Background: Asthma patients in high-income countries (HIC) and low- and middle-income countries (LMIC) need uninterrupted supplies of affordable, quality-assured essential medicines. The World Health Organization (WHO) NonCommunicable Disease (NCD) Global Action Plan sets an 80% target for availability of essential NCD medicines. Access is likely to improve if medicines are on national Essential Medicines Lists (EML) and provided free/subsidised.
Methods: Principal investigators of the Global Asthma Network were sent a questionnaire in 2014-5 about the inclusion of essential asthma medicines in their countries' EML and national reimbursement list (NRL).
Results: 111 of 120 countries sent data. Of 91 (82%) countries with an EML, 72 (79%) included 1 or more inhaled corticosteroids (ICS) and 79 (87%) included salbutamol. Inclusion of WHO-recommended dosages: of HIC with EML, 16 (70%) had beclometasone 50µg and 17 (74%) 100µg; of LMIC with EML, 38 (56%) had beclometasone 50µg and 31 (46%) 100µg.
Of 80 (72%) countries with an NRL, 64 (80%) included 1 or more ICS; 32 (94%) of the HIC and 32 (70%) of the LMIC. There were 29 (85%) HIC but only 23 (50%) LMIC that had 50µg beclometasone; 28 (82%) HIC but only 20 (43%) LMIC had 100µg beclometasone. 69 (86%) had salbutamol; 32 (94%) of HIC and 37 (80%) of LMIC. Patients in HIC with NRL are best served (91% HIC had ICS and salbutamol). Patients in the 24 (34%) LMIC with no NRL as well as those in LMIC with an NRL but no ICS are likely to have very poor access to these ICS.
Conclusion: Many LMIC do not have essential asthma medicines on their EML or NRL. A mechanism for accessing affordable, quality-assured medicines is needed; also technical guidance and advocacy for policy change.