Asthma (Dama): Causes, Triggers and Integrative Care Alongside Your Inhalers

What is asthma?

Asthma is a long-term condition in which the airways become swollen, which makes them narrower and causes breathing problems; it usually starts in childhood but can begin at any age, according to the NHS [1]. In Hindi it is called *dama* (दमा) or *saans ki bimari* (सांस की बीमारी), and breathlessness is often described as *saans phoolna* (सांस फूलना).

• In India: the INSEARCH study of 169,575 adults in 23 urban and rural sites found asthma in 2.05% of adults aged 15 and over, an estimated 17.2 million people [5]; the Global Burden of Disease study estimated 37.9 million people of all ages with asthma in India in 2016 [2].
• A higher burden in India: the health loss per asthma case in India was 2.4 times the global average in 2016 [2].
• Asthma is not COPD: COPD is a different long-term lung disease linked mainly with smoking and air pollution [2]; a chest physician tells them apart.

What are the symptoms of asthma?

The main symptoms are wheezing (a whistling sound when breathing), breathlessness, a tight chest and coughing; symptoms usually come and go and may be worse at night and early in the morning, according to the NHS [1]. The UK guideline lists wheeze, cough, breathlessness and chest tightness that vary over time, for example worse at night or early morning or in some seasons [7].

• Cough variant asthma: in some people a long-lasting cough is the main symptom, without wheezing or breathlessness; a 2025 review estimates that it accounts for 25% to 42% of long-lasting (chronic) cough cases and is often recognised late [8]. The NHS advises seeing a doctor for a cough lasting more than 3 weeks [9].
• Attacks: during an asthma attack, symptoms get much worse, and an attack can be life-threatening [1]; see “What should you do in an asthma attack?” below.

Why does asthma happen? Allergy, weight, smoke and vitamin D

The strongest measured links with asthma and asthma attacks are allergic rhinitis, excess weight, smoke at home and respiratory infections, according to studies in The Lancet, the Global Burden of Disease study and India’s INSEARCH study [3][4][5][6]:

• Allergy and the nose: in a European population study published in The Lancet, allergic rhinitis raised the risk of adult-onset asthma about 3.5 times, and dust mite allergy carried its own extra risk [3]. See our Allergic Rhinitis page.
• Weight: in the Global Burden of Disease 2019 analysis, high body mass index was the largest of the measured risk factors for asthma health loss and deaths worldwide [4]. See our Metabolic Syndrome page.
• Smoke at home: in India’s INSEARCH study, smoking, second-hand smoke at home, a family history of asthma and unclean cooking fuels were linked with asthma [5].
• Infections and other triggers: asthma symptoms can be triggered by allergies, exercise, smoke, cold air or infections, according to the NHS [1].
• Low vitamin D: in 1,024 children with asthma, insufficient vitamin D went with 1.5 times the odds of a hospital or emergency visit over 4 years [6]; studies from Lucknow and an AIIMS meta-analysis found lower vitamin D in Indian and other children with asthma [10][11]. A link is not proof of cause; the trials are described below.

Asthma and allergic rhinitis: why the nose matters

Allergic rhinitis (a sneezing, itchy, runny or blocked nose from allergy) and asthma often occur together, and allergic rhinitis raised the risk of adult-onset asthma about 3.5 times in a population study [3]. In India’s Global Asthma Network study, allergic rhinitis affected 23.5% of 13 to 14 year olds and 9.8% of adults [12]. At Cure4Pain, the nose and the chest are assessed and managed together; see our Allergic Rhinitis page.

How is asthma diagnosed?

The UK guideline (BTS, NICE and SIGN, 2024) advises that asthma is confirmed only with a suggestive history and a supporting objective test, such as a blood eosinophil count, a FeNO breath test, spirometry or peak flow readings [7]. These tests are arranged by your doctor or chest physician; please bring the reports.

• Tests at Cure4Pain: total IgE, eosinophil count and an allergy panel (dust mite, pollen, mould, pets), vitamin D with PTH and calcium, vitamin B12, thyroid tests and kidney function, within our standard panel of about 100 measures, which includes ANA for every patient; this is our clinic protocol, not a guideline requirement.
• In India, the panel is available at a lower cost through our patient portal, with home collection across India. Outside India, the tests are done at a laboratory near you and reviewed with you in the consultation.

