Asthma: policy context
This section outlines the policy context relevant to asthma in Scotland. While there is no policy statement in Scotland that specifically focuses on asthma, policies on respiratory conditions, long term conditions, and allergic conditions are relevant.
Strategies
The Respiratory Care Action Plan 2021 to 2026 sets out the Scottish Government’s vision for the management of respiratory conditions including asthma. It makes 12 commitments designed to drive improvement in 5 key priority areas: prevention; diagnosis, management, and care; supporting self-management; consistent access across Scotland; and the respiratory care workforce. Specific actions for achieving these commitments will be identified during an implementation phase beginning in Summer 2021.
Two older Scottish health strategies - Delivering for Health (archived page, 2005) and Better Health, Better Care: Action Plan (2007) - recognised the importance of a generic (rather than disease specific) approach to long term conditions, with an emphasis on self-management. The delivery plan for long term conditions promised by Better Health, Better Care was published in 2009 as Improving the Health & Wellbeing of People with Long Term Conditions in Scotland: A National Action Plan. In addition to these, a prototype strategy - Good Places Better Health for Scotland's Children (archived site, 2011) - reviewed key environmental influences affecting the health of Scottish children with a focus on four main challenges, of which asthma was one.
Internationally, the World Health Organisation has produced a Strategy for the prevention and control of chronic respiratory disease and has also established the WHO Global Alliance against Respiratory Disease (GARD).
Reviews of services
Asthma UK has examined UK NHS services for those suffering from both difficult and severe asthma in Slipping through the net (2018), and also undertakes an online Annual Asthma Survey to determine the quality of care asthma sufferers receive. Audit Scotland published a report on Managing Long Term Conditions in 2007 which focused mainly on COPD and epilepsy but also made reference to asthma.
A number of reviews of allergy services are potentially relevant to services for asthma. The Scottish Medical and Scientific Advisory Committee (SMASAC) published a review of immunology and allergy services in Scotland in 2000 and a subsequent report on allergy services in Scotland (archived page) in 2009. At a UK level, the All Party Parliamentary Group for Allergy in conjunction with the National Allergy Strategy Group released Meeting the challenges of the National Allergy Crisis in 2021.
Previous reviews of allergy services in the UK include Allergy: the unmet need by the Royal College of Physicians in 2003, which drew attention to the shortcomings of existing services for allergic diseases including asthma. An update on progress in 2010 was titled Allergy services: Still not meeting the unmet need. Asthma was also included in the 2004 House of Commons Health Committee review of The Provision of Allergy Services in England and Wales and in the 2007 UK House of Lords report on allergy. In May 2014 the Royal College of Physicians published The National Review of Asthma Deaths (NRAD), which examines deficiencies in routine asthma care and presents recommendations for improvements.
Guidelines, standards and quality improvement work
Revised clinical guidelines for the management of asthma have been published jointly by the British Thoracic Society and the Scottish Intercollegiate Guidelines Network (SIGN) as SIGN 158. Quality Prescribing for Respiratory 2018-2021, written by the Scottish Government, is designed to encourage both high quality prescribing and non-pharmacological management for conditions including asthma. It promotes self-management of conditions, and does not replace other clinical guidance.
Clinical audits for asthma have been published by the Royal College of Physicians for adults in 2018/19 and 2019/20 and for children in 2019/20, as part of the National Asthma and COPD Audit Programme, with the aim of facilitating improvements in quality of care. These audits examine patients with asthma attacks discharged from hospitals in England, Scotland, and Wales, although note that the Scottish Government has now withdrawn Scotland from the programme.
In March 2007, the then NHS Quality Improvement Scotland (now Healthcare Improvement Scotland) published standards for asthma services for children and young people. A national overview of asthma services for children and young people was subsequently published in November 2008. NHS QIS also commissioned Asthma UK Scotland to review patient experience from the perspective of children and young people. The resulting report was published in November 2008 titled In their own words: asthma services in Scotland from the perspective of children and young people.
Asthma was included in the Quality and Outcomes Framework (QOF) of the General Medical Services contract for primary care, and figures from this scheme were published up to 2015/16. Further information about asthma data in the QOF is available in the primary care data page in this section and data from the QOF in Scotland are available from Public Health Scotland's Quality and Outcomes Framework (QOF) web pages.
In 2017, the National Institute for Health and Care Excellence (NICE) published guidance on diagnosing, monitoring and managing asthma in adults, young people and children. NICE are currently working with The British Thoracic Society and Scottish Intercollegiate Guidelines Network to develop revised guidance, which is expected to be published in November 2023.
Guidance on the use of emergency salbutamol inhalers in schools was published by the Scottish Government in 2017, outlining how schools are able to purchase inhalers for emergency use by pupils who have been diagnosed with asthma. The powers to buy and hold these inhalers is provided by The Human Medicines (Amendment) (No. 2) Regulations 2014.
