This year’s World Asthma Day theme was “Access to anti-inflammatory inhalers for everyone with asthma – still an urgent need”.
Asthma affects more than 260 million people worldwide and causes over 450 000 deaths each year. Asthma care should not begin only when symptoms become severe. People living with asthma need access to the right inhalers and ongoing care that helps control the condition over time.
“Asthma is not only about tightness in the chest or difficulty breathing,” says Dr Dwayne Koot, medical manager at Sanofi South Africa. “Leading up to an asthma attack, a few things happen: the muscles around the airways that are hyper-responsive can tighten in response to a trigger; the airways are also swollen and inflamed; still further there may be a buildup of mucous and even mucous plugging. This makes it harder for air to move in and out of the lungs.”
Treating airway inflammation
Reliever inhalers work quickly to help make breathing easier, but asthma also needs treatment that helps control the symptoms and prevent asthma attacks. This is because asthma is driven by swelling and inflammation in the airways, not only tightness in the chest.
The Global Initiative for Asthma now recommends that most people with asthma use an inhaler that gives quick relief and anti-inflammatory treatment in one device. This helps treat symptoms when they happen, while also reducing the risk of severe asthma attacks.
“World Asthma Day was an important reminder that asthma care should not rely only on quick-relief inhalers,” says Dr Koot. “People with asthma need treatment that helps manage the inflammation behind the condition. If asthma remains uncontrolled, they should also be assessed to understand what type of asthma they have and whether specialist care is needed.”
Where South Africa stands
In the 2025 Severe Asthma Index, South Africa scored 58 out of 100 overall. The report notes some important strengths including national asthma guidelines, asthma medicines available in the public sector, specialist centres such as Groote Schuur Hospital, and wider treatment options in the private sector, including biologic treatments.
But the report also shows that many patients may still struggle to get the care they need. South Africa does not yet have a national asthma strategy, and severe asthma is not formally included in a broader national plan for respiratory or non-communicable diseases.
“Of late, the South African Thoracic Society has started a Severe Asthma Registry that will go a long way to understanding the scale and gaps contributing toward severe asthma,” says Dr Koot.
Severe asthma
Severe asthma can also be missed or misunderstood. If your symptoms keep coming back, if you need repeated courses of oral steroids, or if your asthma is still affecting daily life despite treatment, you may need a more detailed assessment or referral to a specialist.
“Children also need special attention,” says Dr Koot. “If your child has asthma, poor control can affect their sleep, school, sport, play and family life – and over time can remodel their airways, leading to lasting impaired lung function.”
Your environment can also make asthma harder to manage. The Severe Asthma Index found that South Africa has a high environmental risk score, linked to air pollution and poor indoor air quality. These factors can make asthma symptoms worse, especially in communities that already struggle to access healthcare.
Asthma is part of your wider respiratory health. Infections such as whooping cough, flu and respiratory syncytial virus (RSV) can trigger breathing problems and asthma attacks. This is why prevention, vaccination, early treatment and good asthma control all matter.
“Improving asthma care means looking at the whole patient journey,” says Dr Koot. “That includes access to the right inhalers, earlier diagnosis, stronger referral systems, patient education, ongoing assessment of control, cleaner air, vaccination against preventable respiratory infections, and advanced care for people with severe asthma.”
Asthma can be controlled
If you or your child has asthma, speak to a healthcare professional if symptoms are frequent, if a reliever inhaler is needed often, if asthma disrupts sleep, school, work or daily activities, or if repeated courses of oral steroids are needed.
Do not stop or change prescribed asthma treatment without speaking to a healthcare professional.
Image credit: Magnific
