Meeting of the Parliament [Draft]

Meeting date: Wednesday, May 8, 2024

Official Report 1163KB pdf

---

World Asthma Day 2024

The final item of business is a members’ business debate on motion S6M-12707, in the name of Emma Harper, on world asthma day 2024. The debate will be concluded without any question being put.

Motion debated,

That the Parliament notes World Asthma Day 2024, which will take place on 7 May 2024; recognises that the Global Initiative for Asthma, supported by the World Health Organization, will this year mark the theme of “Asthma Education Empowers”; understands that around 360,000 people, including 72,000 children, have an asthma diagnosis in Scotland; further understands that asthma is one of the most common chronic non-communicable diseases that affects over 260 million people globally, and is responsible for over 450,000 deaths each year worldwide, most of which are preventable, and that, according to the Global Initiative for Asthma, one of the key universal issues for which education is required is the under-diagnosis or inaccurate diagnosis, including of people with severe asthma, underuse of anti-inflammatory inhaled corticosteroid inhalers, overuse and over-reliance on short-acting beta2-agonist (SABA) inhalers, and poor recognition of patients requiring specialist assessment and further asthma care management; notes the reported difference in severe asthma compared with unstable asthma, and understands that poorly controlled severe asthma can take a toll on health and wellbeing; welcomes the Scottish Government’s Respiratory Care Action Plan, which aims to improve prevention, diagnosis, treatment, care and self-management of asthma and lung conditions; notes the calls on the Scottish Government to provide an update on the effectiveness of the plan in helping to improve outcomes for people living with asthma; welcomes the work of Asthma + Lung UK Scotland to improve asthma care in Scotland and to support people who receive an asthma diagnosis and their families; further welcomes the creation of the International Coalition of Respiratory Nurses (ICRN) in 2023, which brings together nurses and allied health professionals 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 healthcare can lead to better outcomes and lives for people living with asthma.

17:59  

I welcome the opportunity to lead this important debate to recognise world asthma day 2024, which took place yesterday, 7 May, with the theme “Asthma Education Empowers”. I thank members who have supported my motion, allowing the debate to go ahead today. I also thank Asthma and Lung UK Scotland for its briefing and for all that it does in respect of research, advice and support for persons with an asthma diagnosis and their families.

Gareth Brown from Asthma and Lung UK Scotland serves as the secretariat for the cross-party group on lung health, which I co-convene with my colleague Alexander Stewart. Gareth does a great job, and I thank him for all his work. The CPG has done work relating to asthma previously, and the input from clinicians, asthma support groups and those who are living with asthma is welcome. My thanks go to the Minister for Public Health and Women’s Health for her active engagement with our cross-party group. One of our CPG members, Olivia Fulton, chairs a group that focuses on severe asthma, which meets online—I will say a wee bit more about Olivia later in my speech.

As 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. There is a lot of great info on the GINA website, which I encourage people to visit to find out more.

Asthma is a very common long-term lung health condition. In the United Kingdom, 5.4 million people have an asthma diagnosis—that is one in every 12 adults and one in every 11 children. In Scotland, 368,000 adults and about 71,000 children live with an asthma diagnosis. People with asthma might have sensitive, inflamed and irritated airways. Asthma symptoms can come and go; sometimes people might not have symptoms for weeks or months at a time. However, asthma needs to be treated every day, even if someone feels well, in order to lower the risks of their symptoms being exacerbated and of having an asthma attack.

The most common symptoms of asthma are coughing, wheezing—which is a whistling sound when you breathe—breathlessness and chest tightness. Experiencing one or more of those symptoms could mean that you have asthma. It is more likely to be asthma if your symptoms keep coming back, if they are worse at night or if they occur when you react to a trigger such as exercise, weather or an allergy such as pet hair or pollen. Anyone who experiences those symptoms should speak to their general practitioner as soon as possible.

