By Professor John Robertson, OBA
This morning, BBC Breakfast has:
Failure to diagnose and treat lung disease including asthma is ‘silently suffocating’ the NHS.
Last year, I was able to write:
Why have deaths due to asthma fallen in Scotland while increasing in England & Wales?
BBC Scotland is headlining a story on asthma-related admissions in different parts of the UK with, of course, a tragic case upfront, and parts of Scotland picked out as among the worst but, surely, the survival rate is the news here.
In Scotland, from 2008 to 2021, deaths due to asthma have fallen from 103 to 96, a 6.7% fall.
https://www.scotpho.org.uk/health-wellbeing-and-disease/asthma/data/mortality-data
Deaths from asthma in England and Wales have increased by a third in the past decade, a new analysis has shown.
The analysis of official figures from the Office for National Statistics, released by the charity Asthma UK on 9 August, shows that more than 1400 adults and children died from asthma attacks in 2018, an 8% increase since 2017.
Overall, more than 12 700 people have died from asthma in England and Wales in the past decade. Deaths increased by 33% during 2008-18.
And the rate of deaths?
‘More than 1400’ in England & Wales in 2018.
114 in Scotland in the same year.
England & Wales, with 11 times the population might be expected to have 1254 but has more than 1400, 12% higher.
Why?
Free prescriptions?
A better NHS?
Less air pollution? See, for example:
In December 2022, we saw evidence of an even more dramatic effect of free prescriptions:
Evidence that free asthma prescriptions in Scotland may have saved thousands from a Covid death
On 21 December 2022, there were only 8 patients in ICU in Scotland but 174 in England, nearly twice as many per head of population. Even in Wales with a smaller population, there were more, 10.
Throughout November and December as Covid hospitalisations began to climb again, there have been 2 to 3 times as many, pro rata, in English Hospitals than in Scotland.
I wondered why this might be and Lorna Murray [https://twitter.com/LornaRetiree] tweeted:
People in England are unable to pay for drugs such as ventolin for asthma therefore are hospitalised as a result
I was intrigued and did a quick search for evidence either way. No research group seems to have done this and I offer my hypothesis below ready to be contradicted with better evidence but:
People with moderate-to-severe or uncontrolled asthma are more likely to be hospitalized from COVID-19.https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/asthma.html
People with mild and/or well-controlled asthma are neither at significantly increased risk of hospitalisation with nor more likely to die from COVID-19 than adults without asthma.https://thorax.bmj.com/content/early/2022/03/29/thoraxjnl-2021-218629
I think its reasonable to interpret ‘well-controlled‘ as involving medication.
Can everyone afford to be medicated adequately?
Essential medicines for treating asthma and COPD were largely unavailable and unaffordable in LMICs [low-income and middle-income countries]. This was particularly true for inhalers containing corticosteroids.https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(22)00330-8/fulltext
The Covid death rate in Scotland is 226.8 per 100 000. In England, it is 310.9, 37% higher in a country with a generally higher life expectancy.
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Talking-up Scotland 
https://pharmaceutical-journal.com/article/feature/outdated-illogical-and-unfair-the-true-cost-of-prescription-charges
“In March 2023, a survey of 4,014 people with long-term conditions carried out by the Prescription Charges Coalition, a campaign set up to abolish the prescription charge for people with long-term conditions, found that 1 in 10 (9%) were not able to collect their prescriptions in the past 12 months because of the cost. With 15 million people in England living with long-term conditions, this could equate to hundreds of thousands of people going without medicines they need.”
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https://www.prescriptionchargescoalition.co.uk/latest-news
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https://www.prescriptionchargescoalition.co.uk/latest-news
“Laura Cockram, Chair of the Coalition commented: “There are hundreds of new MPs who may not know that people with many long-term health conditions like Parkinson’s, HIV, asthma, cystic fibrosis, inflammatory bowel disease, heart, lung and liver conditions have to pay for their medicines that keep them alive and well.
England is the only UK country that charges for prescriptions. And research shows that scrapping the charge could actually save the NHS millions of pounds each year.”
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Just catching up with this now. Also as happened to a family member of ours in England, low waged job, could not afford meds for long term chronic condition, so kept ending up in hospital, which of course would cost more and not just in £’s because it meant a hospital bed taken up when it should not have been needed, staff costs etc, so more costly than to have given the medication they needed.
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Sorry about the glitches. I thought I was still logged in. I got there in the end.
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BBC Scotland need not worry – this trend where Scotland is performing better in Health matters won’t continue if FM Sarwar gets his Labour Party to abolish Free Prescriptions in Scotland .
Then the BeeB can proudly broadcast that Scotland Is Worse Together and make it sound like a victory!
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https://www.thelancet.com/journals/lanepe/article/PIIS2666-7762(22)00122-3/fulltext
Here’s one that suggests the number of A&E asthma related incidents reduced due to lockdown, kind of obvious outcome really but makes you wonder why it took so long to introduce lockdown.
Golfnut
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They probably avoid diagnosing people to keep data manageable because if true stats were given re peoples’ long term health conditions in England, it would look even worse.
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