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Dr Cassandra Kelly-Cirino, Executive Director at the International Union Against Tuberculosis and Lung Disease, advocates for improved access to inhaled medicines to tackle global lung health issues and for the standardisation of best practices to enhance outcomes for people with respiratory illnesses
Lung disease is one of the world’s most persistent and neglected health challenges. Together, chronic obstructive pulmonary disease (COPD) and asthma affect an estimated 750 million people and claimed 3.8 million lives in 2023 alone.
The burden on children is particularly significant. According to the Global Asthma Report, as many as one half of children and adolescents have asthma symptoms that are inadequately controlled by treatment – and one in five affected children can receive no effective medicine for their asthma. Between a third and a half of children and adolescents have severe symptoms that regularly interfere with everyday life.
For millions around the world – and particularly in low- and middle-income countries (LMICs) – diagnosis comes too late, and access to treatment is inconsistent.
At the centre of this inequity is a stark and preventable failure: the lack of access to essential inhaled medicines.
A simple device with huge impact
image: ©Wavebreakmedia | iStock
For asthma and COPD, inhalers are the foundation of effective care – reducing symptoms, preventing life-threatening exacerbations, and keeping people out of hospital. They are well-established, cost-effective, and included on the World Health Organization’s Essential Medicines List. And yet, across many LMICs, they are scarce, unaffordable, or absent from national health systems altogether.
Without access to inhalers, people experience debilitating yet avoidable impacts on their health, limiting their ability to work, learn, and lead normal lives. Families face repeated, costly emergency visits. Health systems, already under pressure, absorb the costs of hospitalisation and advanced care.
Preventable hospital admissions and lost productivity also significantly burden national economies. As health systems increasingly grapple with the impact of non-communicable diseases (NCDs), failure to act on lung health will only deepen inequity and strain public finances further.
Fragmentation is a key issue here. Too often, health systems address lung conditions, like asthma and COPD, through siloed, disease-specific programmes – despite them sharing risk factors, service needs and delivery platforms with other respiratory diseases, notably tuberculosis (TB). This leads to inefficiencies and missed opportunities to diagnose and treat lung conditions where and when people need it most.
Change can’t happen alone
In 2025, UN Member States adopted a WHO resolution on integrated lung health and a political declaration on non-communicable diseases, committing to stronger prevention, diagnosis and treatment of respiratory conditions.
These frameworks recognise that integrated, people-centred care, embedded within universal health coverage (UHC) and strengthened primary healthcare (PHC), is essential to progress in treating lung diseases.
This is the first step in improving outcomes for those with respiratory illnesses and saving lives. However, without a clear plan for implementation, they risk remaining unfulfilled.
We have the tools and political will. Now, we need urgency and accountability through action
Better access to essential inhaled medicines will play a key role in meeting these pledges globally. This means making them as available and affordable as other medicines – consistently stocked, covered by national benefit packages, and accessible through primary care.
A growing number of best-practice examples are emerging: countries including Kenya, Malaysia and the Philippines are integrating respiratory services into primary care, aligning national policies with global guidance, and strengthening diagnostics and treatment pathways.
Additionally, Brazil demonstrated that providing free inhaled medicines leads to dramatic reductions in household costs and hospitalisation rates. Meanwhile, Vietnam has shown that integrating evidence-based management of asthma and COPD into primary care can reduce severe episodes and hospitalisations by 20%.
But these examples must become the norm.
An opportunity for integration
TB offers a powerful entry point for integrated lung health services. TB programmes have already built community networks, diagnostic capacity, and primary care infrastructure that can support earlier detection and management of chronic respiratory diseases.
We need to remember that people access healthcare systems not from a fragmented or disease-specific silo; it is the healthcare system that causes their experience to become siloed. Instead, we need to ensure that people can readily access comprehensive screening.
By integrating TB, asthma, COPD, smoking cessation, post-TB lung disease, and broader lung health screening into community and primary care, countries can deliver more people-centred, efficient, and equitable care.
With just five years left to achieve the Sustainable Development Goals, the window for action is closing. Now is the time to turn momentum into concrete action.
Governments must immediately include essential inhaled medicines in national health benefit packages and ensure reliable procurement and supply, while donors and global health agencies must prioritise lung health within NCD funding and urgently invest in integrated, comprehensive lung health screening. Crucially, the global health community must stop treating asthma and COPD as secondary concerns and start giving those suffering the attention and quality of life they deserve.
Failure to act will mean that millions continue to experience worsened illness, avoidable hospitalisations, and preventable deaths – and risk global commitments on NCDs falling short once again.
We have the tools and political will. Now, we need urgency and accountability through action so that every person, everywhere, can access the inhaled medicines they need to breathe.
This article is inspired by an intervention made by Dr Cassandra Kelly-Cirino during an official side event at the 79th World Health Assembly, titled ‘From Global Commitments to Integrated Lung Health Action: Advancing early diagnosis of lung cancer and access to inhaled medicines for COPD and asthma’.
You can read Dr Kelly-Cirino’s full intervention here and watch the recording of the side event here.