The seriousness of asthma varies from person to person. There are different types of asthma—indeed, there is an important difference between severe asthma and uncontrolled asthma. Uncontrolled asthma improves with treatment changes such as steroid inhalers and good inhaler technique, but someone with severe asthma, which affects about 5 per cent of people with asthma, can have symptoms most of the time and can find them very hard to control.

Poorly controlled severe asthma takes a toll on people’s physical and mental health, leading to an average of four asthma attacks per year. Among people who live with severe asthma, 55 per cent report depression, 66 per cent report anxiety and 68 per cent say that it impacts their work and education. Where people live also has a bearing on outcomes, as those in the poorest areas of Scotland are, on average, three times as likely to be admitted to hospital as a result of their asthma.

There is a huge financial cost. In Scotland, the cost of treating respiratory disease is estimated to be £500 million each year, and asthma care represents £97.5 million of that spend. Flare-ups of severe asthma can result in patients presenting in the costliest part of the healthcare system: accident and emergency departments. Data suggest that people with severe asthma attend A and E departments roughly four times more often than people with non-severe asthma.

However, the situation can improve. Earlier, I mentioned Olivia Fulton, who is a great example of how improvement in severe asthma care can be achieved. She had serious challenges with her severe asthma, but thanks to proper care and treatment, she is now playing for Scotland’s women’s wheelchair rugby team. Asthma education has certainly empowered Olivia.

Since 2013, Asthma and Lung UK Scotland has surveyed people with asthma, and, earlier this year, it launched its “Life with a Lung Condition” survey for the second time. The survey results highlighted that 24 per cent of Scots received all three recommended aspects of asthma care: an annual review of their asthma care and treatment, a check-up on their inhaler technique and a written asthma action plan. In particular, 75 per cent of those who were surveyed said that they received an annual review, 50 per cent said that their inhaler technique was checked and 40 per cent said that they had received a written asthma plan.

I would welcome an update from the minister regarding what further steps the Scottish Government could take to increase awareness of asthma education in Scotland so that people know what their entitlements are and are empowered to press for them.

In 2021, the Scottish Government launched the “Respiratory Care Action Plan 2021-2026”, which sets out a vision for driving improvement in prevention and in the diagnosis, care, treatment and support of people living with respiratory conditions in Scotland. One aspect of the plan is that the pillars of asthma care should be available to everyone, so I would welcome an update from the minister on the implementation of the RCAP.

I will touch briefly on the 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 difficult; 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, and it is important to note that good-quality housing, sound state welfare support and good air quality are key components of achieving health equality. With regard to air quality, 57 per cent of those who are living with asthma in Scotland say that air quality makes them feel more breathless.

In closing, I highlight one final point: the importance of working across countries to learn from experience and ensure good practice. The International Coalition for Respiratory Nursing—of which I am a member, as I am still a registered nurse—was created in 2021. The ICRN is a global network of advanced respiratory nurse practitioners, with the aim of working together to improve care for people who live with lung conditions and to educate and empower patients. I support this year’s world asthma day theme, “Asthma Education Empowers”, as educating people empowers them to receive improved care and, consequently, have healthier outcomes.

Again, I welcome the debate, and I look forward to contributions from colleagues.

18:07  

I congratulate Emma Harper on securing this members’ business debate for world asthma day. Asthma is a chronic respiratory disease that affects more than 250 million folk around the world. In Scotland, about 360,000 folk are diagnosed as suffering from asthma, including more than 72,000 children, and there will be many more folk out there without a diagnosis at this point.

I do not think that many colleagues will be surprised to hear that I am one of those 250 million—especially colleagues who noticed me catching my breath when I was trying to ask a general question in the chamber a few weeks ago. It is no always easy to be wheezy.

I remember when I first went to the doctor and was diagnosed as borderline asthmatic or as having borderline chronic obstructive pulmonary disease—I remember that the doctor was unable to tell me which condition it was. I was given three different inhalers: one for asthma symptoms, one for COPD symptoms and a blue inhaler for if and when I needed it. It is a pity that I had not carried it with me on the day that I needed it in the chamber.