What is the standard treatment for asthma?

Standard asthma treatment is based on inhalers that contain an inhaled steroid (corticosteroid). The Global Initiative for Asthma (GINA) does not recommend treatment with a short-acting reliever inhaler alone for adults and adolescents, and advises that their treatment includes an inhaled steroid [13]. The UK guideline advises an inhaler combining a low-dose inhaled steroid with formoterol, taken as needed, for people aged 12 and over with newly diagnosed asthma (anti-inflammatory reliever therapy) [7].

• Severe asthma: steroid tablets, biologic injections and specialist care are used for severe asthma, under a chest physician.
• Allergen immunotherapy: for some people with allergies, an allergy specialist may advise immunotherapy; we discuss it with you and refer you when it may suit you.
• Never stop inhalers on your own: stopping or reducing inhalers without medical guidance can lead to a serious attack. At Cure4Pain, any change is made under clinical guidance from Team Cure4Pain, in coordination with your chest physician.

How does Cure4Pain manage asthma?

Cure4Pain manages asthma as a long-term condition by adding a supervised nutritional layer to standard asthma care, never replacing it. Our aim is supervised correction of nutritional deficiencies alongside conventional treatment and internationally accepted guidelines. The plan includes:

1. Tests first: allergy and blood tests within our panel of about 100 measures (see above), with your breathing test reports.
2. Supervised daily vitamin D therapy (Coimbra Protocol-based methods), dosed by body weight: low daily doses set for each person, never single large doses, with cofactors and regular blood checks (see below).
3. Correcting other deficiencies: magnesium, zinc and other trace minerals, B vitamins and protein as your tests and diet show a need, with vitamin K2, vitamin C, omega-3 and quercetin, within official upper limits where these exist.
4. Diet and gut: the same food plan as for allergic rhinitis (dairy, wheat, sugar, cold foods and drinks, and nightshades removed, with cruciferous (Brassica) vegetables such as cabbage and cauliflower generally limited as an observational clinic practice), with probiotics and support for digestion and bile flow.
5. Breathing: Buteyko breathing and nose breathing, with saline nasal rinses or jal neti for people who also have allergic rhinitis.
6. Triggers at home: dust mites, bedding, pets, mould, smoke and air quality checked and corrected.
7. Linked conditions: allergic rhinitis, reflux, weight and sleep problems are managed in the same plan.
8. Medicines: your inhalers continue; Dr Krushal Pabari manages any change to medicines under clinical guidance from Team Cure4Pain, in coordination with your chest physician.
9. Reviews: blood tests every 3 months, and lifelong management.

Vitamin D therapy for asthma: what the research shows

Trial results on vitamin D for asthma are mixed: the 2023 Cochrane review of 20 trials found no overall reduction in attacks [14], while a 2017 analysis of 955 people in The Lancet Respiratory Medicine found 26% fewer attacks needing steroid tablets, and 67% fewer in a subgroup with very low starting levels, though the difference between subgroups was not statistically confirmed [15]. Vitamin D does not replace asthma inhalers. In several trials, people who took vitamin D regularly for 2 months or longer had fewer attacks or better asthma control, mainly when their vitamin D was low at the start, while other large trials found no benefit. In an analysis of 10,933 people in the BMJ, daily or weekly vitamin D reduced respiratory infections, the most common trigger of asthma attacks, while occasional large doses did not [16].

• Who seems to benefit most: people who start with very low vitamin D; in a later (post hoc) analysis of older adults in New Zealand with asthma or COPD, monthly vitamin D did not change attacks overall but lowered the risk by 89% in those with very low starting levels [24][15].
• Earlier reviews: a 2016 Cochrane review had found fewer attacks needing steroid tablets and fewer emergency visits or hospital stays with vitamin D [25]; the 2023 update, with more trials, did not [14].
• Time matters: in the Arshi trial, lung function was no different at 8 weeks and improved by 24 weeks [18].
• In the VIDA trial, people who reached normal vitamin D levels had slightly more colds [26], so results are not all in one direction.
• How vitamin D may act: in laboratory studies, vitamin D restored a healthy steroid response in immune cells from people with steroid-resistant asthma [27]; in adults, higher vitamin D went with better lung function and a better steroid response [28], and in children, lower vitamin D went with more steroid use [29].

