SEVERE childhood asthma continues to cause major morbidity in low- and middle-income countries despite its low prevalence.
Severe Childhood Asthma Burden Remains Uneven
A new review has highlighted the disproportionate burden of severe childhood asthma in low- and middle-income countries, where preventable exposures, socioeconomic inequities, and restricted access to care continue to worsen outcomes. Although severe asthma is relatively uncommon in these settings, affecting 2.1% of children and 4.3% of adolescents, it remains associated with substantial morbidity, occasional fatality, and persistent management difficulties. The review also noted that nearly 6% of infants experience nighttime symptoms on a weekly basis.
Children from disadvantaged backgrounds were identified as being at greater risk of severe asthma, reflecting the broader impact of social and environmental inequities on respiratory health. The authors pointed to multiple preventable contributors, including tobacco smoke exposure, indoor and outdoor pollution, biomass fuel use, allergens, diet, urbanization, and other lifestyle factors.
Severe Childhood Asthma Treatment Gaps Persist
The review found that almost half of patients with severe asthma in low- and middle-income countries receive inadequate treatment. Only 55% use inhaled corticosteroids. While most physicians favor pressurized metered-dose inhalers, only one-third recommend spacers. In some countries, oral short-acting beta agonists and theophylline are still used as treatment options.
Cost-effectiveness also remains central to treatment decisions. Compared with fixed-dose inhaled corticosteroid and long-acting beta agonist combinations, maintenance and reliever therapy, add-on tiotropium, and triple therapy with inhaled corticosteroids, long-acting beta agonists, and long-acting muscarinic antagonists were identified as more cost-effective options. By contrast, biologic therapies were described as expensive, poorly accessible, and not cost-effective in these settings, including omalizumab and dupilumab.
Public Health Action Is Still Needed
Barriers to follow-up included poorly organized health services, limited spirometry, and patient non-compliance. The authors concluded that public health strategies should prioritize affordable asthma medicines, stronger diagnostic capacity in underserved areas, and interventions targeting environmental risk factors.
Reference
Castro-Rodriguez JA et al. Severe childhood asthma in low and middle-income countries. Paediatr Respir Rev. 2026;57:17-26.
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