Most Ugandan asthma patients undiagnosed, unable to access inhalers

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Most Ugandans living with asthma remain undiagnosed and unable to access lifesaving inhalers, which exposes deep gaps in diagnosis, treatment and affordability, health experts have said.

The concerns emerged on May 6, 2026, during a national webinar organised by the Makerere Lung Institute to mark World Asthma Day 2026, where specialists highlighted that despite clear treatment guidelines, most patients either do not know they have asthma or cannot access recommended medicines.

Health ministry director general of health services Prof. Charles Olaro said asthma remains one of the most common non-communicable diseases globally yet continues to be under-recognised in Uganda despite affecting a significant portion of the population.

“In Uganda, about 11% of adults and nearly 18% of adolescents are affected by asthma, yet most people remain undiagnosed and only seek care when symptoms become severe,” Olaro said.

He revealed that misdiagnosis remains one of the biggest challenges, particularly among children, where asthma symptoms are often mistaken for other respiratory illnesses, leading to delayed or inappropriate treatment and worsening health outcomes over time.

“Up to 90% of children under five with asthma symptoms are misdiagnosed as having pneumonia and are treated with antibiotics without improvement,” Olaro said, adding that such errors contribute to unnecessary suffering and repeated hospital visits.

Among adolescents, he noted that as many as 65% experience severe asthma symptoms, yet only a quarter receive a proper clinical diagnosis, while many continue to live with uncontrolled disease that affects their daily lives.

“These are not just numbers. They represent children missing school, parents unable to work and families burdened by the cost of repeated illness,” he said, underscoring the broader social and economic impact of poorly managed asthma.

Inhalers are still unavailable

Despite the availability of effective treatment, access to essential medicines remains a major barrier. Olaro said inhaled corticosteroids, which are recommended as first-line therapy, are still unavailable in most lower-level health facilities where the majority of patients seek care.

“Only a small proportion of these inhalers are available, and mostly at higher-level facilities, yet most patients first seek care at primary health centres where these medicines are often missing,” he said, describing the situation as deeply concerning.

Dr Hellen Annyu, a senior paediatric consultant and pulmonologist at Mulago National Referral Hospital and Makerere Lung Institute, said accurate diagnosis remains the foundation of effective asthma care, yet it is frequently missed, especially among young children.

“Asthma presents with recurrent cough, wheezing, chest tightness, and difficulty in breathing, but these symptoms are often mistaken for common infections, especially in younger children, where diagnosis is not always straightforward,” Annyu said.

She added that many health workers and caregivers still struggle to distinguish between asthma and other respiratory conditions, resulting in repeated treatment for illnesses like bronchiolitis or pneumonia without addressing the underlying chronic condition.

“Making the right diagnosis is critical because asthma is treatable, but if it is not identified early, the inflammation in the airways continues and leads to worsening symptoms and long-term complications,” Dr Annyu said.

She added that environmental factors such as air pollution, tobacco smoke, dust and recurrent infections continue to drive asthma cases, particularly among children, highlighting the need for both prevention and improved clinical care.

Affordability challenges

Beyond diagnosis, affordability remains a major barrier to treatment. Data presented during the webinar shows that many asthma inhalers are priced beyond the reach of ordinary Ugandans, with some costing the equivalent of more than two weeks’ wages.

This cost burden, combined with limited availability in public facilities, forces many patients to either go without treatment or rely on outdated medicines that do not adequately control the disease, increasing the risk of severe attacks and hospitalisation.

Sarah Rylance, a medical officer for chronic respiratory diseases at the World Health Organisation, reflected a broader global pattern where asthma care remains constrained by weak health systems and limited access to essential tools.

“The global asthma report highlights shortages of trained health workers, limited access to diagnostic tools, and poor availability and affordability of inhaled medicines as key barriers to effective care,” Rylance said.

She emphasised that air pollution is an increasingly important driver of asthma cases and a major trigger for attacks, calling for stronger public health interventions to reduce exposure and protect vulnerable populations.

“The solutions are clear. Strengthening primary healthcare, improving surveillance systems, and investing in research networks can help translate knowledge into action and improve patient outcomes,” she said, urging policymakers to prioritise respiratory health.

Olaro said the health ministry is working to integrate non-communicable disease care into primary healthcare systems, improve supply chains for essential medicines, and strengthen training for health workers to improve diagnosis and management.

Stronger collaboration needed

However, he stressed that government efforts alone will not be sufficient without stronger collaboration with research institutions, development partners, and the private sector to bridge gaps in access and affordability.

“Our goal is clear. No one should suffer or die from asthma due to lack of access to essential care,” Dr Olaro said, calling for urgent and coordinated action to ensure that every patient receives timely diagnosis and effective treatment.

According to the Global Initiative for Asthma, it affects over 250–260 million people globally, making it a major chronic, non-communicable disease. It causes approximately 450,000–455,000 deaths annually, with over 96% of these fatalities occurring in low- and middle-income countries due to limited access to treatment. Approximately 1,000 people die from asthma every day.