. 2022 Nov 1;26(11):1023-1032.

doi: 10.5588/ijtld.22.0270.

Improving access to affordable quality-assured inhaled medicines in low- and middle-income countries

M Stolbrink¹, M J Chinouya², S Jayasooriya³, R Nightingale⁴, L Evans-Hill⁵, K Allan⁶, H Allen⁷, J Balen⁸, T Beacon⁹, K Bissell¹⁰, J Chakaya¹¹, C-Y Chiang¹², M Cohen¹³, G Devereux¹⁴, A El Sony¹⁵, D M G Halpin¹⁶, J R Hurst¹⁷, C Kiprop¹⁸, A Lawson¹⁹, C Macé²⁰, A Makhanu¹⁸, P Makokha¹⁸, R Masekela²¹, H Meme²², E M Khoo²³, R Nantanda²⁴, S Pasternak²⁵, C Perrin²⁰, H Reddel²⁶, S Rylance²⁷, P Schweikert¹⁹, C Were²⁵, S Williams²⁸, T Winders²⁹, A Yorgancioglu³⁰, G B Marks³¹, K Mortimer³²

Affiliations

¹ Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK, Stellenbosch University, Tygerberg, South Africa.
² Education Department, Liverpool School of Tropical Medicine, Liverpool, UK.
³ Academic Unit of Primary Care, University of Sheffield, Sheffield, UK.
⁴ Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK, IcFEM Dreamland Mission Hospital, Kimilili, Kenya.
⁵ Nifty Fox Creative, Sheffield, UK.
⁶ Healthcare Consultant, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, The Gambia.
⁷ Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, The Gambia.
⁸ School of Health and Related Research, University of Sheffield, Sheffield, UK.
⁹ Medical Aid International, Bedford, UK.
¹⁰ School of Population Health, University of Auckland, Auckland, New Zealand.
¹¹ Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK, Department of Medicine, Therapeutics and Dermatology, Kenyatta University, Nairobi, Kenya.
¹² International Union Against Tuberculosis and Lung Disease, Paris, France, Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan, Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
¹³ Asociación Latinoamericana del Tórax, Forum of International Respiratory Societies, Guatemala.
¹⁴ Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
¹⁵ The Epidemiological Laboratory (Epi-Lab) for Public Health, Research and Development, Khartoum Sudan.
¹⁶ University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK.
¹⁷ UCL Respiratory, University College London, London, UK.
¹⁸ IcFEM Dreamland Mission Hospital, Kimilili, Kenya.
¹⁹ AstraZeneca, Cambridge, UK.
²⁰ International Union Against Tuberculosis and Lung Disease, Paris, France.
²¹ Department of Paediatrics and Child Health, School of Clinical Medicine, University of KwaZulu Natal, Durban, South Africa.
²² Centre for Respiratory Diseases Research, Kenya Medical Research Institute, Nairobi, Kenya.
²³ Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia, International Primary Care Respiratory Group, Larbert, Scotland, UK.
²⁴ Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda.
²⁵ GlaxoSmithKline, Brentford, UK.
²⁶ The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia, Global Initiative for Asthma (GINA), Fontana, WI, USA.
²⁷ Noncommunicable Diseases Department, World Health Organization, Geneva, Switzerland.
²⁸ International Primary Care Respiratory Group, Larbert, Scotland, UK.
²⁹ Global Allergy & Airways Patient Platform, Vienna, Austria.
³⁰ Department of Pulmonology, Celal Bayar University Medical Faculty, Manisa, Turkey, Global Alliance Against Chronic Respiratory Diseases, Geneva, Switzerland.
³¹ International Union Against Tuberculosis and Lung Disease, Paris, France, University of New South Wales, Sydney, NSW, Australia.
³² International Union Against Tuberculosis and Lung Disease, Paris, France, University of Cambridge, Cambridge, UK.

PMID: 36281039
PMCID: PMC9621306
DOI: 10.5588/ijtld.22.0270

Improving access to affordable quality-assured inhaled medicines in low- and middle-income countries

M Stolbrink et al. Int J Tuberc Lung Dis. 2022.

. 2022 Nov 1;26(11):1023-1032.

doi: 10.5588/ijtld.22.0270.

