Management of asthma in resource-limited settings: Role of low-cost corticosteroid/β-agonist combination inhaler

The management of asthma requires medicines that are effective in relaxing airway smooth muscles and in reducing airway inflammation. Rapid-acting β₂ agonist is a bronchodilator that provides quick symptom relief in patients with asthma. However, it does not effectively address the underlying problem of airway inflammation. Excess use of inhaled bronchodilators alone for symptom relief may result in delay in seeking health care, which in turn may result in delayed use of anti-inflammatory agents. Inhaled corticosteroid (ICS) is critical in the treatment of airway inflammation; it reduces the risk of life-threatening asthma attacks and the need for hospitalisation. ICS is underused, however, and a substantial proportion of patients with persistent asthma in resource-limited settings have no access to affordable ICS for long-term treatment. International guidelines recommend the use of rapidacting β-agonists as needed as rescue treatment when symptoms occur. Studies have shown that the use of both ICS and rapid-acting β-agonist as needed for symptom relief might be a better option. The combination of ICS and rapid-acting bronchodilator in a single inhaler is currently too expensive and is not affordable for the poor. Although ICS and short-acting β₂ agonist (SABA) for rescue treatment can be obtained to a certain extent by using separate ICS and SABA inhalers, the first step is to ensure access to affordable, quality-assured essential asthma medicine in resourcelimited settings.