Official Report 1057KB pdf
The final item of business is a members’ business debate on motion S6M-14806, in the name of Marie McNair, on world chronic obstructive pulmonary disease day. The debate will be concluded without any question being put.
Motion debated,
That the Parliament recognises that 20 November 2024 is World Chronic Obstructive Pulmonary Disease (COPD) Day, with this year’s theme being Know Your Lung Function; understands that the day takes place to raise awareness of COPD and how to spot the symptoms, which include shortness of breath, a persistent chesty cough with phlegm, frequent chest infections and persistent wheezing; further understands that this lung disease causes restricted airflow and breathing problems and that it is a condition that most commonly affects people who smoke or have smoked, those who have been exposed to dust fumes or chemicals in work, and those who had chest trouble or asthma in childhood; notes with concern that, currently, the condition is estimated to affect over 140,000 people in Scotland who have had a diagnosis and that tens of thousands are living without a proper diagnosis; understands the importance of the five fundamentals of COPD care, which are smoking cessation advice, flu and pneumococcal vaccines, access to pulmonary rehabilitation, co-development of a self-management plan and treatment for co-morbidities; welcomes the work of groups such as Asthma + Lung Scotland, which provides advice and support to people living with COPD, and commends community groups, such as the Clydebank Asbestos Group, which provide support to people living with asbestos-related illnesses, which can include COPD.
17:46
I am pleased to have secured this debate on world COPD day, and I thank all my colleagues for their support in signing the motion and for participating in the debate.
I thank Gareth from Asthma and Lung UK Scotland for meeting me and for providing an extremely helpful briefing. I also thank Emma Harper and Alexander Stewart for the work that they do on the matter as part of the cross-party group on lung health.
World COPD day takes place to raise awareness of chronic obstructive pulmonary disease. The theme this year is “Know your lung function”, which highlights the importance of measuring lung function, also known as spirometry. COPD is a condition that most commonly affects people who smoke or have smoked, who are estimated to make up eight in 10 of those with the condition, but it also affects those who have been exposed to dust fumes or chemicals in work and those who have had chest trouble or asthma in childhood.
Unfortunately, I lost my mother to COPD in 2012, so I have personal experience of the disease. As the MSP who represents Clydebank, which is an area with a tragic legacy of asbestos—a substance that can increase the risk of developing COPD—I also feel that it is my duty to speak up on the matter.
Symptoms of COPD can include shortness of breath, a persistent chesty cough with phlegm, frequent chest infections and persistent wheezing. In Scotland, it is estimated that the condition affects more than 140,000 people who have a diagnosis, with tens of thousands living without a proper diagnosis. It is the third leading cause of mortality worldwide. The ageing population, along with additional complications for older COPD patients, who are more likely to have other long-term conditions, presents a further challenge in managing COPD in Scotland.
COPD, which includes conditions such as chronic bronchitis and emphysema, affects millions of people worldwide, reducing their quality of life and ability to breathe. It can also affect people’s lives in so many other ways. In a recent Asthma and Lung UK Scotland survey, 25 per cent of respondents stated that it affects their ability to work very often, and 39 per cent stated that it very often affects their ability to exercise.
I ask members to imagine feeling out of breath while getting dressed or when walking just a short distance. Unfortunately, that is the reality for many COPD sufferers, as it takes away their independence and reduces their quality of life.
Worryingly, COPD has a strong relationship with deprivation—a recent survey showed that 54 per cent of those with COPD had an income of less than £20,000. That is backed up by the Scottish Public Health Observatory, which notes that:
“the rate of admissions with a diagnosis of COPD is higher for people living in the most deprived areas of Scotland and lowest for those in the least deprived areas.”
Unfortunately, in Clydebank, COPD is also tied to our shared history. As I mentioned, Clydebank has an unfortunate legacy of exposure to asbestos from its use in the shipbuilding and engineering industries. Once touted as a miracle mineral, asbestos was in fact anything but, and the harmful effects of it are now well known. It is linked to serious respiratory conditions such as asbestosis and mesothelioma, and indirectly to COPD, as exposure can increase the risk of developing the condition.
That highlights an important truth about COPD. Although the condition is strongly connected to smoking, it is not just a lifestyle disease—it can be caused by occupational hazards or neglect of workers’ safety. We must, therefore, commit ourselves to action to raise awareness of occupational hazards and push for stronger protection for workers. In that vein, I believe that the removal of asbestos from the built environment is vital. In that regard, I am sincerely grateful to Clydebank Asbestos Group for its tireless work in helping those who have been affected by asbestos.