Authors

Affiliations

¹ Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK, Stellenbosch University, Tygerberg, South Africa.
² Education Department, Liverpool School of Tropical Medicine, Liverpool, UK.
³ Academic Unit of Primary Care, University of Sheffield, Sheffield, UK.
⁴ Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK, IcFEM Dreamland Mission Hospital, Kimilili, Kenya.
⁵ Nifty Fox Creative, Sheffield, UK.
⁶ Healthcare Consultant, Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, The Gambia.
⁷ Medical Research Council Unit The Gambia at London School of Hygiene & Tropical Medicine, The Gambia.
⁸ School of Health and Related Research, University of Sheffield, Sheffield, UK.
⁹ Medical Aid International, Bedford, UK.
¹⁰ School of Population Health, University of Auckland, Auckland, New Zealand.
¹¹ Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK, Department of Medicine, Therapeutics and Dermatology, Kenyatta University, Nairobi, Kenya.
¹² International Union Against Tuberculosis and Lung Disease, Paris, France, Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan, Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
¹³ Asociación Latinoamericana del Tórax, Forum of International Respiratory Societies, Guatemala.
¹⁴ Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
¹⁵ The Epidemiological Laboratory (Epi-Lab) for Public Health, Research and Development, Khartoum Sudan.
¹⁶ University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK.
¹⁷ UCL Respiratory, University College London, London, UK.
¹⁸ IcFEM Dreamland Mission Hospital, Kimilili, Kenya.
¹⁹ AstraZeneca, Cambridge, UK.
²⁰ International Union Against Tuberculosis and Lung Disease, Paris, France.
²¹ Department of Paediatrics and Child Health, School of Clinical Medicine, University of KwaZulu Natal, Durban, South Africa.
²² Centre for Respiratory Diseases Research, Kenya Medical Research Institute, Nairobi, Kenya.
²³ Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia, International Primary Care Respiratory Group, Larbert, Scotland, UK.
²⁴ Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda.
²⁵ GlaxoSmithKline, Brentford, UK.
²⁶ The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia, Global Initiative for Asthma (GINA), Fontana, WI, USA.
²⁷ Noncommunicable Diseases Department, World Health Organization, Geneva, Switzerland.
²⁸ International Primary Care Respiratory Group, Larbert, Scotland, UK.
²⁹ Global Allergy & Airways Patient Platform, Vienna, Austria.
³⁰ Department of Pulmonology, Celal Bayar University Medical Faculty, Manisa, Turkey, Global Alliance Against Chronic Respiratory Diseases, Geneva, Switzerland.
³¹ International Union Against Tuberculosis and Lung Disease, Paris, France, University of New South Wales, Sydney, NSW, Australia.
³² International Union Against Tuberculosis and Lung Disease, Paris, France, University of Cambridge, Cambridge, UK.

PMID: 36281039
PMCID: PMC9621306
DOI: 10.5588/ijtld.22.0270

Abstract
in English, French

BACKGROUND: Access to affordable inhaled medicines for chronic respiratory diseases (CRDs) is severely limited in low- and middle-income countries (LMICs), causing avoidable morbidity and mortality. The International Union Against Tuberculosis and Lung Disease convened a stakeholder meeting on this topic in February 2022.METHODS: Focused group discussions were informed by literature and presentations summarising experiences of obtaining inhaled medicines in LMICs. The virtual meeting was moderated using a topic guide around barriers and solutions to improve access. The thematic framework approach was used for analysis.RESULTS: A total of 58 key stakeholders, including patients, healthcare practitioners, members of national and international organisations, industry and WHO representatives attended the meeting. There were 20 pre-meeting material submissions. The main barriers identified were 1) low awareness of CRDs; 2) limited data on CRD burden and treatments in LMICs; 3) ineffective procurement and distribution networks; and 4) poor communication of the needs of people with CRDs. Solutions discussed were 1) generation of data to inform policy and practice; 2) capacity building; 3) improved procurement mechanisms; 4) strengthened advocacy practices; and 5) a World Health Assembly Resolution.CONCLUSION: There are opportunities to achieve improved access to affordable, quality-assured inhaled medicines in LMICs through coordinated, multi-stakeholder, collaborative efforts.

CONTEXTE :: Dans les pays à faible revenu et à revenu intermédiaire (LMIC), l’accès aux médicaments par inhalation abordables pour les maladies respiratoires chroniques (CRD) est extrêmement limité et entraîne une morbidité et une mortalité qui pourraient être évitées. L’Union internationale contre la tuberculose et les maladies respiratoires a réuni les parties prenantes concernées lors d’une réunion à ce sujet en février 2022.

