Professor John Robertson OBA

Headlining in the Guardian today, the above and:

The number of patients being treated by GPs for asthma attacks has increased by 45% in a year, prompting calls for urgent action to tackle toxic levels of air pollution.

There were 45,458 presentations to family doctors in England between January and June this year, according to data from the Royal College of General Practitioners research and surveillance centre. Across the same period in 2024, there were 31,376 cases.

The figures come a week after a damning report by the Royal College of Physicians revealed that 99% of the UK population was now breathing in “toxic air”. Air pollution was killing 500 people a week and costing £27bn a year in ill health, NHS care and productivity losses, the research showed.

https://www.theguardian.com/society/2025/jun/29/england-air-pollution-gp-visits-for-asthma-attacks-rise-45-per-cent

I don’t have equivalent figures for recent GP visits related to breathing problems but I do have this compelling evidence of a significant difference between asthma rates in Scotland and England:

From 11 November 2024: BBC Breakfast had:

Failure to diagnose and treat lung disease including asthma is ‘silently suffocating’ the NHS.

Not reported, of course, these two starkly contrasting accounts:

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. https://www.bmj.com/content/366/bmj.l5108#:~:text=Overall%2C%20more%20than%2012%20700,a%20GP%20or%20asthma%20nurse

And the rate of deaths?

‘More than 1400’ in England & Wales in 2018.

There were 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?

First, Free prescriptions?

In December 2022, we saw evidence of a dramatic effect of free prescriptions:

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.

Finally, less air pollution?

‘Only seven countries meet WHO air quality standard, research finds’….plus Scotland

According to the Guardian in March 2024y, Scotland is not a country and by implication falls with the UK into the failed group.

The latest WHO level for the deadly PM2.5 particles is 5 micrograms per cubic metre.

Though no Scottish average seems available, you can, I find, go to the IQAir site and find the level of PM2.5 where you live.

How about Glasgow High Street? 3.1, well under the WHO level.

https://www.iqair.com/gb/uk/scotland/glasgow/glasgow-high-street

To my surprise the partly-pedestrianised Ayr High Street – 5.7, just over.

Aberdeen Anderson Drive – 4.5

Edinburgh Tower Street – 1.5!

Busy Queensferry Road – 1.9

Bainsford Falkirk – 2.1.

I can’t find anywhere worse than my local High Street!

So, the Scottish average looks likely to be well within WHO limits.

Greenwich London – 13

Kingston upon Thames – sounds lovely – 15! Gasp.

At that, I’ll leave you to play with the app for your own places of interest, Breathe easy…I hope.