Meeting of the Parliament

Meeting date: Thursday, June 15, 2023

Official Report 1072KB pdf

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World Asthma Day 2023

I ask visitors in the public gallery who are leaving the chamber to do so quickly and quietly, as we are about to resume business.

The next item of business is a members’ business debate on motion S6M-08765, in the name of Emma Harper, on world asthma day 2023. The debate will be concluded without any question being put. I ask members who wish to speak in the debate to press their request-to-speak buttons.

Motion debated,

That the Parliament notes World Asthma Day 2023, which took place on 2 May 2023; recognises that the Global Initiative for Asthma, supported by the World Health Organization, marked the day with the theme of Asthma Care for All; understands that around 360,000 people, including 72,000 children, have an asthma diagnosis in Scotland; believes that the Scottish Government’s Respiratory Care Action Plan aims to improve prevention, diagnosis, treatment, care and self-management of asthma and lung conditions, such as chronic obstructive pulmonary disease (COPD) and bronchiectasis; welcomes the campaign, led by Asthma + Lung UK Scotland, to improve asthma care in Scotland; regrets reports that only 25.4% of people with asthma, surveyed by Asthma + Lung UK Scotland, said that they received all the elements of basic asthma care; understands that six in 10 people in Scotland, who were polled by Asthma + Lung UK Scotland, said that they are concerned about air quality around schools, which, it understands, can cause asthma in children and exacerbate existing conditions; welcomes reports of the creation of the International Coalition of Respiratory Nurses (ICRN), which brings together nurses from across the globe to advance the care and treatment of patients with respiratory conditions, including asthma, and notes the view that better asthma care at all levels of health care can lead to better outcomes and lives for people living with asthma.

12:51  

I welcome the opportunity to lead this important debate, which recognises that world asthma day took place on 2 May 2023. This year, the theme was asthma care for all. I thank members from across the chamber—in fact, from all parties—who supported my motion and so allowed the debate to go ahead. I also thank Asthma and Lung UK Scotland, and its policy officer Gareth Brown, for its briefing and for all that it does to support people with an asthma diagnosis and their families.

In particular, as the co-convener, with my colleague Alexander Stewart, of the Parliament’s cross-party group on lung health, I thank everyone who is involved in that group. In the past, we have carried out a lot of work on asthma, and the input from clinicians, asthma support groups and people living with asthma, such as Asthma and Lung UK ambassador Olivia Fulton, has been absolutely invaluable. It is worth noting that Olivia, who thought that she could never participate in sport because she has quite severe asthma, is now playing wheelchair rugby and loving it.

As the wording of my motion indicates, world asthma day is organised by the Global Initiative for Asthma, which is a World Health Organization collaborative that was founded in 1993.

Asthma is a very common long-term lung condition. In the United Kingdom, 5.4 million people have it—that is one in every 12 adults and one in every 11 children. In Scotland, 360,000 adults and around 72,000 children have an asthma diagnosis.

People with asthma often have sensitive, inflamed airways. Its symptoms can come and go. Sometimes people may not have symptoms for weeks or months at a time. However, asthma needs to be treated every day, even if sufferers feel well, to lower their risk of symptoms and asthma exacerbations and attacks.

The most common symptoms of asthma are coughing, wheezing—a whistling sound when the sufferer breathes—breathlessness and chest tightness. When, as a nurse, I looked after people with asthma, they would sometimes describe it as feeling as though a brick was weighing down on their chest, making it difficult for them to breathe. If someone experiences one or more of those symptoms it could mean that they have asthma, and they should speak to their general practitioner as soon as possible. There are nurse specialists in asthma care and respiratory medicine in many of our GP practices, so there are great experts out there.

There are lots of things that can make asthma worse, but not everyone will be affected by the same things. If people finding out what sets off their symptoms, whether it is colds and viruses, pets, pollen, pollution, house dust mites or stress, they can work out ways to avoid the triggers if possible.

There are certain stages in people’s lives that might affect their asthma, too. For example, some women find that hormonal changes at puberty, pregnancy or menopause can affect their asthma, and research is under way that is looking at the issues that face women with asthma and whether asthma is exacerbated by those changes.

The best way that someone can cope with their asthma triggers is to always take their preventer inhaler as prescribed, even when they feel well.

