Evidence map›Paper›PMID 36113528›Full record

SynthesisThe Lancet. Global health2022

The availability, cost, and affordability of essential medicines for asthma and COPD in low-income and middle-income countries: a systematic review.

Marie Stolbrink, Helen Thomson, Ruth M Hadfield, Obianuju B Ozoh, Rebecca Nantanda, Shamanthi Jayasooriya, Brian Allwood, David M G Halpin, Sundeep Salvi, Maria Montes de Oca and 2 more

Open access · goldAbstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in The Lancet. Global health, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 90 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
90citing papers in PubMed, 4 pooled it
38.8field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

90 citing papers in PubMed, 4 syntheses or guidelines pooled it, 156 citations in OpenAlex.

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  7. The Economic Value of Reducing Asthma Mortality in 64 Countries, 2000-2022, With Projections up to 2040: A Global Modelling Study.Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology · 2026
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30 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

12 authors at 11 institutions in 8 countries.

Marie StolbrinkDepartment of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK; Division of Pulmonology, Department of Medicine, Stellenbosch University, Cape Town, South Africa. Electronic address: mstolbrink@doctors.org.uk.
Helen ThomsonKing's College Hospital, London, UK.
Ruth M HadfieldAustralian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia; Global Initiative for Chronic Obstructive Lung Disease, Deer Park, IL, USA.
Obianuju B OzohDepartment of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria.
Rebecca NantandaMakerere University Lung Institute, College of Health Sciences Kampala, Kampala, Uganda.
Shamanthi JayasooriyaBritish Thoracic Society Global Health Group, London, UK; University of Sheffield, Sheffield, UK.
Brian AllwoodDivision of Pulmonology, Department of Medicine, Stellenbosch University, Cape Town, South Africa; Tygerberg Hospital, Cape Town, South Africa.
David M G HalpinGlobal Initiative for Chronic Obstructive Lung Disease, Deer Park, IL, USA; University of Exeter Medical School, Exeter, UK.
Sundeep SalviGlobal Initiative for Chronic Obstructive Lung Disease, Deer Park, IL, USA; Pulmocare Research and Education (PURE) Foundation, Pune, India.
Maria Montes de OcaGlobal Initiative for Chronic Obstructive Lung Disease, Deer Park, IL, USA; Universidad Central de Venezuela, Caracas, Venezuela; Centro Medico de Caracas Hospital, Caracas, Venezuela.
Kevin MortimerThe International Union Against Tuberculosis and Lung Disease, Paris, France; Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
Sarah RylanceNoncommunicable Disease Management Unit, WHO, Geneva, Switzerland.
British Thoracic Society · GBCentral University of Venezuela · VEInternational Union Against Tuberculosis and Lung Disease · FRKing's College Hospital · GBLiverpool School of Tropical Medicine · GBMacquarie University · AUMakerere University · UGStellenbosch University · ZAUniversity of Exeter · GBUniversity of Lagos · NGWorld Health Organization · CH

Funding

Wellcome TrustWellcome Trust 203919/Z/16/ZWorld Health Organization 001
6 · The paper itself

Abstract

backgroundAsthma and chronic obstructive pulmonary disease (COPD) cause a considerable burden of morbidity and mortality in low-income and middle-income countries (LMICs). Access to safe, effective, quality-assured, and affordable essential medicines is variable. We aimed to review the existing literature relating to the availability, cost, and affordability of WHO's essential medicines for asthma and COPD in LMICs.

methodsA systematic review of the literature was done by searching seven databases to identify research articles published between Jan 1, 2010, and June 30, 2022. Studies on named essential medicines for asthma and COPD in LMICs were included and review articles were excluded. Two authors (MS and HT) screened and extracted data independently, and assessed bias using Joanna Briggs Institute appraisal tools. The main outcome measures were availability (WHO target of 80%), cost (compared with median price ratio [MPR]), and affordability (number of days of work of the lowest paid government worker). The study was registered with PROSPERO, CRD42021281069.

findingsOf 4742 studies identified, 29 met the inclusion criteria providing data from 60 LMICs. All studies had a low risk of bias. Six of 58 countries met the 80% availability target for short-acting beta-agonists (SABAs), three of 48 countries for inhaled corticosteroids (ICSs), and zero of four for inhaled corticosteroid-long-acting beta-agonist (ICS-LABA) combination inhalers. Costs were reported by 12 studies: the range of MPRs was 1·1-351 for SABAs, 2·6-340 for ICSs, and 24 for ICS-LABAs in the single study reporting this. Affordability was calculated in ten studies: SABA inhalers typically cost around 1-4 days' wages, ICSs 2-7 days, and ICS-LABAs at least 6 days. The included studies showed heterogeneity.

interpretationEssential medicines for treating asthma and COPD were largely unavailable and unaffordable in LMICs. This was particularly true for inhalers containing corticosteroids.

fundingWHO and Wellcome Trust.

Indexed as

AsthmaDrugs, EssentialPulmonary Disease, Chronic ObstructiveAdrenal Cortex HormonesCosts and Cost AnalysisDeveloping CountriesHealth Services AccessibilityHumansAdrenal Cortex HormonesDrugs, Essential

Identifiers

PMID36113528
PMCPMC9638033
OpenAlexW4296163307

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.