent severe flare-ups and hospitalisation. Dr Gangakhedkar explains that uncontrolled asthma itself is often far more dangerous than the treatment patients fear.
“All medical professionals agree that the benefits provided by inhaled corticosteroids when used to control inflammation and provide protection against an acute asthma attack far exceed any potential risks associated with their use.” Yet many patients quietly reduce doses on their own or stop using inhalers completely after hearing advice from neighbours, relatives, or social media videos. That gap between medical advice and public belief remains one of the biggest challenges in respiratory care today.
Why inhalers seem “ineffective” for many people
Sometimes the inhaler is not failing. The technique is. Doctors say a large number of patients do not use inhalers correctly. Some spray too early. Some breathe incorrectly. Some fail to hold their breath after inhalation. Others skip daily controller medication and depend only on reliever inhalers during attacks. The result is predictable: poor asthma control.
This creates another dangerous cycle. Patients feel temporary relief is missing, assume inhalers do not work, and then abandon treatment altogether. Many pulmonologists now spend extra time physically demonstrating inhaler technique during consultations because even educated patients often get it wrong. A few seconds of proper instruction can sometimes prevent years of poorly controlled asthma.
The hidden stigma around carrying an inhaler
One of the least discussed parts of asthma treatment is embarrassment. Teenagers often avoid using inhalers in school. Working adults hide them in office drawers. Some elderly patients worry relatives may think their illness is “serious” if inhalers become visible at home.
This social discomfort is especially strong in countries where chronic respiratory diseases are poorly understood. The image of inhalers as a “last-stage treatment” has survived for decades, even though doctors now recommend early inhaler use to prevent worsening disease. Globally, adherence to inhalation therapy remains a serious problem. Studies estimate that around 40% of patients do not consistently follow prescribed inhaler treatment. In India, underdiagnosis and low awareness widen the problem further.
Experts say public conversations around asthma need to change. An inhaler should not be seen as weakness. It should be viewed the same way people see spectacles, insulin pens, or blood pressure medicines — tools that help people live normally.
Asthma care cannot improve until awareness improves
For years, asthma conversations have focused heavily on symptoms. But doctors say the bigger issue now is trust. Patients need to trust the treatment enough to continue it consistently. They need access to proper education. And they need clear information instead of fear-driven myths passed from one generation to another.
Yet despite advances in medicine, many patients still suffer because they delay treatment that could have improved their quality of life much earlier. The truth is simple: asthma becomes harder to control when treatment is delayed out of fear. And sometimes, the most dangerous thing about an inhaler is not the medicine inside it, but the myths surrounding it.
Medical experts consulted
This article includes expert inputs shared with TOI Health by Dr Mihir Gangakhedkar, Consultant – Pulmonology, Fortis Hospital Mulund, Mumbai. Inputs were used to explain how myths, stigma, and lack of awareness around inhalers continue to prevent many asthma patients from using one of the most effective treatments available for managing their condition.