How serious asthma is varies from person to person. There are different types of asthma, too. Someone with severe asthma, which affects around 5 per cent of all people with asthma, can have symptoms most of the time and find them really hard to control, but we now have new biological medicines that target the processes that cause inflammation, and those meds are helping. Asthma can kill. It is serious and it needs continued action.

As my motion states, Asthma and Lung UK Scotland carried out a survey that showed that only 25.4 per cent of people with asthma said that they received all the elements of basic asthma care. Part of how we can address that issue is through ensuring that people have their own personalised asthma action plans and that those plans are being reviewed at appropriate times.

Correct inhaler technique is key, and up to a third of people with asthma are not using their inhaler correctly. That was noted when we did some research ahead of the debate. People with asthma who are unable to use their inhaler correctly are at an increased risk of poor asthma control, potentially resulting in an attack, which may lead to the person being hospitalised.

My go-to person, Garry McDonald, who is a community pharmacist who specialises in asthma, said in a conversation with me that most people can have their inhaler technique checked at their community pharmacy and that community pharmacists are often the only healthcare professionals that people with asthma see.

Recently, when I hosted a lung health event in Parliament to mark that the respiratory care action plan has been running for two years, I met Paul Wilson, who has had many, many hospital admissions for treatment and resuscitation for his poorly controlled asthma. His asthma improved when his inhaler technique improved, and he has had zero further hospital admissions since he had his inhaler technique check and then had his personalised asthma action plan put in place. He is now giving back to the national health service by training to be a nurse, and I hope that Paul will be a respiratory nurse. That is a good news story that we have heard in relation to the work that community pharmacists can do in supporting people.

Inhaler technique is part of the personalised action plan for people’s asthma control. I would be interested to learn how those inhaler techniques and personalised asthma action plans are being communicated to patients, as they are both absolutely necessary, and whether the Scottish Government would consider further awareness-raising efforts in order to support that.

Following lobbying from the cross-party group, the Scottish Government launched the respiratory care action plan 2021 to 2026, which I just mentioned. The plan sets out the vision for driving improvement in the prevention, diagnosis, care, treatment and support of people living with respiratory conditions in Scotland. It identifies five key priorities for respiratory care and is intended to be an enabling document that is driving continuous improvement.

One of the key areas that the plan focuses on is asthma, and it mentions pulmonary rehabilitation. The evidence shows that PR has beneficial effects in patients with asthma, at any stage of the disease, improving exercise capacity, asthma control and quality of life, and reducing wheezing, anxiety, depression, and bronchial inflammation. However, many patients report waiting lists of up to 18 months to access PR referrals and appointments. I ask the minister whether targeted support could be considered to improve waiting times for pulmonary rehabilitation and asthma referrals, as requested by Asthma and Lung UK Scotland.

There is a link between asthma and inequality. We know that people from the most deprived areas of Scotland are much more likely to receive an asthma diagnosis. Managing a variable lifelong condition with complex treatments such as inhalers is hard enough. Managing asthma while juggling multiple jobs, family responsibilities and financial pressures is even harder. I welcome the Scottish Government’s commitment to tackling health inequalities, but it is important to ensure that good-quality housing, sound state welfare support and good air quality are key components of achieving health equality.

Asthma is a serious health condition. We need to ensure that people are aware of its signs and symptoms and that we are taking all the action possible to support people who have been diagnosed. We must ensure that there is the right inhaler for the right person, as that is one of the ways forward. Importantly, we need people to know how to use their inhalers properly.

I look forward to hearing other members’ contributions.

13:00  

I am grateful to Emma Harper for securing the debate and providing us with the opportunity to mark world asthma day 2023, which took place last month. The global initiative, supported by the World Health Organization, had the theme of asthma care for all. The theme holds immense significance for Scotland, a country where an estimated 360,000 people, including 72,000 children, are diagnosed with asthma.

Asthma is more than just a chronic health condition; it is a challenge that touches every aspect of a person’s life, whether it is their ability to play, learn or even work. It impacts not only those who are diagnosed, but their families, schools and communities. We must see it not just as a health issue, but as a social issue that demands our collective attention and action.