There was a fair bit of trial and error to find what worked for me, and I know that I am not alone in that experience. What works best for me is not just inhalers—what I no longer puff has made a real difference. I quit smoking more than four years ago, after being a smoker for nearly four decades of my life, and I feel that that has made a huge difference to my health. Although I am trying to be healthier and I have my inhalers, living with asthma can still be challenging. However, the more I learn about asthma, the easier it gets. Education can empower folk to manage their conditions and to go about their lives as they wish.

There are a few things that it is helpful to know. Those include what asthma is and what is happening to your lungs; what your symptoms are; how to manage your symptoms; how to recognise whether your symptoms are getting worse; and what can be a trigger for your asthma—for example, pets, perfume or deodorant—and how to avoid those triggers. However, that is not an invitation for anyone to stop wearing deodorant; as with many other things in the Parliament, there is a balance to be struck.

Finally, the most important thing that I feel folk should know, whether or not they are asthmatic, is how to recognise an asthma attack and what to do about it. The main symptoms of an asthma attack are if your asthma symptoms—coughing, breathlessness, wheezing or a tight chest—are getting worse; if your inhaler is not working; if you are too breathless to speak, eat or sleep; if your breathing is getting faster and it feels like you cannot catch your breath; or if your peak flow score is lower than normal. Children might also complain of a tummy or chest ache.

Once you have recognised an asthma attack, here is what to do. First, sit up straight and try to keep calm—I realise that that is easier said than done. Take a puff on your inhaler—usually your blue one—every 30 to 60 seconds, for up to 10 puffs. If you feel worse at any point or if you do not feel any better after 10 puffs, dial 999 for an ambulance immediately.

I conclude my remarks with that life-saving advice and congratulate my friend Emma Harper again on securing this important debate.

18:11  

I am delighted to make a contribution to this debate, and I thank Emma Harper, who is a fellow member and co-convener of the cross-party group on lung health, for securing it.

Back in February this year, I lodged a parliamentary motion on people with uncontrolled asthma to highlight the issue of severe asthma. Thereafter in February, I was very pleased to sponsor an exhibition in the members lobby entitled “Better lives for people with uncontrolled asthma”, which was specifically for MSPs and staff to find out more about severe asthma. That is a serious public health challenge in Scotland, and it is classified as a disability under the Equality Act 2010.

The adverse implications of severe asthma can put a significant strain on our healthcare system. We already know that asthma, which affects about 17 per cent of adults, is the most common respiratory disease in Scotland. However, severe asthma affects more than 4 per cent of that population, and it is sometimes quite difficult to manage. In the cross-party group, we have learned about all the things that can support people with that.

Asthma and Lung UK has estimated that Scotland has among the highest prevalences of severe asthma in the United Kingdom. Poorly controlled severe asthma challenges people’s mental and physical abilities. We know that the condition leads to an average of four asthma attacks a year. Well over half of people who live with it have depression or anxiety, which leads them on to other problems with their health and wellbeing. About 70 per cent of patients report that the condition severely impacts their work or education.

A key opportunity to improve outcomes for patients with severe asthma is through improving the pathway towards accurate diagnosis. We have talked in the past about diagnosis and delays in referrals to specialist clinics to undertake patient-centred assessments. We need to deal with that.

I welcome the fact that the theme of this year’s world asthma day is “Asthma Education Empowers”. That tells us a lot about what we can do when we talk about accurate diagnosis and how people can be treated. For some patients, that might mean starting on a medicine class known as biologics. Those medicines transform lives, but only one in five people receives such therapies in Scotland. We need to consider how more people can be accessed, because access to treatment will save lives.

In the cross-party group, we have talked about how pulmonary rehab and singing help with chronic obstructive pulmonary disease. Does Alexander Stewart agree that PR and singing can help folk with asthma, too?

