Uganda’s inhaler gap leaves asthma patients exposed

Asthma is responsible for more than 450,000 deaths globally every year, many of which are preventable

Kampala, Uganda | PATRICIA AKANKWATSA | Uganda’s response to asthma is facing growing scrutiny as health specialists warn that thousands of patients are still unable to access essential inhalers, even as global treatment guidelines shift decisively toward preventive care.

The concerns were raised as Uganda joined the rest of the world to mark World Asthma Day 2026 on May 5, an annual event coordinated by the Global Initiative for Asthma.

This year’s theme, “Make inhaled treatments accessible for all”, placed a spotlight on inequalities in diagnosis and treatment, particularly in low- and middle-income countries.

In Uganda, clinicians say the gap between recommended care and what is actually available in health facilities has become increasingly difficult to ignore.

At a webinar organised by the Makerere University Lung Institute, respiratory specialists, researchers and government officials described a health system still largely dependent on emergency treatment rather than long-term disease control.

The result, they said, is a cycle in which patients experience repeated attacks, frequent hospital admissions and, in some cases, preventable deaths.

Dr Charles Olaro, Director General of Health Services at the Ministry of Health, said asthma is a growing public health concern in Uganda.

“Asthma is responsible for more than 450,000 deaths globally every year, many of which are preventable,” he said. “In Uganda, about 11% of the population is affected, including nearly 18% of adolescents, and many children under five also present with symptoms.”

According to the World Health Organization, asthma affects an estimated 262 million people worldwide and remains one of the most common non-communicable diseases. However, experts say the burden is highest in countries where access to diagnosis and essential medicines remains limited. Uganda reflects this challenge sharply.

A shift in treatment not fully reflected

Over the past decade, global asthma management has changed significantly. The older approach, which relied heavily on quick-relief bronchodilators such as salbutamol, has increasingly been replaced by anti-inflammatory treatment using inhaled corticosteroids (ICS).

The shift is based on a clearer understanding that asthma is a chronic inflammatory condition rather than a short-term breathing disorder.

Without controlling inflammation, specialists say, patients remain vulnerable to severe attacks even when symptoms appear mild.

Dr Patricia Alupo, a physician and respiratory researcher, said current global guidelines no longer support the use of reliever medication alone.

“No patient should be prescribed treatment without inhaled corticosteroids,” she said while presenting the latest 2025 Global Initiative for Asthma recommendations. “Even patients with mild asthma who only use relievers occasionally remain at risk of severe and life-threatening attacks.”

She warned that over-reliance on short-acting beta agonists such as salbutamol can worsen outcomes over time.

“Regular use is associated with airway hyperreactivity, reduced response to treatment, increased exacerbations and higher mortality,” she said.

The recommended global standard now encourages even patients with mild symptoms to use low-dose inhaled corticosteroids combined with formoterol, which both relieves symptoms and reduces underlying inflammation.

However, specialists say Uganda’s health system is still largely operating on the older emergency-based model.

Limited access at primary health level

The scale of the access gap was a central concern during the World Asthma Day discussions. Ministry of Health data shows that only about 4.4% of health facilities in Uganda stock inhaled corticosteroids. Most of these are higher-level hospitals, leaving lower-tier facilities without essential medicines.

This is particularly significant because the majority of patients first seek care at primary health centres.

“Most asthma patients seek care at lower-level facilities where these medicines are often unavailable,” Dr Olaro said.

For patients, this means repeated prescriptions for reliever medication without long-term control of the disease.

The situation is even more challenging for children. Health workers say shortages extend beyond inhalers to include spacers, masks and other devices required for effective drug delivery.

Uganda also faces a shortage of trained respiratory specialists, further limiting the system’s ability to provide consistent care.

Dr Olaro said about one in three asthma patients experiences an exacerbation each year, placing additional pressure on already stretched health facilities.

Children frequently misdiagnosed

Among children, experts say the burden is both significant and often invisible. Dr Hellen Tukamuhebwa Aanyu, a senior paediatric pulmonologist at Mulago National Referral Hospital, said childhood asthma is frequently missed or misdiagnosed.

“Children present with recurrent cough, wheezing and difficulty breathing,” she said. “But many are repeatedly treated for infections like pneumonia or flu.”

Diagnosing asthma in young children remains difficult because standard lung function tests are not suitable for under-fives.

“There is no confirmatory test in that age group,” she said. “Diagnosis depends on symptoms, family history, environmental exposure and response to treatment.”

However, she said many frontline health workers still treat each episode separately rather than identifying long-term patterns.

Dr Olaro noted that nearly 90% of children under five with asthma symptoms are misdiagnosed as pneumonia cases and repeatedly given antibiotics without improvement.

This, experts say, reflects broader gaps in training and diagnostic capacity at primary care level.

Beyond medicine availability, specialists say healthcare worker training is central to improving outcomes.

Dr Alupo stressed that asthma remains a clinical diagnosis, requiring careful assessment of symptoms over time.

“Normal test results do not rule out asthma,” she said. “The history and symptom pattern are critical.”

She urged clinicians to focus on long-term monitoring, including inhaler technique, adherence and environmental triggers.

Dr Tukamuhebwa added that incorrect inhaler use is common even among diagnosed patients.

“Inhalers only work when used correctly,” she said. “Patient education and demonstration are essential.”

System still focused on emergencies

The discussions highlighted a broader structural issue: Uganda’s health system still treats asthma primarily as an acute emergency rather than a chronic condition requiring continuous management.

This has wider consequences for families and the economy. Poorly controlled asthma contributes to repeated hospital visits, school absenteeism, reduced productivity and rising healthcare costs.

Adolescents are particularly affected. While nearly 18% are estimated to have asthma, only about 26% receive a formal diagnosis, according to Ministry of Health data.

The government says it is working to integrate asthma care into chronic disease services and improve procurement of essential medicines.

“These products should be prioritised, especially at Health Centre IVs and hospitals,” Dr Olaro said.

But clinicians argue that procurement alone is not enough. They say Uganda now needs a broader shift in how asthma is understood and managed — from a condition treated only during attacks to one that requires continuous preventive care.

Without that shift, they warn, thousands of patients will continue to fall through the gaps of a system still struggling to catch up with modern treatment standards.