Background There are an estimated 269 million patients with asthma worldwide, with around 35 million in India where the management of asthma remains a great challenge. The main aims of this study were to gain insights into patient and primary care physicians views and perspectives regarding asthma and understand the facilitators and barriers to uptake of treatment and engagement with health services in Vellore district of South India. Methods The study involved semi-structured interviews with a purposively selected sample of patients (n=46) and primary care physicians (n=20) to address the research aims. Fieldwork took place in February-June 2022. Data were analysed using thematic coding. Results The study found there to be substantial gaps in knowledge among patients across the sample, and physicians also reported variable levels of expertise and a desire for additional training. The study also suggested that cultural and religious aspects were important in shaping attitudes and behaviours and that these were consistent across different geographical groups. Conclusions This study suggests the need for multi-pronged strategies including culturally tailored and targeted supportive interventions towards improving asthma care, as well as provision of free or subsidised treatment for those economically deprived. Furthermore, sustainable practical and clinically orientated training initiatives are needed for primary care physicians.