South African Thoracic Society position statement on asthma in children, adolescents and adults

It is estimated that 10% of the global population has asthma. Low- and middle-income countries typically struggle to provide affordable asthma care, including access to combination (inhaled corticosteroid (ICS)-long-acting beta-2-agonist) inhalers currently recommended internationally as standard of care. In South Africa (SA), a study found higher asthma prevalence among children in affluent areas compared with those from less affluent backgrounds. Asthma mortality is increasing in Africa and Southeast Asia compared with declines in high-income countries. This mortality crisis stems from inadequate care strategies, reliance on reliever therapy, and patient non- adherence. Overuse of and over-reliance on short-acting beta-2-agonist (SABA) inhalers worsen outcomes, with severe morbidity related to asthma. Limited access to and use of ICS-based controller therapy worsen outcomes. The carbon footprint of inhalers and proposed changes in propellants to those with lower global warming potential due to be phased in by 2030 may further limit treatment availability in the near future. To combat these challenges, the SA Asthma Action Group has been formed, bringing together healthcare professionals, funders and government representatives to improve asthma management. The strategic plan of this group is to address SABA overuse, contribute to guidelines, and enhance accessibility to essential medications while engaging with pharmaceutical companies to ensure affordable access to high-quality asthma treatments.