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System-level strategies and task-shifted care improve equity in global allergic disease managementSystemic Changes Could Improve Asthma Care in Underserved Communities

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Key Takeaway
Prioritize system-level changes like task-shifting and policy reform to improve asthma care equity in underserved areas.

This guideline serves as a narrative review focused on the global burden of allergic diseases and the specific barriers faced by underserved populations in low- and middle-income countries (LMICs) and marginalized groups in high-income countries. It synthesizes evidence regarding systemic gaps, including the lack of affordable inhaled corticosteroids and other essential medicines in LMICs.

The report highlights that approximately 21.6 million DALYs and 461,000 deaths were attributed to asthma globally in 2019. Notably, approximately 90% of this burden is borne in LMICs, where the majority of deaths occur. The authors advocate for a shift from specialist-centric innovation toward systems-first equity.

Proposed scalable innovations include task-shifted care packages, standardized primary care training, community health worker home visiting, and public-sector access programs. These are intended to address barriers in diagnosis and treatment. While the review identifies significant systemic needs, it does not provide clinical trial data for specific medical interventions.

A review of global data shows that asthma creates a significant burden on health. In 2019, it was linked to millions of years of lost healthy life and hundreds of thousands of deaths globally. Most of this burden falls on people living in low-income countries where essential medicines are often hard to find or too expensive.

To address these gaps, experts suggest moving away from only using specialists. Instead, they recommend system-level changes like training primary care doctors, using community health workers for home visits, and creating national allergy strategies. These methods aim to make asthma management more accessible to everyone regardless of where they live.

Because this is a review of existing systems rather than a clinical trial, it does not provide specific medical treatments. It highlights that improving access to medicine and training local healthcare workers are key steps toward making care fairer for people with allergic diseases.

What this means for you:
System-level changes like community health worker programs may improve asthma care in underserved areas.

Study Details

Study typeGuideline
EvidenceLevel 5
PublishedJun 2026
View Original Abstract ↓
BackgroundAllergic diseases affect more than one billion people globally, yet care access is profoundly unequal. The “forgotten billion” refers to underserved populations—especially in LMICs and marginalized groups within high-income countries—who face disproportionate morbidity and preventable deaths due to gaps in diagnosis, essential medicines, immunotherapy and biologics, trained workforce, and policy prioritization.ObjectiveTo synthesize recent (2014–2026) evidence on global burden and inequities in allergic disease care, analyze system-level gaps, review scalable innovations, present diverse case studies, and propose prioritized recommendations, monitoring frameworks, and a research and financing agenda.MethodsWe conducted a structured narrative review of peer-reviewed literature and global guidance documents, focusing on burden metrics (prevalence, DALYs, mortality), access indicators, interventions (task-sharing, telemedicine, point-of-care tools, immunotherapy access, digital health, procurement/policy levers), and implementation science frameworks. Sources prioritized include WHO materials and guideline bodies (GINA, ARIA, EAACI), plus global reports and primary studies.ResultsAsthma illustrates the equity chasm: in 2019 it caused approximately 21.6 million DALYs and approximately 461,000 deaths globally, with approximately 90% of burden borne in LMICs and most deaths occurring in LMICs. Systematic reviews show essential inhaled asthma medicines—especially inhaled corticosteroids (ICS) and ICS-containing combinations—are often unavailable or unaffordable in LMICs. Scalable strategies with documented impact include task-shifted care packages (Malawi), standardized primary care training (South Africa), community health worker home visiting (Boston), and public-sector access programs (Brazil), alongside national allergy strategies (Finland).ConclusionsClosing the allergy care chasm requires shifting from specialist-centric innovation to systems-first equity: universal access to essential medicines and equitable pathways to targeted therapies for severe disease, standardized primary care delivery with task-sharing, market-shaping and pricing policy reform, digitally enabled self-management designed to reduce (not widen) inequities, and integrated environmental action. Implementation must be measured with equity-sensitive frameworks and supported by durable financing aligned with UHC and NCD agendas.
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