By Prof. Chibuike Uba, Ph.D
Asthma, a chronic inflammatory disease of the airways, is one of the most common non-communicable diseases worldwide and a leading cause of avoidable suffering and death. Globally, an estimated 262–334 million people live with asthma, and the disease contributes significantly to disability-adjusted life years (DALYs). Once considered a condition largely confined to the industrialized West, asthma has become an urgent challenge in low- and middle-income countries, especially across Africa and the Middle East (AMEA). In these regions, millions face late or missed diagnoses, poor access to essential medicines, systemic health financing gaps, and limited awareness of the disease. These barriers not only worsen health outcomes but also deepen socioeconomic vulnerabilities.
In Nigeria, the scale of the problem is sobering. With an estimated 15–20 million patients, the country carries one of the heaviest national burdens. Urban prevalence rates range from 10–13 percent among children and young adults, while rural communities record slightly lower but still significant figures. Yet Nigeria has fewer than 80 registered respiratory physicians—equivalent to just one specialist for every 2.3 million citizens. Most patients are therefore managed by general practitioners who often lack access to spirometry, the diagnostic gold standard. A national audit revealed that only a handful of hospitals and private centers own functional spirometers, and even fewer employ staff trained to use them effectively. The consequences are tragic: thousands of avoidable deaths each year, particularly among the young, while in schools asthma remains one of the leading causes of absenteeism, undermining educational attainment and limiting opportunities for millions of children.
Pix: .Prof. Ubah
Across Africa as a whole, an estimated 40–50 million people live with asthma. Prevalence varies widely, from 3–4 percent in rural East Africa to more than 20 percent in parts of North and Southern Africa. Environmental triggers such as biomass smoke, household dust, industrial emissions, and allergens drive much of the disease burden. Rapid urbanization has intensified exposure while straining health systems to breaking point. The shortage of trained specialists is acute—most countries have fewer than one respiratory physician per million citizens, and some have none at all. This means diagnosis and treatment are frequently delayed, misdirected, or neglected. Severe asthma cases, which represent up to 20 percent of the patient population, consume disproportionate resources and account for preventable deaths across the continent.
The Middle East tells its own story. Here, asthma prevalence ranks among the highest globally, with childhood rates of 15 to 25 percent in countries such as Saudi Arabia, Qatar, and the UAE. Frequent desert dust storms, high humidity, sedentary lifestyles, and tobacco use all contribute. While Gulf states boast advanced tertiary care systems, underdiagnosis and poor adherence to treatment remain common. In conflict-affected countries like Syria and Yemen, the challenge is magnified: displaced populations face service disruptions, medication shortages, and worsening exposures from poor living conditions. In these contexts, asthma is not just a clinical problem but a humanitarian crisis.
The economic burden of asthma is staggering. In Nigeria, average direct treatment costs range from US$309 to US$368 per patient annually, with medicines accounting for nearly 90 percent of the expense. For households living below the poverty line, this can consume more than 30 percent of annual income, forcing families to ration inhalers, skip doses, or abandon treatment altogether. In Gulf states, the cost per patient often reaches US$2,000–3,000 annually, with governments spending tens of millions each year on uncontrolled asthma. Indirect costs further compound the problem: missed school days, lost work productivity, and premature deaths. Globally, the burden runs into hundreds of billions annually, but in AMEA countries it is particularly devastating, pushing vulnerable households deeper into poverty.
Drug affordability remains a central challenge. In Nigeria, the cost of a salbutamol (Ventolin) inhaler has surged from around ₦3,500 to more than ₦7,500 in just two years, with some brands priced as high as ₦15,000–20,000. Long-term controller inhalers often exceed ₦25,000—far beyond the reach of most citizens who pay out-of-pocket. Similar price volatility and shortages are reported across AMEA, driven by weak procurement systems, currency fluctuations, and pharmaceutical market withdrawals.
The mortality and morbidity statistics remain troubling. Africa records over 45,000 asthma-related deaths each year, most of them preventable. In Nigeria, case fatality rates for acute severe asthma range between 5 and 15 percent in tertiary hospitals, reflecting late presentation and inadequate use of controller therapy. In the Middle East, overall mortality is lower but still significant in underserved rural areas and among migrant and displaced populations. Beyond deaths, the wider burden of morbidity is immense: in Sub-Saharan Africa alone, asthma-related absenteeism accounts for millions of lost school days annually, while adults with uncontrolled asthma experience reduced productivity that translates into measurable GDP losses. Asthma, in this sense, is not only a health condition but also a brake on human capital development and long-term economic growth.
Amidst these challenges, the Global Allergy & Airways Patients Platform (GAAPP) has emerged as a key actor, amplifying patient voices and connecting them with policy frameworks. The Lagos 2025 Regional Meeting marked the official launch of the Africa & Middle East Alliance (AMEA), bringing together twelve patient organizations determined to confront allergic and respiratory diseases collaboratively. The meeting produced concrete outcomes: the establishment of working groups for regional awareness campaigns, creation of communication channels for sharing best practices, drafting of a unified advocacy plan targeting governments, and training sessions on grant-writing and fundraising to ensure sustainability. Participants also issued a joint statement urging governments to invest in medical research, healthcare worker training, and expansion of diagnostic infrastructure. By aligning under GAAPP’s four pillars—Awareness, Education, Advocacy, and Research—the alliance laid a strong foundation for a patient-driven, evidence-based, and regionally coordinated response.
Asthma in Africa and the Middle East thus represents both a crisis and an opportunity. Millions suffer unnecessarily from uncontrolled symptoms, thousands die prematurely, and countless families are impoverished by the costs of care. Yet the solutions are clear: expand access to affordable inhaled corticosteroids and combination therapies, strengthen diagnostic and workforce capacity, integrate asthma management into schools and communities, and prioritize patient-centered advocacy. The Lagos AMEA meeting demonstrated that when patient organizations unite under GAAPP, governments listen and change becomes possible.
The next five years present a rare opportunity. By investing in universal access to medicines, strengthening frontline care, and funding patient-led collaborations, policymakers can save lives, reduce economic losses, and transform asthma from a silent crisis into a model of patient-centered health reform. For millions across Africa and the Middle East, the difference between crisis and control is measured not only in breaths but in futures. The call to act is urgent—and the time is now.
About the author
Prof. Chiwuike Uba, Ph.D. is a Development Economist, Governance, PFM, and Health Financing Expert; Chairman of the Board, Amaka Chiwuike-Uba Foundation (ACUF), a GAAPP Member Organisation.