How we use vitamin D therapy at Cure4Pain

At Cure4Pain, vitamin D is used as an immune modulator, not only as a bone supplement: the body turns vitamin D into an active hormone, calcitriol, and many tissues have vitamin D receptors, according to the US National Institutes of Health [30]. We use supervised daily vitamin D therapy (Coimbra Protocol-based methods), dosed by body weight. Coimbra Protocol-based here means that there is no single fixed dose for every person or every condition: the dose is set for each person and checked with blood tests. For asthma this means low daily doses, set by body weight, never single large doses, together with cofactors.

• Body weight: daily doses raise vitamin D gradually, and people with a higher body weight usually need more to reach the same level; in a study of 17,614 adults, the authors recommended 1.5 times more for overweight and 2 to 3 times more for obese people [31]. In a trial of daily doses, most of the rise in blood levels came within the first 3 months [32].
• Cofactors: magnesium (the enzymes that make and break down vitamin D need it, and in a randomised trial magnesium helped balance vitamin D levels [33]), vitamin K2, a diet that manages calcium intake, and enough fluids.
• Target and monitoring: we aim to keep vitamin D steadily within a target range inside the laboratory reference range, and we check vitamin D, calcium, parathyroid hormone, kidney function and urine calcium every 3 months. No trial has tested a specific vitamin D target in asthma; most trials that found a benefit continued dosing for several months.
• Why daily: the Endocrine Society’s 2024 evidence review found that high-dose vitamin D given at long intervals may increase falls compared with lower daily dosing [34].
• Safety: the official upper limit for vitamin D is 1,000 to 4,000 IU a day depending on age, and taking calcium supplements with vitamin D may increase the risk of side effects, according to the US National Institutes of Health [30]; in a 3-year trial, a very high daily dose, well above the official upper limit, slightly lowered bone density compared with a low dose [32]. Taking vitamin D above the official upper limit without medical guidance can raise blood calcium and harm the kidneys.
• Clinic observation: in our clinic, with daily vitamin D as part of the wider plan and regular asthma treatment, many people report attacks that become fewer and milder over time, and in some, steroid medicines have been reduced under medical guidance, never by stopping inhalers on their own. This is part of overall health management, not a replacement for inhalers or an alternative to standard treatment. Trials point the same way only in part: in the VIDA trial the inhaled steroid dose needed to keep asthma controlled was slightly lower with vitamin D [21], and in the New Delhi trial children needed less steroid [17], while other trials found no benefit [14]. Asthma also changes with seasons, infections and treatment, so individual results vary, and further studies are needed.
• Never on your own: please do not copy doses from the internet or from videos.

Magnesium, zinc, vitamin K2, vitamin C and omega-3: what the research shows

Trial evidence for these nutrients in asthma is limited, so Cure4Pain uses them to correct deficiencies alongside the plan, within official upper limits where these exist, not as asthma treatments on their own.

• Magnesium: in a 2026 randomised trial in people with asthma or COPD and low blood magnesium, magnesium glycinate lowered an inflammation marker (CRP) and improved lung function (FEV1) compared with placebo [35]. A blood test does not show how much magnesium the body holds; the upper limit from supplements is 350 mg of elemental magnesium a day for adults and children aged 9 and over (lower for younger children), and absorption varies by form, according to the US National Institutes of Health [36].
• Vitamin C: a 2014 Cochrane review found the evidence insufficient to judge vitamin C (or E) in asthma [37]; the upper limit for adults is 2,000 mg a day [38].
• Omega-3 (fish oil): a 2002 Cochrane review found no consistent effect of fish oil on asthma, and no sign of harm [39].
• Zinc: we found no good-quality trial of zinc for asthma control; the upper limit for adults is 40 mg a day [40].
• Vitamin K2: used with vitamin D as clinic practice; we found no trial in asthma. Vitamin K can interfere with the blood thinner warfarin, so tell us if you take it [41].

Which foods should you avoid with asthma?

