"The majority of asthma patients we see in Karimnagar have two problems: they are under-treating their inflammation with controller medication, and they are using their reliever inhaler too much. Good asthma control means you rarely need your reliever. If you are reaching for it every day, your controller therapy needs to be stepped up," says Dr. Rajkumar Korra, MD (Pulmonology), Consultant Pulmonologist at Lalitha Chest & Skin Hospital, Karimnagar.
What Is Bronchial Asthma?
Bronchial asthma is a chronic inflammatory condition of the airways. The inflammation makes the airways hypersensitive — so that certain triggers cause the airway muscles to contract (bronchoconstriction), the lining to swell, and mucus to be produced excessively. This is what causes the characteristic wheeze, breathlessness, and cough.
The key distinguishing feature from COPD: in asthma, the obstruction is largely reversible — airways open significantly after bronchodilator use, and symptoms can be controlled to near-zero with correct treatment.
Asthma Severity Classification
- Intermittent — Symptoms less than twice a week, no nighttime symptoms, normal lung function between attacks
- Mild persistent — Symptoms 3 to 6 days a week, nighttime symptoms 1 to 2 per month
- Moderate persistent — Daily symptoms, nighttime symptoms weekly, activity somewhat limited
- Severe persistent — Continuous symptoms, frequent nighttime symptoms, severely limited activity, frequent exacerbations
Common Triggers in Karimnagar Context
- Dust — both household dust and outdoor dust from construction and roads
- Pollen from agricultural areas
- Cockroach allergen — very common in Indian homes
- Respiratory infections (especially viral)
- Exercise
- Cold air
- Smoke — cigarette, bidi, and cooking smoke
- Strong odours and chemical fumes
- Aspirin and NSAIDs (aspirin-exacerbated respiratory disease)
- Stress and strong emotions
Treatment — The GINA Step-Wise Approach
Asthma treatment follows a step-wise approach guided by symptom control:
- Step 1 (Intermittent) — Low-dose ICS-formoterol as needed only (MART approach). Avoidance of triggers.
- Step 2 (Mild persistent) — Daily low-dose inhaled corticosteroid (ICS) as controller. Short-acting beta-agonist (salbutamol) as reliever.
- Step 3 (Moderate persistent) — Medium-dose ICS or low-dose ICS + long-acting beta-agonist (LABA) combination (e.g., budesonide + formoterol).
- Step 4 — High-dose ICS + LABA. Add tiotropium (LAMA) if needed.
- Step 5 (Severe asthma) — Biologic therapy. Anti-IgE (omalizumab for allergic asthma), anti-IL-5 (mepolizumab for eosinophilic asthma), or anti-IL-4/13 (dupilumab) injections achieve dramatic control in severe refractory asthma.
Inhaler Technique — The Most Critical Factor
Studies show that 70 to 80 percent of patients use inhalers incorrectly — dramatically reducing their effectiveness. At Lalitha Chest & Skin Hospital, every patient receives personalised inhaler technique training and is observed demonstrating correct technique at each visit.
For patients who struggle with MDI (metered dose inhaler) technique, a spacer device significantly improves drug delivery and is strongly recommended, particularly for children and elderly patients. Dry powder inhalers (DPI) require different technique — breath must be forceful and sustained.
Monitoring Asthma Control
Well-controlled asthma means: daytime symptoms no more than twice per week, no nighttime symptoms, reliever needed no more than twice per week, no activity limitation, and peak flow at or above 80 percent of personal best. Any asthma that fails to meet these criteria should be reassessed with Dr. Korra.
Frequently Asked Questions
Q: Are inhaled corticosteroids (ICS) safe to use long-term?
Yes — inhaled corticosteroids at the doses used for asthma are very safe for long-term use. The amount absorbed into the body is a tiny fraction of oral steroids. The risk of untreated airway inflammation far exceeds any risks from properly dosed ICS.
Q: My child has asthma. Will they grow out of it?
Many children with asthma see significant improvement in adolescence, and some experience remission. However, about 50 percent of childhood asthma persists into adulthood. Trigger avoidance and controller therapy during childhood reduces airway remodelling and gives the best long-term outcome.
Q: Is it safe to exercise with asthma?
Absolutely — and it is beneficial. Exercise-induced bronchoconstriction is preventable with a short-acting bronchodilator taken 15 minutes before exercise. Well-controlled asthmatics should not restrict activity. Many elite athletes have asthma.
Q: I have severe asthma and nothing seems to work. What else can be done?
True severe asthma (not responding to high-dose ICS + LABA despite correct technique and trigger management) should be assessed for biologic therapy eligibility. Blood eosinophil count and IgE level guide which biologic is appropriate. Dr. Korra can evaluate you for this.
Searching for "asthma specialist in Karimnagar" or "chest doctor near me"? Visit Lalitha Chest & Skin Hospital. Dr. Rajkumar Korra provides comprehensive asthma evaluation, spirometry, personalised treatment plans, inhaler technique training, and biologic therapy for severe asthma. Book at +91 94413 59200.