In so many ways, COPD is a silent condition, as it does not always present with dramatic symptoms straight away. That is exacerbated by the barriers to diagnosis that are highlighted by Asthma and Lung UK, which notes that 23 per cent did not know what the signs were, while 22 per cent had their symptoms dismissed as a cough or chest infection.
That is extremely concerning, as we know that early diagnosis is key. There are, however, some positives, and it is welcome to note that the same survey found that 39 per cent had waited only one month or less for a diagnosis.
However, for effective COPD care, we need to focus on the five fundamentals of care. Those are smoking cessation advice; flu and pneumococcal vaccinations—I apologise for my pronunciation of that—access to pulmonary rehabilitation; co-development of a self-management plan; and treatment for comorbidities. All that is essential in tackling COPD.
More must be done, however, as there has, unfortunately, been a drop in the number of people receiving all five fundamentals of care across the United Kingdom since 2021.
Asthma and Lung UK commissioned PwC to evaluate the costs and the potential savings impact of recommendations to improve COPD care in Scotland. It is clear that there are potential savings in relation to COPD, focused on expanding the availability of spirometry to 40 per cent, and on expanding the availability of pulmonary rehabilitation, with referral rates at 80 per cent and completion rates at 50 per cent.
I would be interested to know whether the Minister for Public Health and Women’s Health would be able to look further into those suggestions to ensure that effective COPD care is available across the country. However, each of us in the chamber can play a role, too. We must educate ourselves and others about the symptoms of COPD to ensure early diagnosis; encourage people to stop smoking; and push for better conditions for our workers. We must also stand beside those who are living with COPD, treat them with empathy and ensure that they receive the best care. Let us work together to ensure everyone has a fair chance to live a healthy life, free of COPD.
We move to the open debate.
17:54
I am pleased to speak in the debate for world COPD awareness day, and I thank Marie McNair for bringing it to the chamber—she covered the topic very well in her contribution.
Raising awareness about chronic obstructive pulmonary disease, or COPD, in Scotland is important to me. In session 5 of the Parliament, I was able to create the cross-party group on lung health, and I now co-convene it with my colleagues Alexander Stewart and Mark Ruskell; I am pleased to see Alexander Stewart in the chamber.
I thank the CPG’s excellent secretariat—the function is provided by Gareth Brown from Asthma and Lung UK Scotland—for its continued support and for the briefing ahead of this debate. I also thank Frank Toner and the team at Chiesi for their briefing ahead of the debate.
There is so much that we could cover on COPD care, but the goal today is to shine a light on the challenges of COPD and what we can do together to make a meaningful difference.
For many, the COPD journey begins with symptoms that might be easy to dismiss: a lingering cough, shortness of breath, wheezing or chest tightness. However, as the disease progresses, those symptoms escalate, impacting mobility, independence and quality of life.
Sadly, COPD is among the leading causes of hospital admissions in Scotland, placing a significant burden on our healthcare system and families alike. The exacerbations lead to hospital admissions. In Scotland, COPD accounts for about 122,000 emergency bed days annually, with an average in-patient stay lasting four to eight days, which is assessed as costing around £3,000. It is projected that the cost of COPD treatment will reach £207 million by 2030.
I was pleased to have invited one of the lung health choirs to sing in Parliament in 2018. I mention choirs, because singing is part of pulmonary rehab and the improvement of lung function that I will come on to speak about. The Cheyne Gang, which is another choir, has also sung in Parliament. Singing is an excellent way to improve lung function. It teaches a person to breathe more slowly and deeply, which helps use the full lung volume.
There are now 11 lung health choirs across Scotland. In addition to improving lung function, joining a choir and participating in learning new songs, singing, meeting new people and being part of a group with shared interests also tackles isolation and improves socialisation.
One aspect that COPD groups want to be supported is better diagnosis. Raising awareness about the signs and symptoms of COPD is essential to encourage people to seek medical advice sooner. Educating the public, especially those at risk, such as current and former smokers or individuals exposed to pollutants, as Marie McNair has described, can help to catch the disease in its earlier stages, when interventions can have the greatest impact. I ask that the minister considers Asthma and Lung UK Scotland’s request to run an awareness-raising campaign for COPD.
Supporting those who have already been diagnosed is equally vital. Part of that means advocating for better access to pulmonary rehabilitation programmes. Those programmes are supervised by health professionals and offer a mixture of education, exercise and lifestyle support to improve muscle strength, breathing and mental wellbeing. PR programmes last about six to eight weeks.
Originally, PR was delivered face to face, but Covid meant that it moved online, where it can still be delivered successfully. I would be keen for the minister to provide an update on the implementation of pulmonary rehab across the health boards as set out in the respiratory care action plan.
