Every breath matters

On Tuesday, 5 May 2026, the world observed World Asthma Day. It is organised every year by the Global Initiative for Asthma (GINA), and it exists to wake the world up to a disease that quietly takes away the most basic human function: breathing.

This year’s theme was blunt: “Access to anti-inflammatory inhalers for everyone with asthma – still an urgent need.”

When I read it, I didn’t just nod along. For the past sixteen years that sentence has not been a theme for me. It has been the job.

260 million people, one gap

Asthma affects more than 260 million people worldwide. The science to treat it has existed for decades. Inhaled corticosteroids (ICS), especially combined with long-acting beta-agonists (LABA), are the guideline-recommended backbone of care, and the 2024 and 2025 GINA reports leave no ambiguity about it.

And yet millions of patients in India, and around the world, are not on this therapy. Not because it doesn’t exist. Not because their doctors don’t know about it. Because they cannot afford to take it every month.

That gap, between what medicine recommends and what patients can actually sustain, is not a clinical problem. It is an equity problem, and equity problems need a moral response as well as a commercial one.

Jai

(The name has been changed.)

Jai is a patient I came to know through our field team in Uttar Pradesh. He had been diagnosed with asthma years earlier, and his doctor had prescribed the right treatment: an ICS+LABA combination inhaler.

But Jai couldn’t afford it regularly. So he took it irregularly. Some months he managed. Other months he skipped doses and stretched each inhaler far beyond its life, hoping he wouldn’t need it urgently. His asthma was never controlled. He lived in a loop of symptoms, fear and a smaller life than he should have had.

Then a combination inhaler he could afford reached him. Today Jai is on regular therapy. He works, he sleeps through the night, and he breathes freely. He is not a statistic. He is a person whose life changed because the right treatment finally came within his means.

There are millions of Jais across India. They are the reason I talk so much about #RTI, the Right to Inhalation.

What the Right to Inhalation means in practice

The principle is simple: no patient should be denied guideline-recommended therapy because of cost. In practice it comes down to four things.

Price. A controller inhaler has to cost something a working family can pay every month, not once.

Disclosure: this is the work of my own company. Bayu Healthcare makes Fabhale 200 and Fabhale 400, ICS+LABA dry powder inhalers that are, to our knowledge, the most economical of their kind. I mention it because it is the honest answer to “what are you doing about it”, not as an advertisement.

Education in the patient’s language. Patient materials in Hindi, in print, audio and video. Device-use videos made for real patients, not for medical conferences. Awareness camps in villages and small towns, where respiratory disease is often worst and care is scarcest.

Correct device use. An inhaler used wrongly is as good as no inhaler. Access is not only about price; it is about technique, demonstrated at the doctor’s clinic, at the chemist and at the patient’s side.

COPD too. This is not only about asthma. Millions of COPD patients face the same barriers, and they deserve the same access.

To fellow doctors and industry colleagues

If you work in respiratory medicine, as a pulmonologist, physician, ENT specialist, paediatrician or pharmacist, I want to say this plainly: the patient who can’t afford combination therapy is not failing medicine. Medicine is failing that patient.

Access cannot stop at awareness campaigns and conference talks. It has to reach the chemist’s shelf and the patient’s hands. It has to become a prescription the patient fills, and refills, month after month. That last mile is the hardest one.

What you can do

World Asthma Day comes once a year. Asthma doesn’t take a day off.

• If you are a doctor, the next time you prescribe ICS+LABA, ask whether your patient can sustain the cost month after month. Affordable options exist. Make sure the patient knows about them.
• If you are a caregiver, learn the correct technique for your family member’s inhaler. Wrong technique is one of the most common, and most preventable, reasons treatment fails.
• If you are a patient, you have a right to guideline-recommended therapy. Don’t compromise on regularity because of cost alone. Ask your doctor about options.
• If you work in this industry, let us collaborate. Access is too large a problem for any one company.

Every breath is a right

I have spent more than twenty-five years in this industry: ten at Cipla, where I first understood what affordable therapy can do, and sixteen building Bayu Healthcare on the same conviction.

The work is not done. It will not be done until the last patient who needs an inhaler can afford one and knows how to use it.