Brazil's public health system shows unequal COPD treatment access across states

The 2025 update of Brazil's Clinical Protocol and Therapeutic Guidelines (PCDT) for chronic obstructive pulmonary disease (COPD) added a fixed triple therapy for severe cases to the public health system (SUS). Implementation of the new policy is uneven: São Paulo, Rio Grande do Sul, Goiás and Pernambuco quickly made both powder and spray devices freely available, while Minas Gerais, the Federal District and Rio de Janeiro lag behind. Minas Gerais provides the powder form but has not procured the spray version, leaving many patients without full access.

COPD is the fifth leading cause of death in Brazil, causing over 200,000 hospitalizations annually and costing roughly R$ 103 million to the public system. According to CONITEC, the triple‑therapy combination can reduce expenses by preventing acute exacerbations. Pneumologist Leonardo Meira warned that delayed medication delivery leads to higher emergency admissions and greater costs. The revised protocol also allows primary‑care doctors to prescribe the therapy, but its impact is limited if the drugs are unavailable at health posts. The disparity disproportionately affects low‑income and elderly patients, restricting their ability to maintain daily activities and quality of life.