As the world marked World Asthma Day on Tuesday, global and regional evidence shows that while effective asthma treatment exists, millions of patients—particularly in countries like Bangladesh—still struggle to access timely diagnosis and continuous care.
At a special event in Brussels on Tuesday, WHO Director-General Special Envoy for Chronic Respiratory Diseases José Luis Castro highlighted the gap between medical advances and patient access. “We have the science. We have the medicine. Yet for too many, the distance between a life-saving treatment and the patient’s hand remains far too great,” he said.
His remarks come as the World Health Organization intensifies efforts to integrate asthma and chronic obstructive pulmonary disease (COPD) services into primary health care (PHC), particularly in South Asia.
Chronic respiratory diseases (CRDs) account for around 12% of all deaths in the WHO South-East Asia region, affecting more than 104 million people and causing approximately 1.56 million deaths annually.
In Bangladesh, the burden is rising fast.
“At the primary health care level, asthma and COPD services are still not widely available at community or union facilities. In many cases, patients have to go to upazila or district-level hospitals where medicine specialists are available,” Dr Kazi Saifuddin Bennoor, joint secretary of the Bangladesh Lung Foundation, told Dhaka Tribune on Tuesday.
He added that even for suspected cases, proper diagnosis is often only possible at the district level.
“Basic medicines are generally available at upazila and district facilities, but early detection remains a challenge,” he said.
Bangladesh’s last national asthma survey, conducted about a decade ago, estimated around 7 million patients. A new survey this year is expected to show the number has crossed 10 million, according to Dr Bennoor.
“Environmental factors are driving this increase,” said Dr Bennoor, who is also director of the Bangladesh Medical Research Council.
Apart from asthma, COPD is also a growing concern, affecting nearly 8 million people in Bangladesh, largely due to smoking and air pollution.
Neighbors show how to act
While Bangladesh continues to grapple with implementation gaps, neighboring Nepal and Sri Lanka are piloting a different approach—embedding asthma and COPD care directly into primary health care systems.
Supported by WHO and Bloomberg Philanthropies, these initiatives focus on early diagnosis, inhaler access, frontline worker training, and continuity of care.
In Nepal and Sri Lanka, technical priorities are being translated into practical action through consultation, service mapping, implementation planning, and preparation for frontline health worker training.
The current phase is focused on early implementation in selected settings, with the aim of testing practical approaches, generating operational learning, and informing future scale-up through national health systems.
“The projects closely align with the integrated lung health approach endorsed by the Seventy-eighth World Health Assembly, which emphasizes stronger PHC, effective referral pathways, and improved access to essential diagnostics, medicines, and technologies,” said Dr Sarah Rylance, lead for chronic respiratory diseases at WHO headquarters.
In Nepal, the program is being implemented in Kavre district by integrating asthma and COPD care into existing noncommunicable disease services.
“The approach integrates asthma and COPD services into existing NCD and PHC structures through short training modules, job aids, locally adapted materials, supportive supervision, and community engagement,” said Dr Poma Thapa, NCD and Mental Health Section chief, Epidemiology and Disease Control Division, Department of Health Services, Nepal.
Sri Lanka is implementing a similar model in Kandy and Kalutara districts, focusing on systematic screening, improved diagnosis, and structured follow-up through primary care centers.
These initiatives, experts say, are not creating new systems but strengthening existing ones.
“The initiatives in Nepal and Sri Lanka reflect the wider priorities of the South-East Asia Region, where CRDs account for a substantial share of avoidable illness and death. By integrating asthma and COPD care within PHC and focusing on equitable, people-centered service delivery, these initiatives demonstrate practical pathways for closing persistent gaps in respiratory care across the region,” said Dr Suman Rijal, Director, Department of Health Promotion, Disease Prevention and Control, WHO Regional Office for South-East Asia.
Challenges ahead
Despite global guidelines and policy commitments, implementation remains the weakest link.
“We have strong guidelines, but implementation is lagging. And that gap is where patients suffer,” Castro said.
He pointed to three key gaps: limited access to inhaled corticosteroids, delayed diagnosis, and preventable hospitalizations.
Closing this gap, he argued, requires shifting focus to prevention and early detection, starting at the primary care level.
“That includes something as simple and as powerful as routine lung checks and spirometry in primary care,” he said.
The experiences of Nepal and Sri Lanka offer a clear roadmap for Bangladesh, according to experts.
First, diagnosis must move closer to communities. Second, asthma care should be integrated into existing NCD platforms rather than treated as a separate vertical program. Third, frontline health workers need practical training, not just specialist-level expertise. Fourth, continuity of care—including follow-up and patient education—must be strengthened.
“While global initiatives like the Global Initiative for Asthma and efforts by groups such as the International Primary Care Respiratory Group and its local affiliate Bangladesh Primary Care Respiratory Group have helped improve knowledge and training, the next critical step is to effectively implement these practices at the primary care level,” said Dr Bennoor.
Castro also outlined a time-bound global agenda to combat asthma in three steps on this year’s Asthma Day.
He said the goal is to ensure universal availability of essential asthma medicines within the next year, integrate lung health into primary care systems within two years, and achieve measurable reductions in uncontrolled asthma within five years.
“We have the mandate. We have the tools. Now we need execution. Let us ensure that by next World Asthma Day, we are not just talking about urgent needs but about delivered results. Because in the end, our success will not be measured by the resolutions we pass, but by something far simpler: the quiet, steady, unobstructed breathing of the people we serve,” Castro said.
