Access to Inhaled Therapy in India: Availability, Price and Affordability of Asthma Medicines
RDD Asia 2014. Volume 1, 2014: 55-66.
Chronic respiratory diseases including asthma and chronic obstructive pulmonary diseases (COPD) represent a public health challenge in India because of their prevalence, severity, projected trends, and economic impact. Evidence-based guidelines for asthma treatment using inhalation medicines provide a rational framework to achieve asthma control. In developed countries, the availability and widespread adoption of inhaled corticosteroids have been associated with a significant decline in hospitalization for asthma, as well as asthma-related mortality. However, in developing countries, implementation of these guidelines and the high cost of essential asthma medications constitutes a major obstacle for patient access to treatment. Eight surveys of the price and availability of inhaled salbutamol and beclomethasone were conducted using WHO/ HAI standardized methodology in different states of India during 2003 to 2011. Despite the fact that the National Essential Medicines List (NEML) includes salbutamol, beclomethasone and budesonide inhalers for chronic respiratory diseases, these surveys revealed that the availability and procurement of these inhalers is very poor in the public sector (which is the primary source of medicines for poor populations), while in the private sector the availability of salbutamol inhaler was better than that for corticosteroid inhalers. A limited number of studies relating to quality of treatment and prescription audits for asthma also showed irrational prescribing, poor asthma knowledge by doctors and poor quality of care for asthma patients. Access to rational treatment for asthma in India should be improved by establishing and disseminating national guidelines for asthma, the inclusion of asthma inhalation medicines in all state Essential Medicine List (EML) and pooled procurement of medicines, increasing awareness and education of all stakeholders for asthma management and ensuring that asthma medicines are affordable for the population.
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