Despite its widespread prevalence, asthma remains a misunderstood condition. Society often underestimates the severity of asthma, not fully comprehending that uncontrolled asthma can lead to life-threatening attacks. The Covid pandemic has highlighted the severity of respiratory conditions and has shone a spotlight on their prevention and treatment. Over 80,000 people in Scotland who have respiratory conditions, including asthma, were asked to shield at the height of the Covid-19 pandemic—they were the largest group of people on the shielding list.

With proper diagnosis, appropriate treatment and effective management, people with asthma can lead active, healthy lives. I acknowledge the admirable efforts of the Scottish Government’s respiratory care action plan, which aims to improve the prevention, diagnosis, treatment, care and self-management of asthma and other lung conditions such as chronic obstructive pulmonary disease—COPD—and bronchiectasis. Those comprehensive efforts are geared towards enhancing the quality of life for those affected by those conditions and reducing the burden on our healthcare system. However, the reports about access to basic asthma care make stark reading. The theme of this year’s world asthma day, “asthma care for all”, speaks volumes about our shared commitment and collective aspirations. I know that the Scottish Government and our health ministers are committed to working with people who are living with asthma to better understand the barriers to accessing support.

In my constituency, we are fortunate to have the fantastic Breathe Easy Fife, which provides a support network for people who are living with any kind of lung condition as well as their families and carers. From social activities and exercise sessions to education and information, the invaluable support helps people to self-manage their conditions, while the invaluable peer support from those who understand what it is like to be breathless helps people to live with their condition, rather than just suffer from it.

We cannot underestimate the impact of the cost of living crisis on our constituents’ health. According to a survey that was undertaken by Asthma and Lung UK, 93 per cent of people in Scotland with lung conditions such as asthma have made significant changes to their lives in response to the cost of living crisis. One in three of those surveyed say that their health has been worsening as they have cut back on food and heating. No household should be faced with those difficult decisions.

We must also turn our attention to the environment around us. There is increasing evidence linking air pollution to the worsening of asthma symptoms, with children being particularly vulnerable. We cannot talk about asthma prevention and care without addressing the need for cleaner air and healthier environments. Poor air quality can cause asthma in children, exacerbate their existing conditions and limit their ability to enjoy the simple pleasures of childhood. The role that clean air plays in that narrative cannot be overstated. Our children breathe at a faster rate than adults and their developing lungs absorb more air per unit of body weight, making them more susceptible to airborne pollutants. Our children deserve to grow up in safe environments, which we must commit to delivering for them.

Recognising world asthma day prompts us to focus our collective consciousness on a health issue that is of immense global and national relevance. In order to provide asthma care for all, we need to face the challenges head on. We need to address the stark disparities in access to healthcare, the geographical variations in asthma prevalence and the gaps in public awareness about the condition. Our approach should be multifaceted, integrating prevention, early diagnosis, effective treatment and long-term management of asthma. Once again, I thank Emma Harper for securing the debate and allowing us to renew our dedication, rekindle our determination and continue our journey towards a world that is free from the constraints of asthma.

13:04  

I draw members’ attention to my entry in the register of members’ interests—I am a practising NHS GP—and I thank Emma Harper for bringing the subject of asthma to the chamber.

We need to double down on our efforts to raise awareness of a condition that affects millions of lives worldwide. Asthma is a chronic respiratory disease that knows no boundaries. It demands our attention, and not just on world asthma day, when pollen counts are sky high. I am delivering my speech outside in order to highlight the fact that, despite the glorious weather, lots of people suffer from asthma, which is made worse by the current high pollen levels.

According to Asthma and Lung UK, around 370,000 Scots suffer from asthma. That is about one in 15 of the population. Asthma does not discriminate—it affects people regardless of their age, race or background and robs them of their ability to breathe with freedom.

In 2021, 96 Scots died from the condition, 67 per cent of whom were women. Those are not numbers—we are talking about real people who had dreams, aspirations and loved ones, who mourned their loss. We have a responsibility to strive for better treatment, research and resources to improve management of the condition. Through a concerted effort, the mortality rate can be reduced. We can get it down to zero if people use their inhalers and get their asthma reviews. We need a brighter future.

I want to address one of the leading causes—[Inaudible.]—and that is smoking. Tobacco smoke is a known trigger for attacks. It is crucial that we educate and support individuals on their journey to quit smoking, but we must also create smoke-free environments, promote smoking cessation programmes and have healthier environments.