We found no trial showing that a specific diet treats asthma; avoiding a food matters mainly for people with a confirmed food allergy. As clinic practice, Cure4Pain uses the same food plan as for allergic rhinitis: dairy, wheat, sugar, cold foods and drinks, and nightshades (tomato, potato, brinjal and peppers) are removed, and, as an observational clinic practice, we generally suggest limiting cruciferous (Brassica) vegetables such as cabbage and cauliflower. We state the research on each plainly:

• Milk: a 2005 review found that milk does not increase mucus production or cause asthma [42], and in a 2020 randomised trial, a glass of cow’s milk did not cause symptoms or airway narrowing in children with or without asthma [43]. Removing dairy is our clinic practice, not a research finding.
• Wheat, nightshades, sugar and cold foods: we found no trial of removing them in asthma; wheat matters for people with a wheat allergy or celiac disease.
• Cruciferous vegetables: as an observational clinic practice, we generally suggest limiting cruciferous (Brassica) vegetables such as cabbage and cauliflower; research has not shown that they cause asthma symptoms.
• Balanced replacements: removing dairy and wheat can lower calcium, protein and fibre intake, so the plan includes replacement foods, with extra care for children and in pregnancy.

Do breathing exercises, Buteyko and yoga help asthma?

They may help as additions to standard care. A 2020 Cochrane review found that breathing exercises may improve quality of life, symptoms of over-breathing and lung function in adults with asthma, with evidence of moderate to very low certainty [44]. In a 2026 meta-analysis of 7 randomised trials, Buteyko breathing added to standard care improved asthma control in adults and children, though the evidence is still limited [45].

• Yoga in children: in a 2025 meta-analysis of randomised trials (480 children aged 8 to 16), yoga added to standard treatment improved lung function at 6 and 12 weeks, but not asthma control or quality of life [46].
• At Cure4Pain: we teach Buteyko breathing and nose breathing; breathing exercises support, but do not replace, your inhalers.
• Nose care: for people who also have allergic rhinitis, saline nasal rinses or jal neti are part of the plan; see our Allergic Rhinitis page.

Triggers at home and outside: dust mites, mould, smoke and pollution

The NHS lists exercise, air pollution, cold air and allergies to pollen, dust, mould or animals as common asthma triggers [1]. In Mumbai, damp monsoon months can encourage mould at home, and smoke from cooking fuels, incense (agarbatti) or mosquito coils adds to indoor smoke; in India’s INSEARCH study, second-hand smoke at home and unclean cooking fuels were linked with asthma [5].

• Dust mites: an older Cochrane review of 54 trials found that chemical and physical measures against dust mites, such as mattress covers, did not improve asthma; Cochrane now marks this review as out of date [47].
• At Cure4Pain: we ask you to check and correct dust mites, bedding, pets, mould, smoke and air quality as part of the plan, and we advise a smoke-free home.
• Vaccines: the NHS advises vaccines such as the flu vaccine, because viruses can make asthma worse [1].

Reflux, weight and sleep: conditions linked with asthma

Acid reflux and excess weight are linked with asthma that is harder to control: in a 2021 Cochrane review, treating reflux slightly improved lung function [48], and high body mass index is the largest measured risk factor for asthma health loss worldwide [4]. Cure4Pain manages these conditions in the same plan:

• Acid reflux: in a 2021 Cochrane review, treating reflux in people with asthma slightly improved lung function and reduced reliever use (moderate certainty), though the effect on attacks was uncertain [48]. See our Acidity & Hyperacidity page.
• Weight: high body mass index is the largest measured risk factor for asthma health loss worldwide [4]; a Cochrane review found too few good trials to measure how much weight loss improves asthma control [49]. See our Metabolic Syndrome page.
• Sleep and snoring: see our Snoring & Mouth Breathing page.
• Gut health: see our Gut Dysbiosis page.

Does acupuncture help asthma?

The evidence is limited: an overview of 14 systematic reviews (167 studies, 15,088 people) in the Journal of Asthma found that acupuncture therapies may improve symptoms and some lung tests, but study quality was low to moderate and safety reporting was poor [50]. In a small Indian trial from Chennai, acupuncture with moxibustion at one point (CV17) for 2 weeks improved lung tests more than needling at a sham point [51]. Larger, better trials are needed.