Without question. There is the whole idea of working the lungs. I do not have asthma but, as Emma Harper knows, I do a little bit of singing, and I know how that helps me.

Is Mr Stewart about to burst into song?

I will not sing this evening. Members can come to the choir to hear me some other time.

As I said, we must ensure that we have access to experts and clinicians across Scotland and that the issue of access is looked at. I look forward to hearing what the minister has to say on that, because we know that there needs to be much more equal access to advanced therapies, which can be transformative. We must manage severe asthma.

I hope that the minister will, in her summing up, talk about: where we are when it comes to the progress of the respiratory care action plan; a pledge to address the misdiagnoses and the underdiagnosis that we know are taking place; implementing clear national once-for-Scotland protocols, because we know about the issues of disparity; establishing nationally agreed severe asthma referral pathways that promote collaboration between primary and specialised care; and collaboration across partners, including patient advocacy groups, as well as the third sector.

18:15  

I thank Emma Harper for securing this debate to mark world asthma day 2024. I also say well done to Jackie Dunbar, and urge her to keep going. I gave up smoking 22 years ago and have never looked back, so I encourage her to keep at it.

As Emma Harper and Alexander Stewart have said, this year’s theme is “Asthma Education Empowers”. That is important, because knowledge of how to access good and timely treatment can be life changing for those living with asthma.

Asthma and Lung UK’s 2024 survey revealed that basic asthma care levels continue to fall in Scotland, with only 24 per cent of sufferers receiving the three basic provisions of asthma care. Data also shows that, in Scotland, there are significantly low levels of uptake of specialist treatments such as biologics for those who might be eligible. There is a postcode lottery across Scotland. It is interesting to note that, despite its own challenges, NHS England currently leads Scotland with a 17 to 21 per cent higher uptake. There is something that we can learn from that.

Clearly, there are issues with the levels of education about and knowledge of what services are available in Scotland, in both specialist treatments and basic asthma care. However, the problem lies not with public knowledge alone; Asthma and Lung UK has reported concerns that the Scottish Government does not accurately collect and report the correct number of people living with respiratory conditions, which is an issue that anyone with an interest in long Covid will be familiar with. That matters, because poor data collection means poorer treatment options and, ultimately, poorer patient outcomes. The issue must be addressed.

Patients have also raised concerns about a lack of awareness in primary care, leading to delays in specialist referrals to clinics for patient-centred assessment and to gain an accurate diagnosis. The more that we ensure that GPs are properly supported and have the time to take opportunities to expand their knowledge of and education on subjects such as asthma, the more that we can ensure that patients are signposted and treated before their symptoms worsen or they end up in hospital.

The survey further showed that only 40 per cent of people hospitalised with asthma were getting the follow-up care that they needed within two days of leaving hospital. That is the case, despite current Scottish Intercollegiate Guidelines Network guidance stating that follow-up care is required to ensure that symptoms remain under control. The result is that around one in six people who receives emergency care for an asthma attack needs hospital care again within two weeks. There is, therefore, a logic to our getting prevention right. We know that the national health service is already under immense pressure, and the lack of that basic follow-up care only exacerbates the problem.

Patients and health professionals need support from the Scottish Government if asthma education is to actually empower them. They need better data collection, action in primary care to improve diagnostic tools and public health campaigns that provide up-to-date information about treatment. Scotland also needs the timely implementation of the respiratory care action plan’s severe asthma recommendations, the creation of clear, national, once-for-Scotland protocols for severe asthma and the establishment of nationally agreed severe asthma referral pathways, which will promote collaboration between primary and specialised care.

Without action to address those issues, asthma will continue to be a significant public health challenge in Scotland, causing pain and discomfort and placing strain on the NHS that is avoidable.

18:20  

I thank Emma Harper for bringing this important debate to the chamber. I recognise the knowledge and skills that she has in this area and I praise the on-going work that she is committed to doing in the Parliament and beyond. I have heard her speak about this subject many times, and it is much appreciated.

