Professor Refiloe Masekela is a paediatric pulmonologist, Dean and Head of the School of Medicine at the University of KwaZulu-Natal, President of the South African Thoracic Society, and a scientific member of Global Initiative for Asthma*.
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Most of us take breathing for granted, doing so more than 28,000 times a day without a second thought. For someone living with poorly controlled asthma, every breath can be a struggle.
Waking up at night with a tight chest and struggling for air can be a frightening experience. This is a daily burden that no child or adult should have to endure in a country with the knowledge and tools to control asthma more effectively.
Asthma is the most common non-communicable disease affecting children worldwide. In South Africa, the burden is alarmingly high and ranks as the second highest in the world.
According to the recent Global Asthma Network Phase One study, one in five adolescents in South Africa reports symptoms compatible with asthma. Yet, despite asthma being a common condition — and despite the availability of effective controller medication for more than six decades — people in this country continue to die from the disease. Among those who survive, many live with severe and poorly controlled asthma.
Asthma deaths are often sudden and silent and frequently go unrecorded in official statistics, occurring at home or being misclassified in health records.
What we do know, however, is deeply concerning: South Africa ranks among the top 20 countries globally for asthma-related deaths. This should trouble us all because asthma is largely preventable and controllable.
The Global Initiative for Asthma (GINA), the leading global authority on asthma management, has adopted the theme for World Asthma Day 2026 (May 5): “Access to anti-inflammatory inhalers for everyone with asthma – still an urgent need.”
This message reflects a persistent and dangerous reality. Too many people living with asthma rely almost exclusively on reliever inhalers — the blue asthma pumps — that provide rapid symptom relief but do nothing to treat the underlying airway inflammation that causes asthma attacks.
This approach is not only inadequate — it is dangerous. The vast majority of asthma deaths occur in people who are not using anti-inflammatory treatment (controller medication), particularly during flare-ups. These anti-inflammatory inhalers should be used consistently and over the long term for patients to derive meaningful benefit.
No patient with hypertension or diabetes would take medication only once when they feel unwell. It is accepted that such medication should be taken consistently to prevent complications. Yet in asthma care, this is a scenario that continues to play itself out daily.
In late 2024, the South African Thoracic Society convened a national Asthma Summit, bringing together clinicians, health economists, the Department of Health, pharmacy groups, private health funders and patient organisations. The goal was simple but urgent: to chart a practical path towards better asthma care in South Africa.
One of the most important recommendations to emerge from the summit was the need to expand access to combination inhalers containing both a reliever and an anti-inflammatory medicine — specifically budesonide-formoterol — for all people living with asthma.
GINA now recommends this treatment approach across the full spectrum of the disease, from the mildest to the most severe forms. The evidence supporting this strategy comes from both high-level clinical trials and real-world studies.
This approach has enabled some high-income countries to reduce asthma deaths to near zero, with Finland serving as a notable example. The Finnish National Asthma Programme demonstrated how a coordinated 10-year national strategy could dramatically reduce asthma deaths, hospitalisations and disability through improved diagnosis and access to appropriate treatment at primary healthcare level.
The case for improving access to inhaled steroid and formoterol combination inhalers is compelling. These inhalers perform a dual function: they provide immediate symptom relief while simultaneously treating the underlying airway inflammation. They can be used when patients feel unwell and as part of long-term disease control.
Patients only need to carry one inhaler. This simple and pragmatic approach also makes asthma education easier at primary healthcare level, where more than 80% of asthma patients are treated. This simplified strategy has been shown to reduce severe asthma attacks, prevent deaths and significantly improve quality of life.
Critics of this approach often point to cost. While combination inhalers may have higher upfront costs than separate reliever and anti-inflammatory inhalers, international experience tells a different long-term story.
Brazil, for example, has led the way by making these medicines widely available through its public healthcare system via the Popular Pharmacy Programme, which was designed to improve access to asthma treatment. Robust health-economic data from Brazil shows that this approach is ultimately more cost-effective, reduces hospital admissions and emergency visits, and prevents productivity losses.
The choice before us, therefore, is not merely financial. It is ethical. Do we continue to rely on cheaper, less effective treatments that place lives at risk, or do we invest in proven therapies that prevent deaths and allow people to live full and productive lives?
Encouragingly, global momentum is building. On 27 May 2025, the World Health Assembly adopted a resolution calling for improved access, affordability and availability of safe, effective and quality medicines — including those used to treat asthma.
This global commitment places responsibility squarely on national health systems to respond meaningfully to the needs of people living with chronic lung diseases.
It is time for both government and the private sector in South Africa to act decisively. Ensuring access to effective, life-saving asthma treatment for all South Africans is not only possible — it is long overdue.
*The opinions expressed in this article do not necessarily reflect the views of the newspaper.*
DAILY NEWS