 ddestun iawn i gweithiau Theel Llyfridaw. I welcome the opportunity to lead this vitally important debate to recognise that Worldально Oboncé took place on 2 May 2023 and it had a theme this year for all. Thank members from across the chamber and all parties who supported my motion, dyna ddim yn dweud â'r bwysig i'r gweithio a chael gwahanol ac rwy'n ei wneud eu bod yn ddwybl iawn mesurau i'rfeddorol a'r bwysig i'r polisi ac oes emergelladach Gareth Brown a'r rydw i'r yrthbeth i gyd i'r gwneud i'r pwylau'r gwirioneddau ystyried i'r pwylau. Fy rydw i, bobl i ychydigwyr Cymru, ddyddach i gyd amser Cymru, am adnododd, gweithio arrych i'r bandwg, a'r bandwg i'r agonwygrau. i os yw i adfyllfa nhw While Hearts and The Cross Party. The input from clinicians, asthma support groups, and in that group those living with asthma, likebury has a lot of work relating to asthma in the past. The input from clinicians and asthma support groups and those living with asthma like asthma in the UK ambassador Olivia Fullton is absolutely invaluable. It is worth noting that Olivia, who thought that she could never participate in sport because she has quite severe asthma, is playing wheelchair rugby, and she is absolutely loving it. Asma Day is organised by the global initiative for Asma, a World Health Organization collaborative founded in 1993. Asma is a very common long-term lung condition, and in the UK, 5.4 million people have Asma, 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 Asma diagnosis, and people with with asthma often have sensitive, inflamed airways. Asthma symptoms can come and go sometimes, people will not have symptoms for weeks or months at a time. Asthma needs to be treated every day, even if he feel well to lower the risk of symptoms and asthma exacerbations, and attacks. The most common symptoms of asthma are coughing, wheezing, so it's a whistling sound when you breathe, breathlessness and chest tightness. As a nurse, when I looked after people Sometimes they would describe that it felt like a brick was weighing down on their chest and made it really difficult to breathe. Experience in one or more of these symptoms could mean you have asthma. Anyone experiencing symptoms should speak to their GP practice as soon as possible. There are nurse specialists in asthma care and respiratory medicine in many of our GP practices, so there are some great experts out there. Presiding Officer, there are lots of things that can make asthma worse, but not everyone will be affected by the same things. Finding out what sets off your symptoms, whether it's colds and viruses, pets, pollen, pollution, house dust, might or stress, means that you can work out ways to avoid the triggers, if possible. There are certain stages in your life that might affect your asthma too. For example, some women find that hormonal changes at pubertate, pregnancy or menopause can affect their asthma as well. I know that there is current research under way that is really looking at the issues that face women with asthma and whether it's exacerbated or not, depending on pubertate, pregnancy and menopause, as I've mentioned. The best way to cope with your asthma triggers is to always take your preventer inhaler as prescribed, even when you 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. However, we have new biological medicines now that target the processes that cause inflammation, and those meds are helping as well. Asthma can kill. It is serious and it needs continued action. Presiding Officer, Asthma motion states that Asthma in 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 this is through ensuring that people have their own personalised asthma action plan and that they 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 that may lead to the patient being or the person being hospitalised. Conversations with my go-to person, Gary MacDonald, who is a community pharmacist who specialises in asthma, said that, for most people, they can have their inhaler technique checked at their community pharmacy. The community pharmacists are often the only healthcare professionals that people actually see. Recently, I hosted a Lung health event in Parliament for the two years of the respiratory care action plan. I met Paul Wilson, who has had 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 his other personalised asthma action plan put in place. He is now given back to the NHS by training to be a nurse and, hopefully, Paul will be a respiratory nurse. That is a good news story that we have heard about the work that community pharmacists can do in supporting people. Inhaler technique is part of the personalised action plan for your asthma control. I would be interested in how personalised asthma action plans and how inhaler technique are being communicated to patients, as it is 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 2021-26. The plan sets out the vision for driving improvement in 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 for asthma. 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, quality of life and reducing wheezing, anxiety, depression and bronchial inflammation. Many patients report waiting lists of up to 18 months to access PR referrals and appointments. I would ask the minister whether targeted support could be considered to improve waiting times for pulmonary rehabilitation but also for asthma referrals, as requested by asthma in the UK. There is a link between asthma and inequality, and 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 like 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. In closing, asthma is a serious health condition, and we all need to ensure that people are aware of the signs and symptoms and that they are taken all the action possible to support people who are diagnosed. We must ensure that the right inhaler for the right patient is one of the ways forward, but, importantly, we need to know how people use their inhaler properly. I look forward to hearing other members' contributions. Presiding Officer, I am very grateful to Emma Harper for securing this debate today and providing us with opportunity to mark World Asthma Day 2023, which took place last month. This global initiative, supported by a World Health Organization, was themed asthma care for all. It is a theme that holds immense significance for Scotland, a country where an estimated 360,000 people, including 72,000 children, I diagnose with asthma. Asthma is more than just a chronic health condition. It is