Finally, I declare an interest as a registered nurse. I give a wee shout out to my nurse consultant sister, Dr Phyllis Murphie, who got her PhD recently. She lobbied me to take action to create the cross-party group on lung health and urged me to lobby the Government for a formal plan to improve respiratory care in Scotland.
17:58
I am grateful for the opportunity to contribute to today’s debate, and I thank Marie McNair for bringing this important topic to the chamber.
Ever since I was first elected to this Parliament more than eight years ago, I have sought to highlight the issue of COPD and lung health more generally. That is why I am proud to serve as the co-convener of the cross-party group on lung health along with my colleague Emma Harper MSP. That platform has provided the opportunity to highlight the important work that organisations are carrying out on the issue. That includes the work of organisations such as Asthma and Lung UK, for which I am proud to serve as this Parliament’s smoking cessation champion.
Today’s motion also speaks of the work that small community organisations do. To that end, I acknowledge the fantastic work that is carried out by organisations in my region, such as Breathe Easy Clackmannanshire Community Group. The group provides key support for those facing lung health conditions, and, last year, it launched a befriending service, enabling it to support those who have been left housebound by their condition.
As today’s motion sets out, the theme for this year’s world COPD day is “Know your lung function”. The organisers of world COPD day and the Global Initiative for Chronic Obstructive Lung Disease—GOLD—have highlighted the importance of measuring lung function. The process can be an important tool for diagnosing COPD.
We know that many factors affect lung health throughout a person’s life, including air pollution and respiratory issues, which can increase the risk of developing chronic lung disease later in life. Just as GOLD highlights, we should remember that poor lung health leads to poor health generally. That is why the diagnosis and treatment of lung disease are so important.
Today’s motion speaks about the tens of thousands of individuals in Scotland who have a poor diagnosis of their condition—a statistic that lays bare the true urgency of the issue. Research by Asthma and Lung UK has suggested that half of those individuals with COPD have yet to receive a proper diagnosis.
In that respect, we welcome the publication of the Government’s respiratory care action plan, because it is a much-needed step forward, and I am sure that the minister will talk about that in her summing up. However, a lot of work is still required to ensure that all 12 recommendations, commitments and plans are implemented. Those include the commitment to improving access to screening for lung health problems, and to ensuring that respiratory care is updated in line with recent science. Given the large number of undiagnosed cases of COPD, the work is clearly urgent, and I hope that the Scottish Government will treat it as such.
In conclusion, I take the opportunity to commend the important work of the organisations that strive to raise awareness of this challenging condition. I also commend those who find themselves living with it. As we have heard, it is debilitating for those individuals. As well as raising awareness of COPD, we must continue to improve how we support those who are affected. I hope that the Government can take that message from today’s debate and ensure that everyone who is suffering from the condition can access the support that they truly need.
18:02
I thank Marie McNair for bringing this important debate to the chamber. On behalf of Scottish Labour, I welcome world COPD day, which takes place today and recognises this year’s theme of “Know your lung function”. Raising awareness of COPD and its symptoms is an important part of the national day. I congratulate everyone who is involved on its success and I thank colleagues for the briefings that have updated us on the situation for those who live with COPD.
As we have heard, the symptoms include shortness of breath, a persistent chesty cough with phlegm, frequent chest infections and persistent wheezing. The condition causes restricted airflow and breathing problems and it most commonly affects people who smoke or who have smoked, as well as those who have been exposed to dust fumes or chemicals, often in work. Those who had chest trouble or asthma in childhood can also be affected.
The prevalence of COPD in Scotland and, indeed, globally, should cause us all some concern. The condition is estimated to affect more than 140,000 people in Scotland who have had a diagnosis, and it is suspected that thousands of people are living without a proper diagnosis. COPD continues to be the third leading cause of mortality worldwide.
In order to stop that worrying trend, I consider it important that the causes of the disease are understood and highlighted. That is part of what world COPD day is about. I raised that the previous time I spoke on the issue in the chamber. I want to add again that smoking is the most common cause of COPD; it is the leading factor for eight out of 10 cases. That means that many cases of COPD can be tracked back to a single cause, which highlights for the Parliament where action can be taken. I know that the Scottish Government has plans for a smoke-free generation by 2034, and I state again that I am very supportive of that and will do all that I can to support the minister with it.
We need more action now to protect those living with COPD. We have heard from people who suffer from the condition about some of the things that are happening for them at the moment. For the third year in a row, in a survey of COPD sufferers, only 5 per cent of patients reported receiving the important five pillars of care that Marie McNair mentioned. One in five wait more than five years for diagnosis, and one in eight wait more than 10 years. There are real barriers to diagnosis, which are reflected in those long waits—general practitioner misdiagnosis, difficulty getting appointments and a simple lack of awareness in communities of the signs and symptoms.
