‘My life has shrunk to the size of my inhaler’: How Delhi’s pollution is wrecking lives — and family budgets

Sunita and Manoj have two other college-going children and the family’s income is barely enough to keep them afloat. A week of medicines for Sharmishtha costs about Rs 5,000, and there are doctor’s fees and the cost of pumps, nebulisers, and tests, to pay in addition. “The prices of Sharmishtha’s medicines have been going up. In three months this year, we have spent about Rs 15,000-20,000,” Sunita said. She estimates that expenditure on the treatment of Sharmishtha’s respiratory illness every winter would add up to Rs 4-5 lakh over the last nine years.

The family dreads the winter; it is their season of fear. The first signs of trouble start appearing as early as in September. “Sharmishtha starts coughing, and then the breathing problems begin,” Sunita said. “She needs to use the nebuliser at least twice on normal days and, on some days when she feels particularly ill, every four-five hours,” she said.

Sunita often fears for Sharmishtha. She said she was scarred by the death of her brother-in-law from complications that arose out of respiratory illness some years ago. “During the Covid-19 pandemic, I took extra care of Sharmishtha because the situation was so frightening. Hospitals were focused on Covid patients. Ambulances were not available. On one occasion when Sharmishtha suffered from an extreme bout of coughing and breathlessness, we had to take her to hospital in a police car,” she said.

The family spends eight months of the year preparing for the four months of winter during which Sharmishtha’s bronchitis invariably flares up. “There is enormous mental stress all year. People who have air purifiers at home cannot even imagine what we go through,” Sunita said.

Like many mothers, Sunita worries about Sharmishtha’s future. “I don’t know who will take care of her when we are not in this world. She has to marry someone good and loving,” she said.

The family tries their best not to leave their 2 BHK home during the four months of winter, except to go to the doctor or to the hospital if needed. However, yoga and meditation have brought Sharmishtha some relief; they have strengthened her lungs, improved her breathing, and cut her visits to the hospital to just once a month, Sunita said. The yoga and meditation, which Sharmishtha teaches at a local centre, are also a welcome distraction, as well as a source of income for her.

‘I need a good air purifier, but can’t afford it’

Pooja Khurana, 44, Pitampura
Permanent lung damage

Pooja Khurana lives in Pitampura and takes the Metro to travel to her workplace in Nehru Place. She was diagnosed with asthma in 2014, and her suffering has increased steadily every winter since then.

From October to January, Khurana spends around Rs 50,000 every month on hospital check-ups and medication. “During the peak pollution season, I go through three boxes of medicines in a week. It’s expensive and exhausting,” she said.

Khurana found herself in the hospital for the first time in the winter of 2017. “I could not breathe properly,” she said. “But I didn’t realise at the time how serious it was about to get.”

Pooja Khurana, at her work place in Nehru Place, who is struggling with breathing problems due to pollution, at New Delhi on Thursday, December 12, 2025. Express photo by Abhinav Saha

The hospital visits increased in 2018 and 2019 as her lung inflammation became worse, and eventually left permanent patches that doctors linked directly to prolonged exposure to air pollution. Infection with Covid-19 in 2020 worsened her condition.

“Every year, as pollution increases, my body reacts immediately,” Khurana said. “The inflammation worsens my asthma, and even a short walk outside can leave me gasping.”

The family wants an air purifier, but can’t afford one. “All the good ones are out of my budget,” she said. The private company where Khurana works in the administration department has an air purifier. “Coming to the office is a relief. I feel I breathe better at work,” she said.

The permanent patches in her lungs are a constant reminder to minimise her 10-year-old daughter’s exposure to Delhi’s poisonous air. She has discussed leaving the city with her husband, but the visions of disruption in their jobs and their child’s education are intimidating. “We are not so rich that we can go away for the winter. And we can’t leave permanently because our whole world is here,” she said.

‘I avoid gatherings, my life is now as small as my inhaler’

Sandeep Vij, 63, Freedom Fighters Enclave
Chronic asthma

For Sandeep Vij, winter brings a struggle to breathe that is sometimes so severe that he finds it difficult to even take himself to hospital. He has suffered from chronic asthma since he was a child, but what he has experienced over the past decade is unlike anything he remembers growing up.

Vij retired from his exports business in 2015 and decided to focus on his health. He said he spends Rs 40,000 on average for the treatment of his respiratory illness every year.

This year has been especially bad. “Over the last two weeks, I have spent Rs 35,000. The cost of corticosteroids alone has been Rs 25,000,” he said. “I can still afford to pay, but it hurts.”