a challenge that touches every aspect of a person's life. Their ability to play, learn and even work impacts not only on those who are diagnosed but also their families, schools and communities. We must see this not just as a health issue but as a social one that demands a collective attention and action. Despite its widespread prevalence, asthma remains a misunderstood condition. Society often underestimates the severity of asthma, not fully complementing, but uncontrolled asthma can lead to life-threatening attacks. The Covid pandemic has highlighted the severity of respiratory conditions and has shonelled spotlight on prevention and treatment. Over 80,000 people in Scotland with respiratory conditions, including asthma, were asked to shield at the height of the Covid-19 pandemic and the largest group of people within the shielding list. With proper diagnosis, appropriate treatment and effective management, people with asthma can lead active, healthy lives. In my role, I would like to acknowledge the efforts of the Scottish Government's respiratory care action plan that aims to improve prevention, diagnosed treatment and care, and self-management of asthma and other lung conditions such as chronic obstructive pulmonary disease and bronchitis. Those comprehensive efforts are geared towards enhancing the quality of life of those affected by conditions and reducing the burden on our healthcare system. However, the reports about access to basic asthma care are start reading. The theme this year of world's asthma day, asthma care for all, speaks volumes about shared commitment and collective aspirations. I know that the Scottish Government and our health ministers are committed to working with people living with asthma to better understand the barriers of accessing support. In my constituency, we are fortunate to have the fantastic, brief, easy life. It provides a support network for people living with any kind of lung condition, as well as their families and carers. From social activities, exercise sessions, to education and information, their invaluable support helps people to self-manage their condition, while invaluable peer support for those who understand what it is like to be breathless helps people to live with lung 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 undertaken by asthma and lung UK, 93 per cent of people in Scotland with lung conditions like asthma have made significant changes to their lives in response to the cost of living crisis. One of three of these surveys say that their health is worsening as they cut back on food and heating. No household should be faced with these 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 and exacerbate their existing conditions and limit their ability to enjoy simple pleasures of childhood. The role that cleaner plays as a narrative cannot be overstated. Our children breathe at a faster rate than adults, but developing lungs that absorb more air per unit body weight makes them susceptible to airborne pollution. Our children deserve to grow up in a safer environment that we must commit to delivering this for them. Recognising World Asthma Day prompts us to focus our collective consciousness on the health issues of immense global and national relevance. 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, asthma prevalence and the gaps in public awareness about this condition. Our approach must be multifaceted in integrating prevention, early diagnosis, effective treatment and long-term management of asthma. In conclusion, I like once again to thank Emma Harper for bringing us forward in this debate. In the last year in your dedication, we can do our determination and continue our journey towards a world free from constraints of asthma. I wish to draw members' attention to my register of interests as a practicing NHS GP and thank Emma Harper for bringing today's business to the chamber. We really need to double down on our efforts to raise awareness about a condition that affects millions of lives worldwide. Asthma is a chronic respiratory disease that knows no boundaries. It demands our attention not just on World Asthma Day when pollen counts sky high. This is why I am purposely outside today to highlight that despite the glorious weather, lots of people suffer from asthma and it is made worse by the pollen that is going on at the moment. According to Asthma in the UK, about 370,000 people suffer. That is about one in 15. It does not discriminate. It does not really matter about your age or race or your background. It robs individuals of their ability to breathe freely. In 2021, 96 Scots died from this condition. 67% were women. These are numbers. These are real people with dreams aspirational and loved ones. They mourn their loss. We have a responsibility to strive for better treatments, research and resources to improve management of this condition. Through concerted effort, the mortality rate can reduce and we can get it down to zero if people use their inhalers and get that asthma reviews. We need a brighter future. I also want to address one of the leading causes that there has been. Smoking and tobacco smoke is a known trigger for attacks. It is crucial to educate and support individuals in their journey to quit smoking, but we also must create smoke-free environments to promote smoking cessation programmes and have healthier environments. I am calling on the Scottish Government to also take decisive action to make it easier for patients to switch from traditional aspirational inhalers to dry powder alternatives. We have a duty to explore sustainable solutions for managing this chronic condition. Dry powder inhalers or DPIs offer a green alternative compared to their commonly used propellant-based counterparts. DPIs do not release harmful gases into the atmosphere, so it reduces the carbon emissions that contribute to the cleaner and healthier planets. However, to bring about this change, effective communication is crucial. The Scottish Government must prioritise education awareness campaigns to inform patients of the benefits of dry powder inhalers. To provide 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 responsibility and patient wellbeing can go hand in hand. Let us use world asthma day as a catalyst for change, in which together we can raise awareness, advocate for improved treatment and work towards preventing asthma-related deaths. Let us empower individuals with asthma to engage in their conditions effectively and promote