COPD is another condition that disproportionately impacts the poorest in our society. In Ayrshire, where I live, the rates of COPD are among the highest in Scotland. In 2018, NHS Ayrshire and Arran had the highest proportion of people living with COPD in Scotland. It is important to me, as a South Scotland representative and as someone who lives in Ayrshire, that we take action that supports those people.
I wonder whether Carol Mochan is aware of the work of Dr John Lockhart, who worked with the University of the West of Scotland to look at the prevalence of COPD in the south-west of Scotland and in Ireland? The evidence that he has produced is quite interesting, as it shows that there are links.
I think that I have probably heard Ms Harper speak about him before. I take on board many of Ms Harper’s points and, like others, I appreciate all the work that she does in this area. It is important to have such issues raised in the chamber.
I have a close family friend, Lillian Welsh, who suffers from the condition. Therefore, I know how COPD impacts people’s daily lives and how it restricts work, social life and enjoyment of everyday activities, such as walking the dog or playing with grandchildren. It is a real-life condition, and it is important that the Parliament makes time to debate it.
I thank Marie McNair and others who have contributed to the debate for bringing an issue that is important to our constituents to the Parliament.
18:07
I, too, express my gratitude to Marie McNair for securing this important debate, particularly given her personal connection to the disease.
COPD is a topic of great significance, particularly for the port town of Stranraer in my constituency of Galloway and West Dumfries, which has become an unexplained hotspot for COPD. There, the condition affects 3 per cent of the population, compared with an average across the UK of 2 per cent, earning Stranraer the unenviable title of the COPD capital of the UK.
As we have heard, COPD continues to be the third leading cause of mortality worldwide. With an ageing population, managing the condition presents a significant challenge in Scotland. Smoking remains the primary cause, with an estimated eight in 10 of those living with COPD having smoked or continuing to do so. Alarmingly, the latest survey by Asthma and Lung UK found that COPD care levels are falling for the third consecutive year, with only 5 per cent of patients receiving the five fundamentals of care.
I know that we have already heard this in the debate, but I make no apologies for repeating the concerns. The fundamentals include support to stop smoking, flu vaccines, pulmonary rehabilitation and self-management plans. Unfortunately, performance across all those elements has declined. Detection rates are also poor, with one in five patients waiting more than five years for a diagnosis and one in eight waiting more than 10 years from the onset of symptoms. Barriers to diagnosis include a lack of awareness of the signs, difficulties in securing appointments and GPs initially dismissing symptoms as chest infections or coughs.
Clearly, the financial burdens of COPD in Scotland are concerning. They are staggering—they are estimated to be nearly £618 million, with my constituency bearing a cost of more than £26 million. As I said, Stranraer has the highest number of hospital admissions for COPD in the country. That is a deeply concerning statistic, given the area’s lack of the heavy industry that is typically associated with chronic lung conditions. That disparity highlights the strong link between socioeconomic factors and respiratory health outcomes in Scotland.
Four years ago, as we heard from Emma Harper, a team of scientists and researchers, led by Professor John Lockhart from the University of the West of Scotland, launched the Border and Regions Airways Training Hub project—BREATH—to investigate the high prevalence of COPD in my constituency. Despite their efforts and a £7 million funding boost from the European Union, the proposal for a dedicated centre of excellence to be based in Stranraer was not realised, due to a lack of funding.
Such a facility could have been a major asset in the fight against COPD, providing critical research and training. Although the BREATH project continues its valuable work in research and public engagement, the need for a centre of excellence remains. It is imperative that we revisit the proposal, to ensure better diagnosis, care and treatment for those who suffer from lung conditions.
We must do everything in our power to improve the lives of those who are affected by COPD. Given that lung disease is now one of the top three killers in Scotland, and that one in five people is diagnosed with a lung condition at some point in their life, we owe it to the sufferers to provide the best possible care and support.
I call the Minister for Public Health and Women’s Health, Jenni Minto, to respond to the debate.
18:11
I, too, thank Marie McNair 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 who live with COPD in Scotland, including our fantastic national health service staff and many third sector organisations such as Asthma and Lung UK. It is also important to put on record the important work that the cross-party group on lung health has carried out on COPD. Debates such as this one are valuable, because we get real contributions from members, which helps to raise awareness and brings the topic back to the people who live with COPD.