Scottish Labour welcomes, as my colleague Jackie Baillie does, world asthma day 2024, which is supported by the World Health Organization and took place yesterday. We recognise this year’s theme of “Asthma Education Empowers”.

As far as prevalence is concerned, asthma in Scotland affects, as we have heard, around 368,000, 71,000 of whom are children. An important point that has been raised by Asthma and Lung UK as well as by members relates to the collection and recording of information. Currently we do not have an accurate collection method or an agreed reporting system across health boards and the Scottish Government, and given that, according to the Royal College of Physicians report, two thirds of asthma-related deaths could be preventable, I ask the minister whether the Scottish Government is looking at that issue. Perhaps she will say something about that in her closing remarks.

As other members have said, medical advisers and professionals who work in the field have identified key risk factors in managing the condition, including the overuse of relief inhalers, the underuse of preventer inhalers and recent emergency hospital visits with no follow-up. Such factors give great insight into the reasons for this year’s theme of education empowering people; it makes it clear that it is important to teach people with asthma about their condition and that, by learning about it, they can manage their symptoms better. That helps the patient, the doctors and the NHS.

When I did some research for the debate, it became clear that we need strong will and a strong commitment from the Government to prioritise this lifelong condition. According to recent Asthma and Lung UK research, many Scots with asthma are falling short on the basic care guidelines. We know that there is pressure on NHS staff, so I ask the minister to tell us how she believes that the Government can help to reverse that pressure on staff and offer asthma sufferers some hope that the outcomes from that condition can be changed.

We have heard about three things: an annual review, an inhaler technique check and a written action plan. The research shows that only 24 per cent of Scots received all three; 25 per cent received one; and 17 per cent reported receiving none. This is an important matter, and I know that the minister will consider it to be so. We would, I think, all agree that every person with an asthma diagnosis should be offered all three elements; they should know that that is their basic treatment plan and entitlement.

In my final minute, I ask the minister, as others have done, to update us on the care action plan and to point to some specific points of action that the Government has undertaken, so that people with asthma can feel that moves are being made and improvements for their care are being put in place.

Again, I thank Emma Harper for securing the debate and all the members who have contributed to it.

18:23  

I, too, thank Emma Harper for lodging this important motion, and I welcome the opportunity to respond on behalf of the Scottish Government. I also put on record my thanks to those who support people living with asthma in Scotland, including our NHS and third sector organisations such as Asthma and Lung UK. Finally, I thank Emma Harper and Alexander Stewart for their sterling work in the CPG. I have interacted with them before and will be happy to do so again, if I am still in this role.

Carol Mochan is absolutely right to say that asthma is important to me. Both my father and brother had it, and, going back to what Jackie Dunbar said, I remember that, any time we went out, we had to make sure that the appropriate inhalers were packed. I also thank Emma Harper for outlining the symptoms.

World asthma day gives us time to reflect on the progress that has been made in respiratory care and on the challenges that we face. We know that care and treatment for conditions such as asthma are not always where they need to be, but we are continuing to work collaboratively across our whole system to tackle it.

The Scottish Government is committed to improving services across the country and meeting needs through the implementation of a respiratory care action plan. The plan sets out key priority areas for driving improvement in prevention, diagnosis, care, treatment and support for people living with a range of respiratory conditions.

As well as the national plan, significant work is being done across the wider health and social care landscape. The centre for sustainable delivery supports professionals across Scotland to come together and share best practice while working towards consistent once-for-Scotland pathways in respiratory services, A priority in the current work plan of the respiratory specialty delivery group is the development of a once-for-Scotland asthma pathway. Indeed, the group’s aim is to design a national pathway in partnership with clinicians and, importantly, those who live with asthma.