a world where breathing is a right, not a privilege. Together we can shape the future, where asthma management is both effective and sustainable. Thank you. I now call Jackie Baillie to be followed by Alexander Stewart. Presiding Officer, let me start with an apology for not having a leafy backdrop for my contribution today. Let me start by thanking Emma Harper for securing this debate about world asthma day 2023 and also 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 actually received the three components of basic asthma care that they require. The Scottish Government's respiratory care action plan was introduced in 2021, but there has been little progress made. Scotland is one of the highest respiratory death rates in Europe—137 people per 100,000—and waiting times for essential respiratory rehabilitation in some health board areas are over a year long, so we clearly can do better. One in five Scots have a lung condition, but a lack of decent funding and a lack of 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 like asthma the priority they need, and I am ever hopeful that the new minister will correct that. Surveys 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, that contributes to over 6,000 emergency hospital admissions each year. It is the cause of around 100 asthma-related deaths, as we heard from Sandish Gulhane, two thirds of which are women. It places undue strain on an already-in-crisis NHS just because of a lack of access to something as simple as an annual asthma action plan. In a nation like Scotland in 2023, it should not be acceptable that hundreds of lives are lost each year because of a condition that is well understood. We also need to recognise, as Emma Harper did, that there are significant healthcare inequalities when it comes to asthma. An analysis from asthma in lung UK shows that women are almost twice as likely to die from an asthma attack than men. Data from NHS Scotland reveals that those in the most deprived households are more likely to live with asthma and have more asthma attacks, but they are also two to three times more likely to require an emergency admission for asthma. It is clear that a one-size-fits-all approach does not work. I encourage the Scottish Government to invest in better research, to identify new treatments, to make better use of existing treatments, to both 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 pollution. I am happy to give that point. Thank you very much, Jackie Baillie. I will be really, really quick. One of the things during the pandemic—my sister is a respiratory nurse consultant—was moved upon the rehab to be online, and that is something that they have found that is one of the innovations that is taking forward. Will Jackie Baillie welcome that PR can now be delivered in various forms, face-to-face, online? Anything that gets the service available to people that requires it should be welcomed, so I very much welcome what your sister is doing in her service as well. To conclude, the Scottish Government needs to outline how they are going to invest in training, how they are going to invest in recruitment in those rehabilitation services, to publish a progress report on the achievements and failings of the respiratory care action plan as it reaches its halfway into its five-year term. I hope that the new Public Health Minister, Jenny Minto, will work to ensure that the action plan is not something that simply languishes on a shelf. Health boards need to be supported to rebuild services and deliver the outcomes people with lung conditions like asthma need. The 368,000 people in Scotland living with asthma deserve more than warm words from this Parliament on World Asthma Day. They need real action and they need it now. As my fellow co-convener for the cross-party group on lung health, I congratulate Emma Harper for securing this debate and all the work that she does on this cause. World Asthma Day is organised by the Global Initiative for Asthma, a world health organisation, and, as you have already heard, each May raises awareness on asthma worldwide. For this year's event, we have also heard about asthma care for all has been the theme, which perfectly fits in with the sentiments of the debate, but also with the main aims of our cross-party group. Indeed, only recently, the cross-party group highlighted groundbreaking research into women with asthma and the effects of estrogen on that condition. Our scientists and our secretariat, asthma along UK Scotland, have also highlighted that women are more likely to suffer asthma and severe symptoms are chronic to that. They also experienced significant worsening of symptoms around menstruation and times of the month. That potentially puts them in a very dangerous situation. Research is being undertaken, but that is still quite patchy. 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 in order to prevent. We have heard today about smoking and the smoking sensation programme that is required. That is very important because the mass media campaign that has been put out to achieve by 2034 to target of less than 5 per cent smoking in Scotland has to be worked on and achieved. I play my part and commend that as this Parliament's smoking sensation champion. We also talked about and have been heard already today about the respiratory care plan action, and that has very much been the case. The Government has worked hard to ensure that. Only last month, on 25 April, we had the cross-party group that had members, guests and fellow members attending the parliamentary reception, which was looking at the respiratory care action plan two years on. At that event, we heard from a number of speakers and entertainers about their situation. We also know that we yet have to hear the latest recent progress report from the Scottish Government about what it is achieving and how the plan is progressing and the areas that require to be looked at. As the Scottish Government heads to the halfway point of its session of this five-year parliamentary term, we have also heard from the head of dedicated Joseph Carter, who highlighted and reported that, while things were challenging before the pandemic, things have gotten much worse since. We have also heard today that only 25 per cent of people with asthma are receiving the three components of basic asthma care, that being their annual review, the inhaler technique and the asthma action plan. That needs to be looked at because we already know that we are