Asthma control requires affordable, accessible quality-assured essential medicines. By Bobby Ramakant

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"It's time to control asthma", according to this year's World Asthma Day theme, but the International Union Against Tuberculosis and Lung Disease (The Union) says the low availability and the prohibitive cost of asthma inhalers continue to be serious challenges in low- and middle- income countries. With the vast majority of the 235 million people affected by asthma living in such limited-resource settings, The Union established the Asthma Drug Facility (ADF) to help overcome these barriers.
Through the ADF, low- and middle- income countries can purchase the quality-assured asthma medicines they need at an affordable cost. In countries such as Benin, Burundi, Kenya, Sudan and El Salvador, the cost of inhalers has fallen by as much as 50%, thanks to the ADF. As a result, a patient with severe asthma can be treated with Beclometasone and Salbutamol for one year for less than 40 euros.
To ensure the quality of the medicines it provides, the ADF uses a quality assurance system based on World Health Organization (WHO) norms and standards. Prices are kept down by having a limited competitive process among selected manufacturers based on yearly estimated volumes.
The Union also provides ADF clients with training in diagnosis and standard case management of asthma. This includes a simple system for monitoring patient outcomes, which allows them to evaluate the care offered at their facilities and improve asthma case management – both essential for the long-term control of this chronic disease.
"Anyone who has witnessed patients with asthma struggling for breath immediately understands the impact this disease has on individuals, families and communities", says Dr Nils E Billo, Executive Director of The Union. "Yet asthma remains grossly under-recognised and under-funded".
"ADF is a good example of an intervention that both saves lives and resources", says Dr Billo. "These are the kinds of approaches that will be needed to address not only asthma, but also other non-communicable diseases, as health systems increasingly assume with the dual burden of infectious and chronic diseases."
"Our goal for the ADF is to scale it up to reach the millions of people with asthma in low- and middle-income countries who currently have no treatment or inappropriate treatment", says Christophe Perrin, ADF coordinator for The Union.
Since the ADF does not provide medicines for free, countries need to obtain funds for their initial purchase and set up a sustainable financing strategy. For example, Benin’s National Tuberculosis Programme and Sudan’s Epi-Lab have established revolving funds and cost recovery systems for their asthma programmes. By purchasing ADF’s low-priced asthma medicines and applying a 12-18% margin, these countries are able to make progress towards controlling asthma by providing their patients with both affordable prices and a sustainable supply of medicines.

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