Dr Marie Stolbrink, Liverpool School of Tropical Medicine, UK


There are no contemporary data on the availability, cost, and affordability of essential medicines for the chronic respiratory diseases (CRDs) asthma and chronic obstructive pulmonary disease (COPD) across low-income and middle-income countries (LMICs).


Cross-sectional data on the availability and cost of CRD medicines in a pharmacy, healthcare facility (HCF) and central medicine store (CMS) in LMICs were collected. Costs were summarised in US Dollar equivalents as medians with interquartile ranges (IQR). A medicine was affordable if one month’s treatment cost was <1 day’s wages of the lowest paid government worker.


Data were collected from 60 LMICs.

Inhaled short-acting beta-agonists (SABA) were available in pharmacies of 53/57(93%) LMICs ($2.95,IQR:$1.99-4.97), 44/56(79%) HCFs ($2.34,IQR:$1.38-3.86) and 36/46(78%) CMS ($1.39,IQR:$1.20-2.83). They were affordable in 29/51(57%) pharmacies and 31/44(70%) HCFs.

Inhaled corticosteroids (ICS) were available in 31/57(54%) pharmacies ($5.40,IQR:$2.12-8.60), 31/46(67%) HCFs ($3.01,IQR:$1.21-5.89) and 22/46(48%) CMS ($1.16,IQR:$0.11-3.24). ICS were affordable in 17/31(55%) pharmacies and 20/31(65%) HCFs.

Combination ICS-long-acting beta-agonists (200+6mcg/dose budesonide-formoterol) were available in 31/57(54%) pharmacies ($19.20,IQR:$9.73-27.43), 21/56(38%) HCFs ($18.41,IQR:$11.30-24.49) and 9/46(20%) CMS ($7.14,IQR:$3.90-8.13). ICS-LABA were affordable in 6/31(19%) pharmacies and 3/20(15%) HCFs.

Long-acting anti-muscarinic antagonists (LAMA) were available in 26/57(46%) pharmacies ($30.53,IQR:$9.45-47.29), 16/56(29%) HCFs ($26.01,IQR:$15.32-36.70) and 11/46(24%) CMS ($17.98,IQR:$0.98-32.17). LAMA were affordable in 4/25(16%) pharmacies and 2/16(13%) HCFs.


Inhaled SABA were largely available and affordable whilst ICS, ICS-LABA and LAMA were less widely available and largely unaffordable. Costs ranged between countries with substantial differences between CMS and pharmacy or HCF within countries.


GAN gratefully acknowledges funding from the University of Auckland and Wellcome (Grant number 203919/Z/16/Z) as well as sponsorship from AstraZeneca and GlaxoSmithKline that has helped to make the GAN Symposium 2024 possible. We thank the speakers and the organisations they represent for their contributions including securing their own funding to enable their participation. The Symposium programme was developed independently by the GAN Steering Group.

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