The International Working Group for Health Systems Strengthening (IWGHSS), in collaboration with the Every Breath Counts (EBC) Coalition, convened a Think Tank session to engage with a new global campaign sponsored by the Forum of International Respiratory Societies (FIRS): making inhaled medicines affordable and accessible for all. The session highlighted how chronic respiratory diseases—specifically asthma and chronic obstructive pulmonary disease (COPD)—are not only clinical challenges but also issues of equity, access, and political will.

The campaign comes at a critical time, ahead of the United Nations High-Level Meeting on Non-Communicable Diseases (NCDs) later this year. With respiratory illnesses continuing to claim millions of lives—many of them preventable—this moment presents an opportunity to elevate inhaled medicines as a core issue in the global NCD agenda. The Think Tank sought to mobilize emerging health leaders and health system actors to ensure that access to these medicines is prioritized in national and international policy discussions.

This discussion forms part of IWG’s broader commitment to building health systems that work for everyone, especially the most marginalized. Inhaled medicines represent a life-saving yet largely inaccessible treatment for millions in low- and middle-income countries (LMICs)—a reality that demands urgent attention.

Background to the campaign: a global crisis in respiratory health

The session started with a presentation by Leith Greenslade, Coordinator of the Every Breath Counts Coalition. Her presentation emphasized that globally, 652 million people are living with chronic respiratory conditions such as asthma and COPD. Asthma alone is the second leading cause of Years Lived With Disability in children under five, a shocking statistic that highlights the widespread and early impact of these diseases.

These burdens are not evenly shared. An astounding 86% of COPD and 96% of asthma-related deaths occur in LMICs, where access to proper diagnosis and treatment remains limited. Despite being preventable and manageable conditions, many lives are lost due to systemic neglect, unaffordable medications, and underfunded health systems.

At the heart of the FIRS campaign is the call to action for equitable access to inhaled medicines—an essential, life-saving intervention that remains financially out of reach for many. In several LMICs, a month’s supply of inhalers can cost more than a week’s wages, making consistent treatment nearly impossible for millions of households.

One example shared during the session offered a compelling case for policy change:

“After Brazil introduced free inhaled medicines for asthma care, household costs fell from 29% of income to 2%, and the hospitalization rate dropped from 90 to 60 per 100,000 people.”

This evidence demonstrates that access to inhaled medicines is not just a health imperative—it’s an economic and social one.

Themes from the session 

Koye Oye-Igbemo (KO) emphasized the importance of integrating inhaled medicines into Universal Health Coverage (UHC) frameworks and national health policies. In many LMICs, access to inhaled medicines is currently available in only 7–11% of pharmacies and health facilities. Advocacy efforts must focus on ensuring that essential medicines for asthma and COPD are not sidelined but recognized as a core part of health system obligations.

KO also proposed the adoption of innovative distribution strategies, such as using data-driven forecasting models and electronic tracking systems to reduce stockouts and improve delivery of inhalers and vaccines, particularly pneumococcal and rotavirus vaccines, which together could prevent nearly 3 million child deaths by 2030. Strengthening the healthcare workforce through training and capacity-building was also identified as key to ensuring proper diagnosis and prescribing practices.

Immaculata Amadi shared insights from her work on oxygen supply in Nigeria. She pointed to the broader policy and systems-level conversations needed to ensure equitable access—not only to inhaled medicines but also to the full continuum of respiratory care. Her remarks reframed the campaign as not just about commodities, but about building sustainable systems for respiratory health.

This requires rethinking national procurement strategies, expanding supply chains, and ensuring public sector prioritization of chronic respiratory disease management—particularly in countries where access to oxygen and inhaled therapies is determined more by geography and income than by need.

Oluseyi Sanyaolu (OS) shared a deeply concerning development from Nigeria: the official exit of GlaxoSmithKline (GSK)—one of the country’s main pharmaceutical suppliers—due to economic challenges and declining revenues. One major consequence has been the shortage of Seretide (salmeterol xinafoate–fluticasone propionate), a key inhaler for asthma patients.

“Prices have skyrocketed…making it almost impossible for many to continue treatment.” OS

This is particularly alarming given that Nigeria ranks among the top 20 countries with concentrated asthma deaths, highlighting the urgent need for government intervention and domestic manufacturing solutions.

Members shared personal reflections on family members living with COPD, highlighting the emotional toll and everyday struggles behind the statistics. Bettina Buabeng-Baidoo (BB) spoke from her experience working in healthcare facilities, drawing attention to the stigma surrounding COPD.

“Because COPD is often linked to smoking, patients are sometimes treated as if they deserve the disease. We forget that behind every statistic is a person, a family, a story.” BB

BB also shared the heartbreaking loss of two high school classmates whose lives were cut short by asthma attacks in South Africa. These were not just numbers on a chart, but friends with dreams, families, and futures that ended far too soon. In remembering them, she reminded the group that every statistic hides a name, a face, a voice, and a story that deserved a different ending.

Moving forward: from awareness to action

The think tank closed with a renewed sense of urgency and shared commitment. Members called for:

• National policy change to include inhaled medicines on essential drugs lists
• Public awareness campaigns to combat stigma and promote early diagnosis
• Global solidarity to support countries navigating pharmaceutical market exits
• Storytelling and advocacy to centre the voices of those directly affected
• Stronger advocacy toward the UNGA NCD High-Level Meeting to ensure respiratory illnesses and inhaled medicine access are not side-lined
• Integration of inhaled medicines into UHC and primary healthcare frameworks
• Investments in training and data-driven systems to improve distribution and reduce stockouts

As the IWG continues to partner with the Every Breath Counts Coalition, we reaffirm our belief that access to inhaled medicines is not a luxury—it’s a right. To build resilient, people-centered health systems, we must ensure that no one is left gasping for breath.

“Every breath counts—and every life matters.”

The official launch of the campaign is on World Asthma Day, 6 May 2025, and all campaign materials can be found here: https://firsnet.org/campaigns/access-to-inhaled-medicines/

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Special Contributions from: Bettina Buabeng-Baidoo (BB), Leith Greenslade (LG), Oluseyi Sanyaolu (OS), Nurul Hussain (NH), Koye Oye-Igbemo (KO), Immaculata Amadi (IA), Marcelle Costa Marinho (MM), Nwamaka Ezeanya (NE), Flata Mwale (FW), Godfrey Kagaayi, (GK) Juliet Shaibu (JS)