Vij said he normally spends Rs 2,500-3,000 a month on nebulisers, but costs can go up to lakhs if there’s an emergency. “There is no limit. It’s killing.”

He said he was hit hard after returning to Delhi from London in early November, both due to the pollution and the fact that he had neglected his daily medication because he “felt healthy” abroad. “I was put on the heaviest dose of asthma medication I’ve ever taken,” Vij said.

The steroids and cortisone inhalations, taken three-six times daily, have had side effects. “My hands shake, I get cramps, I am dehydrated, and I’ve become irritable. I quarrel for no reason. I don’t drive because I don’t feel in control,” he said.

Vij won’t leave Delhi, where he has friends and memories. But he has forbidden his children and grandchildren, who live in the UK and the US, from visiting him from October to February. He barely steps out, avoids gatherings, and uses an air purifier constantly. “My life”, he told The Indian Express, “has shrunk to the size of my inhaler”.

‘Yeh (expenses) toh har saal ka ho gaya hai ab’

Chandan Sawai, 33, Karol Bagh
Asthmatic since birth

Chandan Sawai has suffered from asthma since birth. But unlike many in this city, he is able to frequently escape from Delhi to the hills with family and friends. “After I was born, the doctor asked my mother to leave Delhi but we could not. Yahaan se kahaan jaayein (Where do we go)?”

Sawai has struggled against breathlessness and respiratory problems all his life, but he has tried to take control of his health through a combination of discipline, exercise, and careful lifestyle choices.

Asthma Patient Chandan at his house, in New Delhi on Friday. Express photo by Praveen Khanna

But that has not plugged expenses on medicines, doctors’ consultation, tests, machines, and medical equipment. Sawai told The Indian Express that he has spent more than Rs 8 lakh on his respiratory health in the last 10 years, including on medicines, inhalers, nebulisers, tests, and buying an oxygen concentrator.

“Yeh toh har saal ka ho gaya hai ab. (These expenses arise every year now.) The medicines that go into nebulisers and inhalers are very expensive. I would have spent Rs 12,000-13,000 on medicines alone over the last one month,” he said. For years, his reliance on an oxygen concentrator was almost continuous, and his nebuliser use could reach 10 times a day during severe episodes.

However, lifestyle changes have helped. He walks regularly, and does breathing exercises with a spirometer. He watches his diet, avoids heavy foods, and consumes a lot of fluids. He takes multivitamin tablets and does yoga.

Over the last two years, his dependence on medical support has reduced, Sawai said. He now needs the oxygen concentrator only when he sleeps, and his nebuliser usage has halved from 8-10 times a day. “I still take precautions, wear a mask outdoors, and use air purifiers at home.”

Illness, unease that take a toll psychologically

Sadin Kumar Baruah, 60, Pitampura
Allergies and asthma

For Sadin Kumar Baruah, the onset of winter brings a fight for every breath, weeks or months of extreme cough, and a constant worry about his finances. It impacts his mental health, he says.

Baruah has a CGHS card, but not all expenses are covered. A problem with the renewal of the card that is still to be sorted out has meant this winter has been particularly hard. His medicines cost around Rs 3,000 every month. “They are often not available at the CGHS pharmacy, and have to be purchased from the market,” he said.

Sadin Kumar Barua, at his work place in Hauz Khas, who is struggling with breathing problems due to pollution, at New Delhi on Thursday, December 12, 2025. Express photo by Abhinav Saha

Baruah’s history of respiratory illness goes back about a decade — it began with allergies around 2015, progressed to bronchitis, and eventually evolved into chronic asthma. His condition has deteriorated sharply in the last three years, especially during the winter, when the polluted air triggers severe flare-ups.

“The period from November to January is terrible. I feel uneasy constantly, and sometimes I cough up blood,” he said. His pulmonologist attributes his asthma primarily to air pollution in Delhi during the winter.

“The doctor gave me guidelines: avoid dust, stay indoors especially during the early mornings, and don’t drink water without warming it first,” Baruah told The Indian Express.

He has followed the doctor’s advice as closely as possible, which, along with the use of inhalers and medication, has helped significantly. Over the years, Baruah’s dependence on an oxygen concentrator has reduced from almost round-the-clock use to use just when he sleeps at night.

Similarly, his nebuliser usage has come down from 10 times a day to about four-five times a day. But there is no scope for relaxing.

“Around Diwali and afterward, as the smog gets worse, so do my symptoms. They persist late into December. It is only in January that I get some relief,” he said.

