The forthcoming post-Millennium Development Goals era will bring about new challenges in global health. Low- and middle-income countries will have to contend with a dual burden of infectious and non-communicable diseases (NCDs). Some of these NCDs, such as neoplasms, COPD, cardiovascular diseases and diabetes, cause much health loss worldwide and are already widely recognized as doing so.
The chronic nature of asthma and COPD requires continuous care and reliable access to affordable medications. These conditions have been set out by the Global Initiative for Asthma (GINA) and Global Initiative for Chronic Obstructive Lung Disease (GOLD) together with the need to prevent exacerbations with the use, in the first instance, of inhaled drugs. However the costs and availability of inhaled drugs are very variable and there is a tendency for these to cost more in low income countries.