On World Asthma Day: A Doctor’s Prescription For Punjab 

By Dr. Puneet Aulakh Pooni, Honorary Executive Member, Ludhiana Forum,  Doctors for Clean Air and Climate Action
As  a  senior  pediatrician  who  has  spent  decades  treating  children  with  respiratory  illness,  I  have watched  World  Asthma  Day  evolve  from  a  routine  awareness  campaign  into  something  far  more urgent.  In  Punjab  today,  asthma  is  no  longer  just  a  disease  managed  in  clinics.  It  is  becoming  a  public health  crisis  unfolding  in  classrooms,  playgrounds,  and  homes.  And  the  most  disturbing  part  is  that many  children  suffering  from  asthma  don’t  even  know  they  have  it.  We  are  raising  a  generation  that is learning to live with breathlessness as if it is normal, and it is not.
New  comparative  research  conducted  by  the  Lung  Care  Foundation  and  the  Pulmocare  Research  and Education  (PURE)  Foundation  offers  a  worrying  glimpse  into  the  respiratory  future  of  children growing  up  in  polluted  North  Indian  environments.  In  Delhi,  whose  pollution  profile  is  comparable  to many  parts  of  Punjab,  nearly  one  in  three  adolescents  (29.4%)  were  found  to  have  spirometrically defined airflow obstruction.
This  is  not  a  minor  concern.  It  means  thousands  of  children  are  entering  adulthood  with  reduced lung  capacity,  lower  stamina,  and  increased  vulnerability  to  chronic  respiratory  disease.  As  doctors, we  are  no  longer  only  treating  asthma  attacks—we  are  witnessing  lung  damage  being  built  in  real time.
While  some  research  also  points  to  broader  metabolic  consequences  of  pollution,  including  possible links  to  weight  gain,  the  core  message  is  clear:  polluted  air  is  harming  children’s  lungs,  quietly  and relentlessly.  The  most  alarming  finding,  however,  is  not  just  the  prevalence  of  asthma.  It is  the massive  diagnosis  gap.  The  study  revealed  that  nearly  88%  of  children  identified  as  asthmatic  were unaware  of  their  condition. 
Even  more  disturbing,  only  3%  of  these  children  were  using  inhalers, despite  inhalers  being  the  foundation  of  asthma  management  and  control.  This  is  not  simply  poor awareness; it is a dangerous failure of the system. Children  are  coughing  daily,  waking  up  breathless  at  night,  avoiding  sports,  and  struggling  through routine  activity  without  a  diagnosis,  without  treatment,  and  without  support.  Parents  often  dismiss symptoms  as  “seasonal  allergy”  or  “weak  chest.”  Teachers  may  assume  the  child  is  unfit  or inattentive.  The  child,  meanwhile,  grows  up  believing  breathlessness  is  part  of  life. 
But  asthma  does not wait for adulthood. It can turn fatal in childhood. Punjab’s  growing  pollution  burden,  from  traffic  emissions,  industrial  activity,  construction  dust,  and seasonal  spikes,  pushes  air  quality  far  beyond  safe  limits.  Yet  we  continue  to  treat  air  pollution  like  a temporary  inconvenience,  something  to  be  tolerated  for  a  few  weeks  and  forgotten.  That  approach  is costing  children  their  health.  And  pollution  is  not  the  only  enemy.  In  many  homes,  asthma  is  silently triggered  by  cigarette  smoke  and  second-hand  smoke  exposure,  incense  sticks  and  dhoop,  mosquito coils,  indoor  dampness  and  mould,  and  poorly  ventilated  cooking  fumes. 
These  everyday  exposures, often considered harmless, can provoke repeated attacks and steadily worsen a child’s lung health. PFine  particulate  matter  penetrates  deep  into  developing  lungs,  triggering  inflammation  and narrowing  of  airways.  Over  time,  repeated  exposure  increases  airway  sensitivity,  worsens  asthma severity,  and  may  even  contribute  to  the  development  of  asthma  itself.  For  Punjab,  this  is  no  longer an environmental issue alone.
It is a pediatric emergency. On  this  World  Asthma  Day,  Punjab  must  move  beyond  symbolic  messaging  and  take  real  action. Schools  should  not  wait  for  an  emergency.  Mandatory  asthma  management  policies  must  be introduced  across  educational  institutions,  including  training  of  teachers,  emergency  response protocols,  and  early  identification  systems.  Every  school  should  know  how  to  handle  an  asthma attack, and every child with symptoms should be guided toward diagnosis and care. At  the  same  time,  we  must  expand  screening  and  early  diagnosis  beyond  tertiary  hospitals.
Spirometry  and  symptom-based  screening  should  be  integrated  into  school  health  programs  and strengthened  at  primary  health  centers.  But  medical  action  alone  will  not  solve  the  crisis  if  pollution continues  unchecked.  Policymakers  need  to  address  the  source  of  pollution  along  with  regular advisories.  Pollution  levels  in  North  India  continue  to  exceed  WHO  safety  standards  by  many multiples. This is neither normal nor acceptable. Equally  damaging  are  the  myths  surrounding  inhalers.  Many  families  still  believe  that  inhalers  are addictive,  unsafe,  or  meant  only  for  “serious”  patients.  This  misinformation  delays  treatment  and pushes  children  toward  repeated  antibiotics,  cough  syrups,  and  emergency  hospital  visits. 
The  truth is  simple:  inhalers  are  the  safest  and  most  effective  foundation  of  asthma  control.  They  prevent attacks, protect lung function, and allow children to live normal, active lives. Finally,  Punjab  needs  its  own  large-scale  respiratory  research. 
Delhi’s  data  is  a  warning,  but  Punjab must  map  its  own  burden  to  plan  targeted  interventions  and  prevent  long-term  damage.  WHO Director-General  Dr.  Tedros  Adhanom  Ghebreyesus  has  said,  “There  is  little  time  to  waste.”  For Punjab,  these  words  are  not  a  global  statement;  they  are  a  local  truth.  If  we  delay,  we  risk  raising  a generation  of  children  who  cannot  run  freely,  cannot  play  without  coughing,  and  cannot  breathe without struggle. On  this  World  Asthma  Day,  Punjab  must  decide  whether  breathlessness  becomes  normal  or unacceptable. Breathing is not a privilege; it is a child’s right.
(Views are personal)