Associate feature: Scots gasp for breath whilst the Scottish Government fails to act

Imagine not being able to breath, a feeling that you are suffocating, gasping for breath. In truth, this is the reality that many thousands of people face every day, coping with a potentially life-threatening asthma attack, severe COPD flare-ups or living with debilitating lung conditions like pulmonary fibrosis. 

Respiratory diseases are the third biggest killer in Scotland¹ and are one of the leading causes of winter pressures in the health service.² But despite this, lung conditions like chronic obstructive pulmonary disease (COPD) and asthma continue to be drastically overlooked. 

It’s four years since the Respiratory Care Action Plan was launched by the Scottish Government and extraordinarily little progress has been made to implement it. Diagnostic waiting times are too long³, the proportion of people getting basic asthma and COPD care is declining⁴ and the number of people accessing pulmonary rehabilitation is far too low.⁵

It’s a hard to imagine a situation of someone living with diabetes or a heart condition not being able to get a proper diagnosis³, but in Scotland thousands of people wait years for a diagnosis. In our latest Life with a Lung Conditions Survey, only 24% of Scots with asthma had the three basics of asthma care – annual reviews, inhaler technique checked and having a personalised action plan.⁴ For COPD only 5% of people were receiving the five fundamentals of COPD care.⁴ Both, the lowest on record.

We’ve just come out of a devasting winter, with flu admissions more than three times what they were last year⁶ and the NHS struggling to cope. Lung conditions including COPD, asthma and respiratory infections place a huge burden on the health service, especially in the winter months when respiratory admissions increase by 90%.⁷ Put simply, lung conditions are a major part of the winter pressure. The Scottish Government puts a lot of focus on trying to discharge people from hospital quicker, but what if we could stop them from being admitted in the first place?

We asked PwC to model the direct and indirect impact of investing in better diagnosis, improving basic asthma and COPD care, and increasing access to pulmonary rehabilitation across Scotland. We couldn’t give a full Scotland analysis due to several health boards not publishing the number of people with lung conditions in their areas, but we were able to show the thousands of bed days that could be saved. In Greater Glasgow and Clyde alone an estimated 5,602 bed days could be saved, including 1,905 in the winter, and over £7 million.⁸

With so many people living with and dying from lung conditions, you would have thought that implementing the Respiratory Care Action Plan would be a priority, but instead the plan has stalled, funding and civil service time reduced. The Scottish Government is now proposing a Chronic conditions strategy to supersede all other plans apart from cancer, further downgrading the importance of lung health. With 1 in 5 Scots living with a lung condition we are a big enough group of people to justify a full funded strategy with the political will to deliver it.

We only get one set of lungs, so we all must have the tools available to look after them. That is why we are calling for new diagnostic hubs across the country. No cough should be left uninvestigated, no wheeze should be ignored, and no one should be misdiagnosed and access to the best treatment should be readily available, whether that is biological drugs for asthma or pulmonary rehabilitation for chronic conditions like COPD. 

Asthma + Lung UK Scotland will continue to fight for better lung health. Thousands are not getting the care they need, causing avoidable problems which cost them and the health service. We need the Scottish Government to make lung health a priority.

This article is sponsored by Asthma + Lung UK Scotland. 

www.asthmaandlung.org.uk/scotland

References

1. In 2023 (latest available data), respiratory diseases were the third biggest killer accounting for 6,953 deaths after cancers with 17,014 deaths and heart disease responsible for 15,818 deaths. Vital Events Reference Tables 2023, National Records of Scotland. Accessed here.
2. Out in the cold: lung disease, the hidden driver of NHS winter pressure. Asthma + Lung UK, 2017. Accessed here.
3. Data from Asthma + Lung UK’s annual Life with a Lung Condition Survey 2024 which had 1,231 responses across Scotland. 1 in 5 (19%) respondents reported waiting 5 years or more to receive a diagnosis after first noticing their symptoms.

4. Data from Asthma + Lung UK’s annual Life with a Lung Condition Survey 2024 which had 1,231 responses across Scotland. Basic care for asthma entails having a written personalised asthma action plan, an annual review, and an inhaler technique check. Basic COPD care, known as the 5 fundamentals of care, comprise a co-developed personalised self-management plan, pulmonary rehab offer, if eligible, stop smoking treatment offer if eligible, offer of pneumococcal and influenza vaccinations and optimised treatment for comorbidities.

5. Data from Asthma + Lung UK’s annual Life with a Lung Condition Survey 2024 which had 1,231 responses across Scotland. Pulmonary rehabilitation statistics below are for COPD respondents who scored 3+ on the MRC breathlessness scale (eligibility criteria for pulmonary rehabilitation). 

6. In the week ending 15^th December, 677 people were hospitalised with flu which is nearly triple the 232 hospitalised with flu during the same week (ending 17^th December) in 2023. Public Health Scotland’s viral respiratory diseases surveillance report week 50 2024 and week 50 2023.
7. In 2022/23, there were 16,417 hospital admissions for respiratory conditions in summer (June-August). This increased by 90% to 31,218 hospital admissions in winter (December-March, NHS definition). Asthma + Lung UK internal analysis of Public Health Scotland monthly hospital admissions data.
8. Investing in Breath: Measuring the economic cost of asthma and COPD in the UK and identifying ways to reduce it through better diagnosis and care, Technical Report, 2023.