18 December, 2025
The Forum of International Respiratory Societies (FIRS), which includes the European Respiratory Society and other world leading international professional respiratory societies applauds the UN General Assembly for recognising that chronic respiratory diseases are a major cause of disability and death requiring urgent action with their vote in favor of the “Political declaration of the fourth high-level meeting of the General Assembly on the prevention and control of noncommunicable diseases and the promotion of mental health and well-being,” on 15 December 2025.
More than 650 million children and adults live with chronic respiratory diseases, and 4.4 million die each year, most from chronic obstructive pulmonary disease (COPD) and asthma. Chronic respiratory disease is the third highest cause of death globally, according to the Global Burden of Disease. It also creates massive economic costs due to lost school and work days. A recent study estimated that the global economic burden from COPD alone will amount to $US40 trillion by 2050.
Inhaled medicines reduce these health and economic costs by enabling patients to work and study, and by preventing frequent hospital visits. Yet more than two-thirds of pharmacies and hospitals in low- and middle-income countries (LMICS) do not stock inhaled medicines far below the global target of 80% facility availability of essential NCD medicines. Where they are available, they are often unaffordable.
Professor Guy Marks, President of FIRS and the International Union Against Tuberculosis and Lung Disease (The Union), said:
For too long, hundreds of millions of children and adults living with COPD and asthma have struggled without access to effective inhaled medicines. By calling out their importance in the Political Declaration, governments are committing to closing the unacceptably high access gaps. When Brazil made inhalers free, household asthma costs fell from 29% of income to 2% and the hospitalisation rate fell from 90 per 100,000 to 60 per 100,000 people.
Acknowledging the FIRS campaign, Increasing Access to Inhaled Medicines for COPD and Asthma, which was launched on World Asthma Day in May 2025, Professor David Halpin, from the Global Initiative for Chronic Obstructive Lung Disease (GOLD) and FIRS, commented:
Governments have listened to our arguments and responded. The burden of COPD is just staggering and rising rapidly in low- and middle-income countries, including among working-age people. Governments must ensure access to affordable inhaled medicines to manage COPD or face massive health and economic costs.
Highlighting the rising burden of chronic lung disease, Cassandra Kelly-Cirino, Executive Director of The Union, said:
Since 2000, the number of people living with chronic lung disease has risen by 27% and deaths are forecast to double by 2050. While reducing smoking, outdoor air pollution, and occupational exposures are essential to prevent disease, the Political Declaration underscores the vital importance of better care for the hundreds of millions who will continue to live with chronic lung disease.
FIRS is calling on governments, industry, global health agencies, and donors to immediately mobilise to implement the Political Declaration by investing greater resources to increase access to inhaled medicines for COPD and asthma by addressing five priority areas:
- Policy: Inclusion of the latest evidence-based inhalers in all global and national COPD and asthma treatment guidelines, essential medicine lists, and UHC reimbursement lists
- Product: Improved availability of recommended inhaled medicines by facilitating registration, technology transfer, voluntary licensing agreements, and participation in the WHO Prequalification Programme, Collaborative Registration Procedure, and other programs
- Price: Reductions in Inhaler prices from bulk purchasing, pooled procurement, tiered/differential pricing, generic alternatives, and other proven strategies
- Primary Care: Increased training for primary healthcare providers to diagnose and manage COPD and asthma, including improved access to spirometry and peak flow measurement tools
- Patient Advocacy: Investments in campaigns to increase community awareness of COPD and asthma and destigmatise use of inhalers
José Luis Castro, WHO Director-General Special Envoy for Chronic Respiratory Diseases, congratulated government leaders for ensuring the Political Declaration provided such a strong foundation for action to reduce the burden of chronic respiratory diseases.
The 4th High-level Meeting ends the era of neglect for chronic respiratory diseases. Member States now have an historic opportunity to make rapid progress in the five years left to achieve the Sustainable Development Goals and NCD Action Plan targets, and unlock significant economic benefits.
This Statement was developed by the FIRS Working Group on Increasing Access to Inhaled Medicines for COPD and Asthma led by Professors David Halpin, Fellow, Royal College Physicians, Member, British Thoracic Society (BTS), European Respiratory Society (ERS), American Thoracic Society (ATS), International Union Against Tuberculosis and Lung Disease (The Union), Member of Board of Directors of Global Initiative for Chronic Obstructive Lung Disease (GOLD), and Professor, University of Exeter, United Kingdom; Guy Marks, President, The Union, Board of Directors, NCD Alliance, President, FIRS, Professor, UNSW Sydney, and Honorary Professor, University of Sydney, Australia; and Heather Zar, Professor and Chair, Department of Paediatrics and Child Health, University of Cape Town, South Africa.
All media inquiries: Leith Greenslade, leith@justactions.org