LIVING BREATHLESS: A JOURNEY THROUGH ASTHMA, GENDER DISPARITIES AND ENVIRONMENTAL HEALTH IN NIGERIA
By Nneoma Eneh.
INTRODUCTION
Asthma, a chronic respiratory condition characterized by airway inflammation and hyperresponsiveness, affects millions worldwide. In Nigeria, the burden of asthma is significant, with environmental factors like indoor air pollution exacerbating the condition. As we observe World Asthma Day 2025, themed “Make Inhaled Treatments Accessible for All” by the Global Initiative for Asthma (GINA), it’s imperative to address the intertwined issues of asthma management, gender equity, and environmental health. Asthma remains a critical yet often overlooked public health challenge in Nigeria, affecting millions across both urban and rural communities. Characterized by recurring symptoms such as wheezing, persistent coughing, chest tightness and shortness of breath, asthma significantly hampers the quality of life of those who suffer from it. The condition is usually triggered by a variety of environmental and physiological factors, including allergens, exposure to air pollutants, respiratory infections, and even physical exertion. For effective long-term management, healthcare professionals globally recommend the consistent use of inhaled medications, particularly inhaled corticosteroids, which play a key role in reducing airway inflammation and preventing exacerbations. However, in Nigeria, the ideal picture of asthma management is far removed from the lived reality of most patients. While estimates suggest that between 13 to 15 million Nigerians live with asthma, studies show that only about 4% of these individuals have received a formal diagnosis by a healthcare provider. This diagnostic gap is driven largely by a combination of stigma, lack of awareness, and a chronic shortage of trained personnel, particularly in rural and underserved regions of the country.
Beyond economic and infrastructural limitations, systemic issues within Nigeria’s healthcare delivery also pose barriers to asthma management. Although many Nigerian doctors are aware of global asthma management guidelines such as those developed by the Global Initiative for Asthma (GINA), their implementation remains limited due to poor dissemination, lack of continuing education, and inadequate supply chains. A qualitative study conducted by the Journal of Global Health Reports confirmed that most physicians, even in tertiary institutions, struggle to translate asthma guidelines into daily clinical practice, thereby perpetuating mismanagement and under-treatment.
ENVIRONMENTAL TRIGGERS AND URBANISATION
Environmental factors play a pivotal role in influencing both the prevalence and severity of asthma across Nigeria. With the country’s rapid urbanisation, millions of Nigerians are now exposed to heightened levels of air pollution caused by increased vehicular traffic, industrial activities, open waste burning and unregulated construction. This unchecked development has led to a surge in airborne pollutants such as particulate matter, nitrogen dioxide and sulfur dioxide, all of which are known to exacerbate asthma symptoms.
Studies have consistently shown that environmental smoke, dust, and exposure to tobacco smoke are among the most common triggers of respiratory complications in Nigeria, affecting individuals in both urban and rural areas. Nigeria’s tropical climate adds another layer of complexity to asthma management. Hot and dry weather conditions, common in the northern parts of the country, often carry fine dust particles that irritate the respiratory tract. In other regions, the onset of the rainy season brings a proliferation of pollen and mould spores, both of which can prompt asthma attacks in sensitised individuals. These environmental triggers, when combined with the country’s limited public health response and poor air quality regulation, continue to pose a serious challenge to asthma control and prevention.
Effectively addressing asthma in Nigeria, therefore, must include a strong environmental health component, one that takes into account the impacts of urban planning, climate change, and pollution control in order to create safer, healthier breathing spaces for all.
GENDER DISPARITIES IN ASTHMA INCIDENCE
Gender plays a crucial role in the prevalence, severity, and overall management of asthma, revealing important disparities that are often overlooked in both clinical and policy spaces. During childhood, asthma is generally more common in boys, largely due to anatomical differences in lung size and airway development. However, this trend shifts significantly during adolescence and adulthood, when hormonal and physiological changes begin to play a more prominent role. Women, particularly from their teenage years onward, experience a higher prevalence of asthma and often report more intense and frequent symptoms compared to men.
A major factor contributing to this shift is the influence of female sex hormones, specifically estrogen and progesterone, on the respiratory system. Research has shown that hormonal fluctuations during key life stages such as menstruation, pregnancy and menopause can trigger or worsen asthma symptoms in many women. For instance, some women experience what is known as perimenstrual asthma, where symptoms flare up just before or during their menstrual periods due to declining levels of progesterone. During pregnancy, asthma may either improve, worsen or remain unchanged, but poorly managed symptoms can affect both maternal and fetal outcomes. The transition into menopause, which brings about dramatic hormonal changes, is also linked to altered asthma control and heightened symptom sensitivity.
Beyond biological factors, societal and cultural roles further complicate asthma outcomes for women, especially in low- and middle-income countries like Nigeria. Traditional gender roles often place women at the center of household responsibilities, including cooking with biomass fuels such as firewood, charcoal, and kerosene. These fuels are major sources of indoor air pollution, exposing women and girls to high levels of particulate matter and toxic gases daily. Prolonged exposure not only increases their risk of developing asthma but also exacerbates existing respiratory conditions, often in settings where access to healthcare is limited or delayed due to cultural and economic constraints. It is to tackle this problem that Clean Technology Hub and other actors in the sector promote clean cooking technologies and methods that produce less pollution.
Moreover, cleaning agents and other chemical products commonly used in domestic tasks can emit volatile organic compounds that act as asthma triggers. In poorly ventilated homes, common in urban slums or informal housing, the cumulative effect of these exposures becomes particularly dangerous. For women already living with asthma, these environmental and occupational exposures can undermine efforts to maintain good symptom control, leading to more frequent hospital visits, missed workdays, and a reduced quality of life.
Despite this, gender-specific approaches to asthma diagnosis, treatment, and management remain limited in healthcare systems across Africa. Few asthma programs or public health campaigns recognize the intersection of gender and environmental exposure, resulting in generalized strategies that fail to address the unique challenges faced by women. As such, it is critical for national health policies to integrate a gender lens into respiratory health interventions, from clinical guidelines and medical training to community-based education and access to clean energy alternatives.
BARRIERS TO ASTHMA CARE
Several challenges hinder effective asthma management in Nigeria:
- Limited Access to Medications: Essential inhaled treatments are often unavailable or unaffordable for many Nigerians.
- Lack of Awareness: Many individuals are unaware of asthma symptoms and management strategies, leading to underdiagnosis and undertreatment.
- Healthcare Infrastructure: Inadequate healthcare facilities and trained personnel limit the provision of quality asthma care.
- Stigma: Cultural misconceptions about asthma can lead to social stigma, discouraging individuals from seeking treatment.
CALL TO ACTION
To address the asthma crisis in Nigeria, concerted efforts are required:
- Policy Implementation: Government policies should prioritize asthma care, ensuring the availability and affordability of essential medications.
- Public Awareness Campaigns: Educational initiatives can demystify asthma, promoting early diagnosis and effective management.
- Healthcare Infrastructure Development: Investing in healthcare facilities and training can enhance the quality of asthma care.
- Research and Data Collection: Comprehensive data on asthma prevalence and management can inform targeted interventions.
- Gender-Sensitive Approaches: Recognizing and addressing gender-specific challenges can improve asthma outcomes for women.
Asthma remains a significant public health concern in Nigeria, exacerbated by environmental factors and gender disparities. As we observe World Asthma Day 2025, it’s crucial to commit to strategies that ensure equitable access to care, raise awareness, and address the unique challenges faced by different demographics. Through collective action, we can improve the lives of those living with asthma and foster a healthier society.