I call on the Scottish Government to take decisive action to make it easier for patients to switch from traditional asthma inhalers to dry-powder alternatives. We have a duty to explore sustainable solutions for managing this chronic condition, and dry-powder inhalers, or DPIs, offer a greener alternative to their commonly used, propellant-based counterparts. As DPIs do not release harmful gases into the atmosphere, use of them reduces carbon emissions, thereby contributing to a cleaner and healthier planet.

However, to bring about that change, effective communication is crucial. The Scottish Government must prioritise education and awareness campaigns to inform patients of the benefits of dry-powder inhalers. By providing accessible information to healthcare professionals, asthma clinics and patients themselves, we can dispel any misconceptions and encourage a transition to more sustainable and user-friendly options.

Let us strive for a Scotland where environmental—[Inaudible.]—and patient wellbeing can go hand in hand. Let us use world asthma day as a catalyst for change so that, together, we can raise awareness, advocate for improved treatment and work towards preventing asthma-related deaths. Let us empower people with asthma to engage with their condition effectively and promote a world where breathing is a right, not a privilege. Together, we can shape a future in which asthma management is both effective and sustainable.

13:08  

I start by apologising for not having a leafy backdrop as I make my speech.

I thank Emma Harper for securing today’s debate about world asthma day 2023, and I compliment her on the content of her speech. The theme this year is asthma care for all, but the statistics tell us that just 35 per cent of Scots with asthma receive the three components of basic asthma care that they require.

The Scottish Government’s respiratory care action plan was introduced in 2021, but little progress has been made. At 137 per 100,000 people, Scotland has one of the highest death rates from respiratory disease in Europe and, in some health board areas, waiting times for essential respiratory rehabilitation are longer than a year, so it is clear that we can do better.

One in five Scots has a lung condition, but a lack of decent funding and workforce planning to meet patients’ needs has resulted in the lowest levels of access to care since 2013. Unfortunately, the data shows that the Scottish Government is not giving lung conditions such as asthma the priority that they need. I am ever hopeful that the new minister will correct that situation.

Surveys that are carried out by Asthma and Lung UK consistently find that Scotland fares worse than the rest of the UK for basic asthma care. It is depressing to note that just 11 per cent of those who responded reported that their asthma care is improving, compared with previous years.

That lack of basic care has consequences. In Scotland, it contributes to more than 6,000 emergency hospital admissions each year. It is the cause of around 100 asthma-related deaths, as we heard from Sandesh Gulhane, two thirds of which are of women. The lack of access to something as simple as an annual asthma action plan places undue strain on an already in-crisis NHS.

In a nation such as Scotland in 2023, it should not be acceptable that hundreds of lives are lost each year because of a condition that is actually well understood. We also need to recognise, as Emma Harper did, that there are significant healthcare inequalities when it comes to asthma, and analysis from Asthma and Lung UK shows that women are almost twice as likely as men to die from an asthma attack. Data from NHS Scotland reveals that people in the most deprived households are more likely to live with asthma and have more asthma attacks, but are also two to three times more likely to require an emergency admission for asthma.

Therefore, it is clear that a one-size-fits-all approach does not work, and I encourage the Scottish Government to invest in better research to identify new treatments, and make better use of existing treatments, to save women’s lives and to address levels of asthma that are triggered by things such as housing conditions or living closer to areas of higher air pollution.

My sister is a respiratory nurse consultant. During the pandemic, pulmonary rehab was moved online—that is one of the innovations that has been taken forward. Does Jackie Baillie welcome the fact that PR can now be delivered in various forms—face to face and online?

Yes. Anything that makes the service available to people who require it should be welcomed, and I very much welcome what Emma Harper’s sister is doing in her service.

The Scottish Government needs to outline how it will invest in training and recruitment in those rehabilitation services, and to publish a progress report on the achievements and failings of the respiratory care action plan as it reaches halfway into its five-year term.

I hope that the new public health minister, Jenni Minto, will work to ensure that the action plan does not simply languish on the shelf. Health boards need to be supported to rebuild services and deliver the outcomes that people with lung conditions such as asthma need. The 358,000 people in Scotland who live with asthma deserve more than warm words from this Parliament on world asthma day; they need real action and they need it now.

13:13  

As co-convener of the cross-party group on lung health, I congratulate Emma Harper on securing the debate and on all the work that she does for the cause.

