This is important because treatment guidelines for both asthma and COPD have undergone significant changes recently. While smoking cessation and vaccination are important in disease management, pharmacotherapy using a symptom-driven stepwise approach is the mainstay of treatment. The guidelines make no recommendation for ICS-based maintenance therapy for asthma while for COPD, smoking cessation and antibiotic treatment with Amoxicillin and Erythromycin are the only treatment recommendations. In The Gambia, national treatment guidelines published in 2017 recommend Salbutamol for the treatment of mild asthma while Salbutamol, Prednisolone, and intravenous Aminophylline are recommended as first-line treatments for acute asthma exacerbations. In both studies, public hospitals had lower availability than private pharmacies. Similarly, in Uganda, a nationwide random survey of 130 facilities including a mixture of public and private hospitals and pharmacies found a low availability of asthma and COPD medicines and diagnostic tests. Out of 128 pharmacies surveyed across a wide geographic area in Nigeria, inhaled corticosteroids (ICSs) were unavailable at any of the surveyed public pharmacies, with other guideline recommended medications including long-acting muscarinic antagonist (LAMA), and ICS – combination inhalers failing to meet an availability threshold of 80%. ĭata on asthma and COPD medication availability and affordability in Sub-Saharan Africa are sparse, however, two recent studies in Nigeria and Uganda highlight important gaps in access. Accurate diagnosis is also limited due to a lack of pulmonologists, absence of spirometry, peak expiratory flow (PEF) meters, and a lack of context appropriate evidence-based treatment guidelines. Treatment of both diseases remains a challenge in the region with between 70% and 90% of asthma patients having poor symptom control. Recent studies in Nigeria estimate the prevalence of asthma and COPD at 6.4% and 7%, respectively and both conditions account for between 25% and 82% of patients seen at some specialist clinics in Burkina Faso and Senegal. Īlthough population prevalence estimates are lacking in Gambia, in 2016, asthma was the third leading cause of outpatient visits and the sixth leading cause of death at public health facilities in the Gambian Health Service.
Global asthma mortality is estimated at 250,000 deaths annually, while COPD-related mortality is estimated 18/100,000. Guideline recommended medications for the management of asthma and COPD in The Gambia are unavailable, expensive, and unaffordable.Īsthma and chronic obstructive pulmonary disease (COPD) are leading causes of morbidity and mortality globally with a large proportion of deaths occurring in low- and middle-income (LMICs) like The Gambia. Combination of ICS/LABA inhaler was 26 days’ wages while tiotropium bromide 18 mcg affordability was 95 days’ wages. ICS maintenance inhalers at private pharmacies cost 15, 26, and 28 days’ wages for beclomethasone 50 mcg, fluticasone propionate 125 mcg, and budesonide 100 mcg, respectively. The price of salbutamol 100 mcg inhaler was Gambian Dalasi (GMD) 200 (US$ 4, 4 days’ wages), while ipratropium bromide 20 mcg cost GMD 675 (US$ 14, 15 days’ wages). Aminophylline was stocked by 4/8 pharmacists. Only one pharmacist reported stocking beclometasone 50 mcg, budesonide 100 mcg, and fluticasone propionate 125 mcg inhalers. Salbutamol inhalers were widely available, stocked by the central medical stores and 6 out of 8 surveyed pharmacists. Respondents were responsible for stocking 19 out 26 registered pharmacies in the country, resulting in a response rate of 44%. Results:Įight out of 18 registered pharmacists responded to the survey.
We surveyed all registered pharmacists in Gambia and calculated affordability indices relative to the prevailing wage of the lowest government worker. Data on local availability, cost, and affordability of these medicines in The Gambia are unknown. Specifically, inhaled corticosteroids (ICSs) either alone or in combination with a long-acting beta2-agonist (LABA) are now first-line treatment for asthma, while long-acting muscarinic antagonists alone or in combination with LABAs are first-line treatment of COPD. Guidelines for asthma and chronic obstructive pulmonary disease (COPD) have undergone significant changes.
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