Some years are worse than others, Baruah said. In general, during this period, even routine outdoor activities become difficult, and wearing a mask becomes a necessity rather than an option. His work is restricted, and there are constraints on his pocket as medical expenses increase.

Baruah keeps referring to the psychological toll it takes on him. “I get negative thoughts, especially after the Covid pandemic. It affects the mind as much as the lungs,” he said.

Baruah contracted the virus three times in two years, which made his asthma worse, though his lungs did subsequently recover with medical care.

Like many others in his situation, he considered leaving Delhi, but found himself unable to do so. “I was born here. I have thought about leaving, but I have decided to stay,” Baruah said.

He uses air purifiers at home, avoids early morning outings, and meticulously follows medical advice. It has made his winters less difficult to endure, putting his mind more at ease. He remains hopeful that through vigilance, medical care, and lifestyle adjustments, even the most vulnerable can find ways to breathe a little easier in the city’s choking haze.

Pulmonologists speak

Air pollution places a heavy financial burden on patients, particularly those with existing respiratory illnesses, through hospital or outpatient visits, extra medicines like steroids, antibiotics, inhalers or nebulisation, and in severe cases, hospitalisation or ICU admission involving ventilators, investigations and prolonged stays. Patients come to AIIMS because they have faith, but also because they are unable to afford private hospitals. Often, indirect costs resulting from missing work or losing jobs are even higher. Air pollution triggers a cycle of illness, lost incomes and rising healthcare costs, disproportionately affecting lower- and middle-income families.

Dr SAURABH MITTAL, AIIMS, New Delhi

If there is an increase in the air pollution, there is an increase in the morbidity. More and more patients are getting admitted to hospital, and obviously, that is leading to increased healthcare costs for those families. While any admission is expensive, in case of a severe attack or increased cough, the amount of doses consumed will also increase, leading to an increase in costs. We often see a large number of patients lining up from October to December as the condition of those who are vulnerable deteriorates, requiring higher doses of medication.

Dr VIKAS MAURYA, Fortis Hospital

The increase in healthcare costs happens because patients have to increasingly have consultations with doctors, followed by investigations including CT scans, and take antibiotics. As the elderly and those with chronic lung disease get admitted to hospital, the burden is both on the individual and on the public healthcare system, including government hospitals. We need to get to the source of this problem, which this year has been primarily vehicular pollution. Improving fuel quality, moving towards hybrid and electric vehicles, and improving public transport is the solution.

Dr G C KHILNANI, PSRI Hospital

This year there is a clear increase in the number of people coming to OPD with breathing issues, long-lasting cough, tightness in the chest, and burning in the eyes and throat. Pollution levels have been higher for longer, and this is showing in the number of people seeking help. Even previously stable patients are deteriorating. The usual inhalers are sometimes not enough to keep things under control. Oxygen needs have increased and stable COPD patients are requiring oxygen. This aggravation is far more pronounced than what we have seen in previous years.

Dr RAJESH CHAWLA, Indraprastha Apollo Hospitals

Delhi’s annual winter pollution crisis has once again overwhelmed hospitals, which are reporting a dramatic increase in respiratory illnesses linked directly to worsening air quality. We are seeing almost a 20% increase in patients coming with respiratory problems, fever, cough and breathlessness in the OPD. Every time air quality dips, a surge follows within 4-6 days, and there is usually an increase in emergency visits with respiratory problems. This also leads to increased admissions both in the hospital and the Intensive Care Unit.

Dr RANDEEP GULERIA, Medanta Hospital

What data shows

Large loss to India’s GDP

LOST OUTPUT from premature deaths and morbidity attributable to air pollution accounted for economic losses of $28.8 bn and $8 bn respectively in India in 2019, adding up to 1.36% of GDP, according to the ‘Health and economic impact of air pollution in the states of India: the Global Burden of Disease Study 2019’, published in The Lancet Planetary Health.

DELHI had the highest per-capita economic loss due to air pollution, followed by Haryana in 2019, according to the study.

Pressure on public funds

A UK STUDY found that a standard deviation increase in 𝑃𝑀10 levels increases the enrolment of patients aged 60 years and older by 6.2% and that of patients under 18 years of age by 3.1%.

THIS DEVIATION across the city of Leicester would cost the UHL NHS Trust an additional £873,985 annually. (‘The contemporaneous healthcare cost of particulate matter pollution for youth and older adult populations’, Journal of Environmental Economics and Management, 2024)