Asthma is the most common chronic respiratory condition, but it is also one of the most poorly managed in general practice, and the gap between guideline-recommended management and what most patients in Kolkata are actually receiving was the reason Krithika K waited two years in poorly controlled asthma before being referred to a pulmonologist. Two years of inadequate treatment without spirometry, without allergy evaluation, without objective confirmation of the diagnosis. When she came to my clinic at Fortis Hospital, Anandapur, I performed spirometry, confirmed reversible airway obstruction, identified house dust mite sensitisation that had never been tested for, and restructured the entire treatment plan. Her asthma control improved dramatically. The lesson from this clinical pattern, which is not specific to Krithika K but reflects a consistent finding in my practice across 12 years of respiratory medicine in West Bengal, is that asthma managed within a respiratory medicine framework produces a systematically different quality of evaluation from asthma managed empirically in general practice. The EDARM, European Diploma in Adult Respiratory Medicine, and my DNB in Respiratory Medicine from Apollo Hospital Calcutta, reflect a specialist respiratory training that places objective lung function assessment at the centre of every asthma evaluation rather than treating it as an optional investigation.
The Asthma-COPD Overlap and ABPA: Two Diagnoses West Bengal's Climate and Population Makes Clinically Frequent
The asthma-COPD overlap syndrome, where a patient has features of both conditions simultaneously, is one of the most clinically challenging respiratory presentations in Kolkata's middle-aged and older population. West Bengal's substantial proportion of adult smokers, the significant use of biomass cooking fuels in peri-urban and rural households, and the historical tuberculosis burden that produces post-infectious airway damage all create the conditions for airflow limitation that is only partially reversible. A patient who has been smoking for 20 years, who developed asthma in childhood, and who now has a spirometry pattern showing incomplete bronchodilator reversibility alongside a history of atopy and episodic wheeze, has the asthma-COPD overlap syndrome. Managing this patient with either a pure asthma protocol or a pure COPD protocol is suboptimal. The respiratory medicine framework accounts for both components: the allergic airway inflammation dimension that requires inhaled corticosteroids and allergen management, and the fixed airflow limitation component that requires long-acting bronchodilators and, critically, smoking cessation as the most effective intervention available for slowing COPD progression. Allergic bronchopulmonary aspergillosis, ABPA, is a specific hypersensitivity condition to Aspergillus fumigatus that occurs in patients with asthma or cystic fibrosis, and that is particularly clinically relevant in Kolkata's monsoon climate. Aspergillus spore counts in Kolkata's air peak dramatically during and immediately after the monsoon season, from June through September, when the combination of high humidity, abundant decaying vegetation, and damp indoor environments creates ideal conditions for Aspergillus proliferation. In the patient with poorly controlled asthma, new infiltrates on chest imaging, elevated total IgE, positive Aspergillus-specific IgE or skin prick test, and eosinophilia, ABPA should be specifically considered. Missing the diagnosis and treating with antibiotics for presumed bacterial pneumonia, or increasing inhaled steroids without recognising the fungal hypersensitivity component, are the management errors that a pulmonologist's systematic respiratory evaluation prevents.
Occupational Asthma in Kolkata and Why Spirometry-Based Diagnosis Changes Long-Term Outcomes
Kolkata's industrial, construction, and manufacturing sector creates occupational asthma exposures that are rarely identified in general practice because the history that would reveal the occupational connection is not routinely taken. A patient with asthma whose symptoms are better on weekends and holidays, worse on workdays, and who works in a textile mill, a chemical plant, a flour processing facility, or a construction environment where dust, isocyanates, or chemical sensitisers are present, may have occupational asthma: sensitisation to a workplace allergen that is driving their bronchial disease and that will not adequately respond to pharmacotherapy without removing the exposure. The serial peak flow measurements across working and non-working days that confirm the work-related pattern, and the specific sensitisation testing that identifies the causal agent, are the investigations that establish the diagnosis and lead to the management decision that most changes the prognosis: removal from the exposure, which in early occupational asthma can lead to improvement or resolution. Spirometry with bronchodilator reversibility testing is the investigation that begins every asthma evaluation at my Kolkata practice. It establishes the objective evidence of reversible airway obstruction that differentiates asthma from other causes of breathlessness, quantifies the degree of reversibility, and provides a baseline against which subsequent consultations can measure whether treatment is producing the improvement the patient deserves. A patient managed for asthma for two years without a single spirometry, as Krithika K was, has never had her diagnosis objectively confirmed. The spirometry changes that.
To book a pulmonology consultation with Dr. Subhajit Sen at Fortis Hospital, 730, Eastern Metropolitan Bypass, Anandapur, Kolkata, West Bengal 700107 (Monday to Saturday, 2:00 PM to 5:00 PM), call +91 9007734015.
Written by Dr. Subhajit Sen, MBBS (Medical College, Calcutta), MD (IPGME&R, Calcutta), DNB (Respiratory Medicine, Apollo Hospital Calcutta, National Board of Examinations), EDARM (European Diploma in Adult Respiratory Medicine), DRNB (Critical Care), Consultant Pulmonologist and Critical Care Specialist, Fortis Hospital, 730, Eastern Metropolitan Bypass, Anandapur, Kolkata, West Bengal 700107 (Monday to Saturday, 2:00 PM to 5:00 PM). Phone: +91 9007734015. Also consulting at Apollo Clinic Bansdroni, Golf View Hospital Tollygunge, and Medisus Lab and Clinic, Kolkata.
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