MÉTHODES :: Les discussions ciblées de groupe étaient étayées par les données de la littérature et des présentations synthétisant les différentes expériences en matière d’accès aux médicaments par inhalation dans les LMIC. Le déroulement de la réunion en ligne respectait les thèmes définis dans un guide dédié portant sur les obstacles et solutions visant à améliorer cet accès. Cette approche thématique a été utilisée pour l’analyse.

RÉSULTATS :: Au total, 58 parties prenantes clés (dont patients, personnel soignant, membres d’organisations nationales et internationales, représentants de l’industrie et de l’OMS) ont pris part à cette réunion. Avant la réunion, 20 éléments de documentation ont été soumis. Les principaux obstacles identifiés étaient : 1) une mauvaise connaissance des CRD, 2) des données limitées sur le poids sanitaire des CRD et les traitements dans les LMIC, 3) l’inefficacité des réseaux d’approvisionnement et de distribution et 4) une mauvaise communication quant aux besoins des patients atteints de CRD. Les solutions évoquées étaient : 1) génération de données pour orienter les politiques et la pratique, 2) renforcement des capacités, 3) amélioration des mécanismes d’approvisionnement, 4) renforcement des pratiques de plaidoyer et 5) adoption d’une résolution par l’Assemblée mondiale de la santé.

CONCLUSION :: Il est possible d’améliorer l’accès à des traitements par inhalation abordables de qualité dans les LMIC, au travers d’efforts collaboratifs et coordonnés impliquant toutes les parties prenantes.

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Conflict of interest statement

Conflicts of interest: The authors report no conflicts of interest. No other conflicts of interest were reported.

Figures

**Figure 1**
Overview of the presentations available pre-meeting. (https://prezi.com/view/eOuY7719eZlGKvrgf1Vj/). LMIC = low- and middle-income countries; GINA = Global Initiative for Asthma; CRD = chronic respiratory disorder; GOLD = Global Initiative for Chronic Obstructive Lung Disease; GARD = Global Alliance Against Chronic Respiratory Disease; COPD = chronic obstructive pulmonary disease.

**Figure 2**
Visualisation created during the meeting: discussion of barriers. SDG = Sustainable Development Goals; CRD = chronic respiratory disorder.

**Figure 3**
Visualisations created during the meeting: discussions about solutions.

**Figure 5**
Multi-stakeholder action plan. COPD = chronic obstructive pulmonary disease; LMIC = low- and middle-income countries; CRD = chronic respiratory disorder.

See this image and copyright information in PMC

Comment in

Key messages and partnerships to raise awareness and improve outcomes for people with asthma and COPD in low- and middle-income countries.
Rylance S, Bateman ED, Boulet L, Cohen M, El Sony A, Halpin DMG, Khoo EM, Marks GB, Masekela R, Mikkelsen B, Mortimer KJ, Chakaya Muhwa J, Nunes da Cunha I, Šajnić A, Salvi S, Slama S, Winders T, Yorgancioglu A, Zar HJ. Rylance S, et al. Int J Tuberc Lung Dis. 2022 Dec 1;26(12):1106-1108. doi: 10.5588/ijtld.22.0544. Int J Tuberc Lung Dis. 2022. PMID: 36447314 No abstract available.

References

1. World Health Organization Geneva, Switzerland: WHO; 2021. WHO Factsheet. Noncommunicable diseases.https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases
1. NCD Alliance Geneva, Switzerland: NCD Alliance; 2022. Supporting prevention & control of NCDs.https://ncdalliance.org/
1. World Health Organization Geneva, Switzerland: WHO; 2013. 2013–2020 Global Action Plan for the prevention and control of noncommunicable diseases.http://apps.who.int/iris/bitstream/10665/94384/1/9789241506236_eng.pdf
1. United Nations New York, NY, USA: UN; 2021. Sustainable Development Goals.https://sdgs.un.org/goals
1. World Health Organization Geneva, Switzerland: WHO; 2021. WHO Model List of Essential Medicines - 22nd List.https://www.who.int/leishmaniasis/burden/Leishmaniasis_India/en/

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Improving access to affordable quality-assured inhaled medicines in low- and middle-income countries

Affiliations

Improving access to affordable quality-assured inhaled medicines in low- and middle-income countries

Authors

Affiliations

Abstract
in English, French

Conflict of interest statement

Figures

Comment in

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Abstract in English, French

Conflict of interest statement

Figures

Comment in

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Abstract
in English, French