Aljadeeah Saleh, Ravinetto Raffaella, Tomas Ana
Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
School of Public Health, University of the Western Cape, Cape Town, South Africa.
Glob Health Action. 2025 Dec;18(1):2556526. doi: 10.1080/16549716.2025.2556526. Epub 2025 Sep 12.
Asthma and chronic obstructive pulmonary disease (COPD) are common noncommunicable diseases, exacerbated in conflict settings by the heightened environmental exposure to triggers, weakened health systems, and poor access to medicines and healthcare. However, accurate data on medicines dispensing in this context are generally scarce.
We examined the patterns and rates of medicines dispensing for asthma and COPD among the beneficiaries of the Syrian governmental health insurance scheme between June 2018 and March 2021.
We retrospectively analyzed the outpatient dispensing records for 125,371 adults. Medicines for asthma and COPD were identified using the Anatomical Therapeutic Chemical (ATC) classification system. Dispensing rates were calculated as the number of packages per 1,000 beneficiaries per month, stratified by age, sex, and route of administration.
Out of our sample, 15.02% received at least one package of a medicine for asthma or COPD. Oral formulations were the most frequently dispensed (92.67% of patients), particularly oral salbutamol and xanthines. Inhaled medicines, including inhaled corticosteroids (ICS) and ICS long-acting β2-agonists (ICS-LABA) combinations, were markedly under-dispensed (17.08% of patients). Dispensing rates were higher in females and older adults. Seasonal variation showed peaks in autumn and winter, with a notable decline in April 2020, coinciding with the early COVID-19 period.
The study highlights substantial gaps in dispensing of medicines for asthma and COPD, with particularly low rates for inhalers, likely reflecting barriers driven by the conflict, economic instability, and sanctions. Robust coordinated action is needed to improve their availability in Syria.
哮喘和慢性阻塞性肺疾病（COPD）是常见的非传染性疾病，在冲突环境中，由于环境中触发因素暴露增加、卫生系统薄弱以及药品和医疗保健获取困难而加剧。然而，在这种情况下关于药品配给的准确数据通常很少。
我们研究了2018年6月至2021年3月期间叙利亚政府医疗保险计划受益人中哮喘和COPD药品的配给模式和比率。
我们回顾性分析了125371名成年人的门诊配药记录。使用解剖治疗化学（ATC）分类系统识别哮喘和COPD的药物。配给率计算为每月每1000名受益人中的药品包装数量，按年龄、性别和给药途径分层。
在我们的样本中，15.02%的人至少收到了一包哮喘或COPD药物。口服制剂是最常配给的（92.67%的患者），尤其是口服沙丁胺醇和黄嘌呤。吸入药物，包括吸入性糖皮质激素（ICS）和ICS长效β2受体激动剂（ICS-LABA）组合，配给明显不足（17.08%的患者）。女性和老年人的配给率较高。季节性变化在秋季和冬季出现高峰，2020年4月显著下降，与早期COVID-19时期一致。
该研究突出了哮喘和COPD药物配给方面的巨大差距，吸入器配给率尤其低，这可能反映了冲突、经济不稳定和制裁带来的障碍。需要采取强有力的协调行动来提高这些药物在叙利亚的可及性。