World asthma day is organised by the Global Initiative for Asthma and supported by the World Health Organization, and, as we have heard, each May, the day raises awareness of asthma worldwide. For this year’s event, as we have heard, the theme has been asthma care for all, which fits in perfectly not only with the sentiments of the debate, but with the main aims of our cross-party group.

Indeed, only recently, the cross-party group highlighted ground-breaking research into women with asthma and the effects of oestrogen on the condition. Our scientists and secretariat, Asthma and Lung UK Scotland, have also highlighted that women are more likely to suffer asthma and have more severe symptoms. They also experience a significant worsening of symptoms around menstruation and at certain times of the month, which potentially puts them in a very dangerous situation. Research, although still quite patchy, is being undertaken, and I look forward to seeing what comes through when that is established and solutions are found.

The charity also works with additional collaborative organisations such as ASH Scotland to prevent smoking. We have heard today about smoking cessation programmes. Those are important, along with mass media campaigns to achieve the 2034 target of less than 5 per cent of people smoking in Scotland, which has to be achieved. I commend that, and I play my part as the Parliament’s smoking cessation champion.

We have talked about the campaign for a respiratory care action plan—the Government has worked hard to ensure that that happens. Only last month, on 25 April, our cross-party group held a reception in Parliament, attended by patients, guests and fellow members, to look at the respiratory care action plan two years on. At that event, we heard from a number of speakers and entertainers about the situation. We also know, however, that we have yet to see the latest progress report from the Scottish Government on what it is achieving, how the plan is progressing and the areas that require to be looked at.

As the Scottish Government heads to the halfway point of the current five-year session of Parliament, we also heard from the charity’s head of devolved nations, Joseph Carter, who highlighted that, although things were challenging before the pandemic, they have got much worse since.

As we have heard today, only 25 per cent of people with asthma are receiving the three components of basic asthma care: their annual review, the inhaler technique and the asthma action plan. That needs to be looked at, because we already know that in Scotland, we suffer from one of the worst respiratory death rates. Only 14.5 per cent of chronic obstructive pulmonary disease patients are receiving the five fundamentals of care that they require.

However, I was disappointed, but not surprised, to learn, through the charity’s freedom of information requests to Scotland’s health boards, that in my region, in NHS Forth Valley, patients are still waiting between 12 and 18 months for respiratory treatment. Despite the excellent campaign by the breathe easy Clackmannanshire group in my region, it is still looking for things to happen.

In conclusion, with regard to COPD and all the issues that we are talking about today, I commend Asthma and Lung UK Scotland for the work that it is doing, and I reiterate what Joseph Carter said about the lack of respiratory care for those with lung disease across the country.

It is vitally important that the situation is turned around, urgently, for the sake of all those respiratory patients who are suffering in Scotland, because they deserve nothing less from this Government and this Parliament.

13:17  

I thank Emma Harper for lodging this important motion, and I welcome the opportunity to respond to the debate on behalf of the Scottish Government. I know how much work Emma Harper does regarding asthma and respiratory diseases and as part of the cross-party group that she co-chairs with Alexander Stewart. I had the pleasure of joining the group at one of its round-table meetings one evening, and it was great to hear the choir, with members from Leith and across Edinburgh, sing as part of that event.

I also thank my fellow members on all sides of the chamber for contributing to this important debate. A number of questions were asked, which I will try to cover—if I do not, I am happy to discuss them further with members later on.

I put on record my thanks to those who are supporting people across Scotland who are living with asthma, including those in NHS Scotland, other public services and third sector organisations such as Asthma and Lung UK. That collaborative working enables progress to be made.

The theme of this May’s world asthma day, as other members have said, was asthma care for all. That resonates with our commitment to tackling health inequalities. We know that those who are living in poverty in Scotland are much more likely to develop a lung condition, and we know that care and treatment for conditions such as asthma is not always as accessible as it could be. I recognise the difficulties that are faced by those who are living with respiratory conditions such as asthma, and I am committed to improving services across Scotland to meet their needs through the implementation of our respiratory care action plan.

As others have said, that plan, which was published in 2021, sets out key priority areas for driving improvement in prevention, diagnosis, care, treatment and support for people who are living with a range of respiratory conditions. The Scottish respiratory advisory committee oversees the implementation of the plan. Its membership includes healthcare professionals, third sector groups and other national policy teams, and I am grateful for their input and leadership. Importantly, it has engaged with those living with respiratory conditions to ensure that their voices remain at the heart of the plan’s implementation.

