“Non-pharmacological management of bronchial asthma:” A comprehensive narrative based on the Dr. R. K. Modi Memorial Lecture 2025

Bronchial asthma is a chronic inflammatory airway disorder characterized by variable respiratory symptoms and reversible airflow obstruction. Although inhaled pharmacotherapy remains the cornerstone of asthma management, many patients, especially in low- and middle-income countries, continue to have inadequate control due to modifiable environmental, behavioral and psychosocial factors. The Dr. R. K. Modi Memorial Oration (2025), delivered by the author emphasized that no-pharmacological strategies are not optional add-ons but essential complements to controller medications. Evidence from India and across the world demonstrates that structured nonpharmacological interventions – including allergen and trigger avoidance, smoking cessation, optimal management of comorbidities, yoga and pranayama, breathing retraining, pulmonary rehabilitation, dietary optimization, vaccination, and patient education – significantly improve symptom control, lung function, oxidative stress markers, and quality of life, while reducing exacerbations and healthcare utilization. This narrative review synthesizes available evidence, with special emphasis on Indian data and oration-linked studies, to present a comprehensive, human-centered overview of nonpharmacological management of bronchial asthma. The article highlights how a rational integration of these strategies with guideline-directed pharmacotherapy can substantially improve long-term outcomes and address India-specific challenges related to pollution, biomass use, allergen burden, underdiagnosis, inhaler hesitancy, and comorbidity clustering.