Health sector reform, which is currently taking place in low or middle income countries following the implementation of structural adjustment programmes, advocates the use of rational measures aimed at increasing the efficiency of the health services. These measures are being applied unevenly. Cuts in governments' social budgets have had the effect of favouring the development of the private medical and pharmaceutical sector, rather than rationalising the choice of priorities. The emphasis on cost recovery in basic health services is penalising the poorest and most vulnerable groups. In developing countries, a managerial approach that does not take into account the socio-political structures of these countries and the priorities of health policies only serves to aggravate the inequalities inherent in obtaining access to health care. Under these circumstances, the promotion of lung health runs the risk of being forgotten or compromised. The persisting or worsening weaknesses of the basic health services do not facilitate the application of an integrated approach to respiratory diseases (including tuberculosis), nor the support of a minimum package of health activities to offer to the population. Environmental factors affecting respiratory health (such as smoking and air pollution) are not taken into account in health sector reform, even though they constitute an obvious threat and demand urgent, widespread action. It is a new challenge for health personnel to promote and guarantee lung health.