The point that Emma Harper raised about inhaler technique is really important, and that is included in the draft Scottish respiratory quality prescribing guidance.

A key part of the plan is to ensure early and accurate diagnosis of asthma. With an early diagnosis, people have much more opportunity to explore self-management techniques and are more likely to avoid the need for additional intensive treatments. We are working closely with colleagues in primary care and specialist respiratory services to identify improvements in diagnostic pathways.

We recognise the benefits of pulmonary rehabilitation for people who are living with lung conditions. We have a commitment on that in our respiratory care action plan, and a working group has been established. We are working with physiotherapists and other key clinical staff from across Scotland to improve access to pulmonary rehabilitation.

Another key area of focus is ensuring a positive transition from child to adult services, which David Torrance touched on. We want to ensure that young people who are living with asthma receive the best possible support as they progress into adulthood by helping them to gain a greater understanding of their condition and how to manage it. A best practice document that is due to be published this summer aims to improve the consistency of transition services for young people across Scotland.

Several other large-scale improvement projects are being progressed in collaboration with key stakeholders. For example, the centre for sustainable delivery has a specific respiratory speciality delivery group that supports improvements in processes, pathways and innovation, and it is developing a severe asthma pathway.

Public Health Scotland is also supporting us to enhance data collection, so that we have a deeper understanding of people who are living with asthma and other respiratory conditions, to enable us to undertake improvement work accordingly. Funding has been initiated this year to develop a much-awaited respiratory audit programme.

I will touch briefly on dry powder inhalers, which are included in the quality prescribing guidance. Driving a better quality of care is the main aim, and there is an understanding that many people find DPIs easier to use. However, they might not be suitable for everyone, which is why inhaler technique education, which Emma Harper touched on, is so important.

Jackie Baillie raised a few points, but I note that the progress report has been shared with all respiratory stakeholders. David Torrance and others highlighted some of the areas that we need to focus on with regard to prevention. We have a number of approaches that aim to reduce the impact of factors such as air pollution, smoking and cold homes, all of which are closely linked to the onset of respiratory conditions.

The Scottish Government takes air pollution very seriously. Our vision is for Scotland to have the cleanest air in Europe, and we are committed to protecting the public from the effects of poor-quality air as soon as possible, as the First Minister mentioned during First Minister’s question time. For example, the introduction of low-emission zones in our four largest cities in 2022 was a key initiative in further improving urban air quality, and I was pleased to meet the healthy air Scotland coalition outside the Parliament yesterday.

As Alexander Stewart noted, exposure to cigarette smoke, whether directly or second hand, is another well-known risk factor. We aim to have a tobacco-free Scotland by lowering smoking rates in our communities to 5 per cent or less by 2034. We want to see a generation of young people who do not want to smoke. Our refreshed tobacco action plan, which will be published in the autumn, will renew our focus on meeting our ambitious 2034 target.

As we begin to understand the potential harms of vaping, we are considering our next steps in that area. It is an evolving issue, and we want to better identify ways to prevent children and young people from vaping as a lifestyle choice.

None of that important work would be possible without the dedicated clinicians who provide asthma services in our NHS. I note the creation of an international coalition of respiratory nurses, and I hope that that, in addition to our Scottish respiratory nurse forum, will provide a further opportunity for sharing good practice and learning. Perhaps Emma Harper’s sister can be involved in that, too.

NHS staffing levels are at a historic high, following 10 years of consecutive growth, but we recognise the pressures that boards and front-line staff are experiencing. We continue to invest in international recruitment to increase capacity in the short to medium term, but we are also exploring more innovative solutions, such as broadening the remit of respiratory physiotherapists and other allied healthcare professionals.

I reiterate the Government’s commitment to ensuring that everyone in Scotland who is living with asthma receives the best possible care and support. Although we have made progress, I recognise that there is much more that we can do.

Again, my thanks go to all the members who have contributed to this important debate and, most importantly, to the people across health and social care who are working to deliver the commitments.

That concludes the debate. I suspend the meeting until 2 pm.

13:25 Meeting suspended.  

14:00 On resuming—