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There is a teenager I still think about whenever we talk about asthma awareness. The young patient had been taken to hospital several times in one year for breathlessness, wheezing and cough, especially at night or after exercise. Each time, the family did what they believed was right: they reached for the familiar blue inhaler. It helped for a while, so naturally they thought asthma was under control. But it was not. What the family had never fully understood was that asthma is not only about sudden tightening of the airways. Asthma is also about inflammation. Relief was being treated. The disease itself was not.
That is why this year’s World Asthma Day theme speaks so strongly to me: “Access to anti-inflammatory inhalers for everyone with asthma – still an urgent need.” It is a powerful reminder that asthma care has changed, but access has not changed nearly enough. Globally, asthma affects more than 260 million people and causes over 450,000 deaths every year, most of them preventable. GINA continues to emphasize that people with asthma need inhaled corticosteroid-containing treatment, ideally through a 2-in-1 inhaler that gives both relief and anti-inflammatory treatment.
For many years, asthma was commonly understood in very simple terms: if you wheeze, take the reliever inhaler. If you feel better, you are fine. But that thinking is no longer enough. The current direction in asthma care is to move away from symptom-only relief and toward treatment that also reduces the underlying airway inflammation that drives attacks. The 2025 GINA update retained ICS-formoterol as the preferred anti-inflammatory reliever strategy for many patients because it reduces severe exacerbations and urgent healthcare use more effectively than SABA-based regimens. The same guidance warns that high SABA use is a danger signal: three or more canisters a year are linked with increased emergency visits or hospitalization, and 12 or more canisters a year are linked with a higher risk of death.
In Kenya, this message is especially important. At the recent 29th Annual Kenya Association of Physicians conference, one of the clearest themes was that while the science is advancing, implementation remains difficult because of local realities. The conference highlighted that all adults and adolescents with asthma should receive ICS containing therapy, and that SABA-only treatment is no longer appropriate. It also made a strong case that Kenya needs practical, locally relevant adaptation of global guidance because access, affordability, diagnostic capacity and treatment behavior all shape outcomes.
That is the part we must speak about honestly. In many low- and middle-income countries, the inhalers patients need most are still too expensive, inconsistently available, or simply not prioritised. In Kenya, inhalers are often bought over the counter, sometimes without a proper asthma review, inhaler technique counselling or follow-up. This makes it easy for patients to depend on quick-relief inhalers while missing the anti-inflammatory treatment that could reduce attacks, hospital visits and fear. The issue is not that we do not know what works. The issue is that the right treatment still does not reach the people who need it.
Diagnosis is another part of the story. Not every chronic cough is asthma. Not every wheeze is asthma. In Kenya, clinicians often work in settings where spirometry is limited, and where asthma overlaps with conditions such as post-TB lung disease and COPD. There’s a role for using peak expiratory flow in settings where spirometry is unavailable, while also reminding us that poor reversibility or atypical symptoms should prompt broader thinking, including evaluation for structural lung disease. When I think of that teenager, what stays with me is how much changed once the family understood one simple truth: a rescue inhaler is not the same thing as asthma control. Once the right anti-inflammatory treatment was introduced, and once the family understood why it mattered, the hospital visits reduced and confidence returned. That is why this year’s World Asthma Day theme should not remain a slogan on a poster. It should become a public health priority. If we are serious about reducing preventable asthma attacks and deaths in Kenya, then we must move beyond awareness alone. We need better diagnosis, better patient education, better inhaler technique, and above all, better access to anti-inflammatory inhalers. Because in 2026, the greatest injustice in asthma care is not lack of knowledge. It is the gap between what we know can save lives and what too many patients still cannot access.
– The writer is Regional Medical Advisor-SSA
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There is a teenager I still think about whenever we talk about asthma awareness. The young patient had been taken to hospital several times in one year for breathlessness, wheezing and cough, especially at night or after exercise. Each time, the family did what they believed was right: they reached for the familiar blue inhaler. It helped for a while, so naturally they thought asthma was under control. But it was not. What the family had never fully understood was that asthma is not only about sudden tightening of the airways. Asthma is also about inflammation. Relief was being treated. The disease itself was not.
That is why this year’s World Asthma Day theme speaks so strongly to me: “Access to anti-inflammatory inhalers for everyone with asthma – still an urgent need.” It is a powerful reminder that asthma care has changed, but access has not changed nearly enough. Globally, asthma affects more than 260 million people and causes over 450,000 deaths every year, most of them preventable. GINA continues to emphasize that people with asthma need inhaled corticosteroid-containing treatment, ideally through a 2-in-1 inhaler that gives both relief and anti-inflammatory treatment.
For many years, asthma was commonly understood in very simple terms: if you wheeze, take the reliever inhaler. If you feel better, you are fine. But that thinking is no longer enough. The current direction in asthma care is to move away from symptom-only relief and toward treatment that also reduces the underlying airway inflammation that drives attacks. The 2025 GINA update retained ICS-formoterol as the preferred anti-inflammatory reliever strategy for many patients because it reduces severe exacerbations and urgent healthcare use more effectively than SABA-based regimens. The same guidance warns that high SABA use is a danger signal: three or more canisters a year are linked with increased emergency visits or hospitalization, and 12 or more canisters a year are linked with a higher risk of death.
In Kenya, this message is especially important. At the recent 29th Annual Kenya Association of Physicians conference, one of the clearest themes was that while the science is advancing, implementation remains difficult because of local realities. The conference highlighted that all adults and adolescents with asthma should receive ICS containing therapy, and that SABA-only treatment is no longer appropriate. It also made a strong case that Kenya needs practical, locally relevant adaptation of global guidance because access, affordability, diagnostic capacity and treatment behavior all shape outcomes.
That is the part we must speak about honestly. In many low- and middle-income countries, the inhalers patients need most are still too expensive, inconsistently available, or simply not prioritised. In Kenya, inhalers are often bought over the counter, sometimes without a proper asthma review, inhaler technique counselling or follow-up. This makes it easy for patients to depend on quick-relief inhalers while missing the anti-inflammatory treatment that could reduce attacks, hospital visits and fear. The issue is not that we do not know what works. The issue is that the right treatment still does not reach the people who need it.
Diagnosis is another part of the story. Not every chronic cough is asthma. Not every wheeze is asthma. In Kenya, clinicians often work in settings where spirometry is limited, and where asthma overlaps with conditions such as post-TB lung disease and COPD. There’s a role for using peak expiratory flow in settings where spirometry is unavailable, while also reminding us that poor reversibility or atypical symptoms should prompt broader thinking, including evaluation for structural lung disease. When I think of that teenager, what stays with me is how much changed once the family understood one simple truth: a rescue inhaler is not the same thing as asthma control. Once the right anti-inflammatory treatment was introduced, and once the family understood why it mattered, the hospital visits reduced and confidence returned. That is why this year’s World Asthma Day theme should not remain a slogan on a poster. It should become a public health priority. If we are serious about reducing preventable asthma attacks and deaths in Kenya, then we must move beyond awareness alone. We need better diagnosis, better patient education, better inhaler technique, and above all, better access to anti-inflammatory inhalers. Because in 2026, the greatest injustice in asthma care is not lack of knowledge. It is the gap between what we know can save lives and what too many patients still cannot access.
– The writer is Regional Medical Advisor-SSA
By Josephine Muiru