Asthma in children

Asthma usually starts in childhood [1]. At Cure4Pain, the plan for children is almost the same as for adults; Dr Krushal Pabari adapts tests, vitamin D, nutrients and diet to age and body weight under medical supervision, in coordination with your child’s paediatrician. Vitamin D upper limits are lower in children, according to the US National Institutes of Health [30].

• Trials in children: vitamin D trials in children are mixed: some found fewer attacks or better control [17][20], and others found no benefit [22][23].
• Yoga: improved children’s lung function in trials [46].

Asthma in pregnancy

It is important to manage asthma in pregnancy to keep you and your baby well, and to tell your doctor or midwife about your asthma, according to the NHS [1]. At Cure4Pain, medicines and supplements in pregnancy are reviewed by Dr Krushal Pabari with your obstetrician, and we use only standard supplement doses in pregnancy.

Is asthma lifelong?

Asthma is a long-term condition; the NHS says it does not currently go away for good, but if it is well treated you should not have problems with symptoms [1]. At Cure4Pain, asthma is managed for life: reviews and blood tests continue every 3 months, the plan changes with seasons and triggers, and inhalers continue under medical guidance. Individual results vary.

What should you do in an asthma attack?

In an asthma attack, sit up straight, try to stay calm and use your reliever inhaler as your personal asthma action plan says, according to the NHS [1]. Call emergency services (112 in India, 911 in the US, 999 in the UK) if you start to feel worse at any time, do not feel better after the maximum dose of your reliever inhaler, or do not have your inhaler [1]. Cure4Pain does not treat asthma attacks; an attack is an emergency.

• See a doctor soon if you use your reliever more often, or symptoms stop your usual activities or wake you at night [1].

Which doctor should I see for asthma?

Asthma is diagnosed and treated by your family doctor or a chest physician (pulmonologist), with a paediatrician for children; an allergy specialist helps with allergy tests and immunotherapy. At Cure4Pain, Dr Krushal Pabari and AT. Chintan Dalal, N.D. work alongside them to add the nutritional layer.

Does Cure4Pain work with my chest physician?

Yes. Cure4Pain works alongside your existing consulting physician, chest physician, paediatrician or allergy specialist, shares its findings with them, and any change to medicines is made under clinical guidance from Team Cure4Pain, in coordination with them.

How do I book a consultation?

Please register your case on our patient portal with your latest blood tests, breathing test reports (spirometry, peak flow or FeNO), allergy tests and medical history, including your inhalers. We take patients on only after reviewing these reports and an assessment. Consultations are in person in Mumbai or online worldwide. Registrations and appointments are made only through our patient portal.

Evidence: key studies

Who treats you

• Dr Krushal PabariMD, PGCP - Rheumatic & Musculoskeletal Diseases. Assistant Professor, Cooper Hospital; Guest Professor, CMP Homoeopathic Medical College.
• AT. Chintan Dalal, N.D.BNYS, R.AP. Functional nutrition and Coimbra Protocol practitioner.

Consultations look at the whole person: alongside the medical and nutritional plan, we bring a strong interest in behavioural science to counselling on stress, sleep and lasting lifestyle change.

How consultations work: Mumbai or online worldwide

Book through our patient portal. You can see us in person at our clinic in Malad West, Mumbai, or online from anywhere. Your first consultation reviews your history and tests; we then agree a plan together and set the monitoring schedule.

Related conditions and articles

• Allergic RhinitisSneezing, blocked nose and dust allergy; vitamin D, gut and nasal care.
• Snoring & Mouth BreathingSnoring, mouth breathing and sleep apnoea; airway, tongue and nutrition care.
• Acidity & HyperacidityHeartburn, acid reflux and gastritis; tests, diet, gut support and medicine review.
• Metabolic SyndromeInsulin resistance, belly fat, triglycerides and fatty liver; tests, diet, exercise and medicine review.

• Lifestyle and metabolic conditions
• Allergic rhinitis

This page is for education and does not replace medical advice. Do not start, stop or change any medicine or supplement without medical guidance.

References

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