This morning, I was at Ninewells hospital for a visit about another area of work. As I was leaving, I was pleased to see the Asthma and Lung UK stand, front and centre in the foyer, giving people advice on the symptoms that Marie McNair, Emma Harper, Carol Mochan and others mentioned: shortness of breath, coughing and wheezing, chest tightness and fatigue.
I also thank Marie McNair and Carol Mochan for highlighting the important fact that people might be living with COPD because of not just lifestyle but occupational reasons. In addition, Carol Mochan specifically mentioned the connection between health and deprivation. As she indicated, that can be seen from the increased number of people with COPD in areas of deprivation, and is linked to significant reductions in life expectancy. I thank Carol Mochan for that; it is just one of the areas on which she is a passionate speaker.
Emma Harper mentioned the impact of COPD on our health service. An estimated 8 per cent of hospital admissions, and 10 per cent of bed days, are related to respiratory disease. That underlines the importance of prevention and diagnosis, as everybody has spoken about.
World COPD day allows us the time to reflect on the progress that has been made in respiratory care as well as on the challenges that we face. We know that the care and treatment for COPD is not always where it needs to be. The Scottish Government is committed to improving services across the country to meet people’s needs through the implementation of a respiratory care action plan, as many have mentioned. The NHS centre for sustainable delivery supports professionals to implement key aspects of that plan, while working towards consistent “once for Scotland” clinical pathways in respiratory services.
A current priority for that group is to develop a “once for Scotland” COPD pathway. The group recently conducted conversations with people living with COPD to better understand where improvements can be made, and it will work with clinical specialists from a variety of professions to develop that pathway.
As many members have said, the theme of this year’s world COPD day is “Know your lung function”. Although we know that about 140,000 people in Scotland have a COPD diagnosis, many other people are living with symptoms.
For those who are already receiving treatment, a key aspect of care is pulmonary rehab. Improved access to that is one of the priorities in the respiratory care action plan, and I credit the many dedicated and committed respiratory physiotherapists, nurses and other members of the multidisciplinary team that provide pulmonary rehab across Scotland. The benefits of pulmonary rehab are well evidenced, but we know that many people living with COPD are not able to access that support. Significant work has been done to better understand access routes in and out of those services. We also want to provide more support to in-patients and create better links to third sector support.
I commend the work of the Cheyne Gang and other choirs. Last year, I had the privilege of spending an hour or so with members of the Cheyne Gang, listening to and trying to sing with them. Alexander Stewart has a far better voice than I do, and I wondered whether, at one point, he was going to give an illustration of how singing can help. I absolutely agree with Emma Harper that the choir not only supports lung function but helps to tackle isolation.
Another major milestone in COPD care this year was the publication of the quality prescribing guide for improvement, which aims to keep people at the centre of their treatment and promotes safe, evidence-based and sustainable prescribing. The guide will ensure that decision making is shared between clinicians across the multidisciplinary team and people living with respiratory conditions.
The prescribing guide has a focus on net zero. It is important to recognise that the environmental impact of inhaler use for the treatment of asthma and COPD is equivalent to about 80,000 tonnes of carbon dioxide a year. We want to ensure that patients and their prescribing clinicians are equipped with facts to enable them to make the right choices. As Alexander Stewart and others said, for those living with COPD and other lung conditions, environmental factors play a huge role in their daily lives. Our vision is for Scotland to have the cleanest air in Europe, and we are committed to protecting people from the effects and harms of poor air quality. 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.
As Carol Mochan said, the Scottish Government is committed to creating a tobacco-free Scotland by 2034, and I welcome the reintroduction of the United Kingdom-wide Tobacco and Vapes Bill, which will help us to achieve our ambitious target.
I do not want to take us down a rabbit hole about vaping, but does the minister agree that we should be concerned about the increased prevalence of vaping, including among young people, and its links to COPD?
To slightly go down that rabbit hole, I agree that we must be aware of the issue of vaping among young people. That is why I was very pleased that, earlier this year, the Scottish Government ran the take hold campaign, which involved working with the parents and carers of young people in informing them of the impact of vaping. Having spoken to many young people, I know that they are concerned about the issue, too.
Scotland has a range of world-leading tobacco control measures, and smoking rates continue to decline. The suite of preventative measures will help people to better manage their condition and will support us in preventing respiratory disease among future generations.
I reiterate our commitment to ensuring that everyone living with COPD in Scotland receives the best possible treatment, care and support. We know that there is still more to do in respiratory care, and we can improve by better understanding the needs of people living with COPD. As Marie McNair said, we need to work together to find solutions to support people living with COPD in Scotland.
Meeting closed at 18:19.Air ais
Decision Time