Review of inhaled medicines availability and affordability

Dr Marie Stolbrink, Liverpool School of Tropical Medicine, UK


Asthma and COPD cause a considerable burden of morbidity and mortality in low- and middle-income countries (LMICs). Access to safe, effective, quality-assured and affordable essential medicines is variable. We aimed to review the existing literature relating to the availability, cost, and affordability of World Health Organization (WHO) Essential Medicines for asthma and COPD in LMICs.


A systematic review of the literature was conducted by searching seven databases to identify research articles published between January 2010–June 2022 (PROSPERO: CRD42021281069). Studies on named essential medicines for asthma and COPD in LMICs were included, review articles excluded. Two authors screened, extracted data and assessed bias independently. The main outcome measures were availability (WHO target of 80%), cost (compared to median price ratio (MPR)) and affordability (number days of work of the lowest paid government worker).


Of 4,742 studies identified, 29 met the inclusion criteria providing data from 60 LMICs. All studies had a low risk of bias but heterogeneity. Six (of 58) countries met the availability target for short-acting beta-agonist agonists (SABA), 3/48 countries for inhaled corticosteroids (ICS) and 0/4 for ICS-long-acting beta-agonist combination (ICS-LABA). Costs were reported by twelve studies: the range of MPRs was 1.1-351 for SABA, 2.6-340 for ICS, 24 for ICS-LABA. Affordability was calculated in ten studies: SABA inhalers typically cost around 1-4 days’ wages, ICS 2-7 and ICS-LABA at least six.


Essential medicines for treating asthma and COPD were largely unavailable and unaffordable in LMICs. This was particularly true for inhalers containing corticosteroids.