Better access to standard treatment for adult asthma in resource-limited countries

Abstract

Thank you for publishing Diallo et al.'s article, which highlights an avoidable care gap in the management of adult asthma that urgently needs to be closed. [1]Asthma is one of the most common non-infectious respiratory disorders, affecting over 262 million individuals and causing over 455,000 deaths yearly worldwide. [2]In Guinea, where an estimated 2,000 people die from asthma each year, the impact of the disease is particularly acute and demands focused attention from national policymakers. [2]Despite many years of research into its pathophysiology and interventions with proven efficacy in modifying the disease, uncontrolled asthma continues to be an important issue in many low-and middle-income countries (LMICs).This unmet need for asthma control does not reflect failure of treatment but rather gaps in access and availability.The retrospective study recently published in this journal by Diallo et al. from the Pneumophthisiology Department of Ignace Deen National Hospital in Conakry, Guinea, represents a timely and important contribution to our understanding of asthma management in adult patients from LMICs. [1]Providing granular detail on barriers to receipt of standard asthma treatment and clinical outcomes among a representative sample of patients with asthma seen in ambulatory care, this report illustrates how system-level deficiencies interact with household economic realities and patient-related factors to lead to poor asthma control in sub-Saharan Africa and elsewhere.Standard of care asthma management guidelines, as published by the Global Initiative for Asthma (GINA), clearly indicate that asthma should be treated with inhaled corticosteroids (ICS), with or without a long-acting 2-agonist (LABA), for all adolescents and adults. [3]Notably, the GINA 2021 update marked an important shift away from short-acting 2-agonists (SABA) only treatment, emphasizing that ICS should be part of asthma management at every step, including mild disease.ICS therapy decreases airway inflammation, prevents exacerbations, and improves quality of life and lung function over time when used regularly.Using only SABA is associated with worse outcomes. [3]While GINA's stepwise approach is widely endorsed, it often requires tools such as spirometry or peak-flow meters that may be unavailable in many primary-care settings in LMICs.These constraints highlight the need to adapt guideline recommendations to the realities of providers in these environments, ensuring that core principles, such as regular ICS use, can still be prioritized even in the absence of advanced diagnostics.The Guinea study found that only a small proportion of patients received ICS-containing background therapy; instead, most were prescribed SABA or systemic corticosteroids such as prednisolone.This treatment imbalance resulted in a majority of patients experiencing uncontrolled or partially controlled asthma, in contrast to higher-income settings where better access to standard asthma treatment