suffering in Scotland as one of the worst with the highest areas of respiratory care that people are affected by. People with COPD, only 14.5 per cent of patients are receiving the five fundamentals of COPD that they require. However, through the charity's freedom of information request to Scotland's health boards, I was very disappointed but not surprised that, in my region, Forth Valley is still waiting between 12 to 18 months for respiratory treatment. Despite the campaign that goes forward by the excellent group of Brewery Zeclack managers in my region, they are still looking for and wish for things to happen. In conclusion, throughout all the issues that we are talking about today, I commend asthma lung UK Scotland for what they are doing and also talk about what Joseph indicated, that they wait for and there is a lack of respiratory care and lung disease across the country. It is vitally important that the situation must be turned around and urgently for the sake of all those individuals who are suffering respiratory patients in Scotland, because they deserve that nothing less from this Government and this Parliament. I would like to thank Emma Harper for lodging this important motion and welcome the opportunity to respond on behalf of the Scottish Government this afternoon. I know how much work Emma Harper does regarding asthma and respiratory diseases and also the work of the cross-party group that she co-chairs with Alexander Stewart. I had the pleasure of joining them at one of their round-table meetings one evening, and it was great to hear the choir from Leith and across Edinburgh sing as part of that event. I would also like to thank my fellow members from across the chamber for contributing to this important debate. There were a number of questions to ask, which I will try and cover, if not, then I am happy to discuss further with members. I would also like to put on record my thanks to those supporting people living with asthma across Scotland, including in our NHS Scotland public services and third sector organisations, such as Asthma Long UK. It is this collaborative working that enables progress to be made. The theme that many others have said of this May's World Asthma Day was asthma care for all. That resonates with our commitment to tackle health inequalities. We know that those those living in poverty in Scotland are much more likely to develop a lung condition. We also know that care and treatment for conditions like asthma is not always as accessible as it could be. I recognise the difficulties faced by those 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. That plan, published as others have said, in 2021 sets out key priority areas for driving improvement in the prevention, diagnosis care, treatment and support for people 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. I am very 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 its implementation. I thought that the point raised by Emma Harper regarding inhaler technique is really important. That is included in the draft Scottish respiratory quality prescribing guidelines. A key part of the plan is ensuring early and accurate diagnosis of asthma. With an early diagnosis, people are able to 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 as well as specialist respiratory services to identify improvements in current diagnostic pathways. We recognise the benefits of pulmonary rehab for people living with lung conditions. We have a commitment within 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. Another key area of focus is ensuring a positive transition from child to adult services, which David Torrance touched upon. We want to ensure that young people 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 due to being 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. It is currently 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 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 also want to touch briefly on dry powder inhalers. They are included in the quality prescribing guidance, driving better quality care as the main aim and understanding that many people find DPI's easier to use. However, they may not be suitable for all. That is why inhaler technique education, as Emma Harper has touched upon, is so important. Jackie Baillie raised a few points, but I would like to note that the progress report has been shared with all respiratory stakeholders. David Torrance highlighted some of the areas that we need to focus on, as did others, on 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 condition. The Scottish Government takes the issue of air pollution very seriously. 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 soon as possible, as the First Minister referenced in First Minister's Questions today. 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. I was pleased yesterday to meet the healthy air Scotland outside the Parliament. Alexander Stewart noted exposure to cigarette smoke 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 will be published in the autumn this year and renews our focus on meeting our ambitious 2034 target. As we begin to understand the potential harms of vaping, we are also considering next steps in this area. That is an involving issue, and we want to better identify ways to prevent children and young people vaping as a lifestyle choice. Of course, none of this important work would be possible without the dedicated clinicians providing asthma services in our NHS. I note the creation of an international coalition of respiratory nurses and hope that this provides a further opportunity for sharing good practice and learning in addition to our own Scottish respiratory nurse forum. Perhaps Emma Harper's sister can be involved in that as well. NHS staffing levels are at a historic high following 10 years consecutive growth, but we recognise the pressures that boards and front-line staff are experiencing. We are continuing 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 professions. To conclude, I would like to close by reiterating this Government's commitment to ensuring that everyone living with asthma in Scotland receives the best possible care and support. Although we have made progress, I do recognise that there is still much more we can do. My thanks again took go to all the members of this chamber who have contributed to this important debate today, and most importantly to those working across health and social care to deliver those commitments.