On the occasion of World Asthma Day, whose theme is “Making inhaled treatments accessible to ALL,” it is imperative to revisit this condition, which affects so many people globally.

As I noted a year ago in another column, the World Health Organization estimates that asthma affects around 262 million people worldwide and causes approximately 455,000 deaths annually, with a prevalence of 5–10% of the population. Global studies estimate that the most affected populations are children aged 5 to 9 years (5,717 per 100,000 people), while men aged 75–79 and women aged 80–84 show the highest number of asthma-related deaths. As is widely known, asthma is a chronic disease that affects the airways and can cause shortness of breath, coughing, wheezing, sleep disturbances, and, in more severe cases, a substantial deterioration in quality of life.

As mentioned at the outset, the focus of this commemoration is the need to improve access to inhaled treatments. Despite existing advances, limited access to these essential medicines remains a significant issue, particularly in low- and middle-income countries, where 96% of asthma-related deaths occur. These treatments include inhaled corticosteroids (ICS) and short-acting beta-agonists (SABA), which are essential for controlling inflammation and providing rapid symptom relief. ICS, such as fluticasone and budesonide, reduce inflammation in the airways, while SABAs, such as salbutamol, relax the muscles around the airways to provide quick relief.

In these countries, the availability of these essential medicines is limited due to economic and logistical factors. Treatment costs vary significantly across low- and middle-income countries. A study conducted in such settings indicates that the monthly cost of a salbutamol inhaler—used to treat intermittent asthma—can range from 0.47 days’ wages in some countries to 3.33 days’ wages in others. Availability in pharmacies is close to or below 30%, with significant differences between private and public pharmacies. These economic disparities reflect substantial barriers faced by patients in accessing essential treatments.

Access to inhaled treatments is crucial for effective asthma management. In low-income countries, the vast majority of asthma patients are treated only when they reach a healthcare facility or hospital with a severe asthma attack.

From a pharmacoeconomic perspective—as I conceptualized in a previous column—the coverage of inhaled treatments such as ICS/SABA combinations represents a highly cost-effective strategy compared to treating patients with uncontrolled asthma. Studies have shown that regular use of inhaled corticosteroids significantly reduces severe exacerbations, hospitalizations, and emergency visits, which are high-cost clinical events for healthcare systems. For example, an analysis published in The New England Journal of Medicine highlights that patients with poorly controlled asthma—often due to lack of access or adherence to inhaled treatments—make disproportionate use of healthcare resources, including repeated hospitalizations and more costly systemic treatments. Furthermore, lack of early access to these essential medicines in low- and middle-income countries contributes to an even greater economic burden by shifting treatment to more advanced and expensive stages of the disease.

International best practices, such as those promoted by the Global Initiative for Asthma (GINA), recommend using ICS/formoterol or ICS/SABA combinations as reliever therapy even in mild cases, with the aim of reducing inflammation early and preventing disease progression. This strategy not only improves clinical outcomes but also optimizes healthcare resource use, making it a sustainable and equitable health investment.

On this World Asthma Day, it is time to move from diagnosis to action. Governments, health organizations, the pharmaceutical industry, and civil society must take joint responsibility to ensure equitable access to inhaled treatments. Investing in availability, education, and treatment adherence not only saves lives but also strengthens healthcare systems.