A major milestone in asthma care this year has been the publication of “Quality Prescribing Strategy for Respiratory: A Guide for Improvement 2024-2027”. The document aims to keep people at the centre of their treatment and respiratory disease management and to promote safe, evidence-based and sustainable prescribing with regular reviews of medication. The guide will support clinicians across the multidisciplinary team and people with respiratory conditions in shared decision making, and it offers practical advice and options for tailoring care to individuals’ needs and preferences.

Alongside the guide, a suite of national therapeutic indicators that has been developed with Public Health Scotland will allow clinicians to identify those most in need of a review. Primary care teams will be able to drill down to cluster and practice-level data and benchmark across Scotland, driving consistency in care.

It is important to address the point that Jackie Baillie and Carol Mochan made about the importance of data. We are currently working with Asthma and Lung UK and other key partners on commissioning a full national audit programme for respiratory conditions.

The prescribing guide also has a focus on net zero. Many people with asthma might be surprised to learn that the environmental impact of inhalers for treating asthma and COPD is equivalent to around 80,000 tonnes of CO₂ a year. That is more than the emissions from the entire NHS fleet and full NHS waste combined. We want to ensure that patients and their prescribing clinicians are equipped with the facts to enable them to make choices.

We also understand that environmental factors play a huge role in the day-to-day lives of people who live with lung conditions such as asthma. Our vision for Scotland is to have the cleanest air in Europe, and we are committed to protecting the public from the effects of poor-quality air as quickly as possible. The introduction of low-emission zones in our four largest cities in 2022 was a key initiative in further improving urban air quality.

I congratulate Jackie Baillie and Jackie Dunbar on their smoking cessation. I was just commenting to a friend that I can remember getting the no-smoking lesson back in primary school; one of my friends went back to his parents’ house, where his father smoked, and he stuck stickers all the way up the stairway. They got ripped off, but the marks were still there. The father has now stopped smoking, which is great. It took a long time, but he did it.

As a Government, we remain committed to a tobacco-free Scotland by 2034, and the United Kingdom Tobacco and Vapes Bill will help us to achieve our ambitious target. Scotland has a range of world-leading tobacco-control measures, and smoking rates continue to decline. Our tobacco and vaping framework, which was launched on 22 November last year, sets out our road map to 2034 and outlines decisive action, including work on the Tobacco and Vapes Bill, to ensure that we hit our goal. That suite of preventative measures will help people better manage their condition and support us in preventing respiratory disease in future generations.

I agree with everyone who has talked about the appropriateness of the theme of this year’s world asthma day: “Asthma Education Empowers”. As Carol Mochan has said, we understand the benefits of empowering people with asthma through the appropriate education, so that they can manage their disease and recognise when to seek medical help.

We also work with many third sector partners who provide invaluable support to those living with lung disease. I am not going to start singing now, but I spent an amazing couple of hours singing for lung health with the Cheyne Gang in Leith, which Emma Harper introduced me to. I know that the chamber would not want me to sing, but it was great.

The fact that you were singing will be clear for the Official Report, minister, so please do not start.

I will not, but it was amazing—I thought that you were about to tell me that my seven minutes was up, Presiding Officer. In any case, the event was clearly about encouraging people to think about breathing with their entire lungs and giving each other peer support.

In 2023-24, more than 600 nurses accessed training modules as part of our respiratory care action plan to build on the knowledge and skills in the NHS workforce. Another positive development has been the delivery of guidance for children living with asthma transitioning into adult services. We know that that is a particularly challenging time for young people, their families and carers, and that not all areas of Scotland offer transition services, but guidance has been developed by a group of asthma specialists in partnership with the third sector and those with first-hand experience of a good transition.

I will close by reiterating the Government’s commitment to ensuring that everyone living with asthma in Scotland receives the best possible care and support. As we move through 2024, we know that there is still a way to go in respiratory care and the only way that we will improve is by understanding the needs of those who live with the condition. My thanks go to all members who have contributed to this important debate today, and, most important, to those working across health and social care to deliver those commitments.

That concludes the debate.

Meeting closed at 18:31.