World Asthma Day

Jim Shannon Excerpts

Thursday 15th May 2025 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I beg to move,

That this House has considered World Asthma Day.

It is a real pleasure to serve under your chairship, Dr Huq. We had a very productive parliamentary visit to Egypt to promote freedom of religious belief. I commend you for that publicly today in the Chamber.

I am grateful to the Backbench Business Committee for accepting this debate. I am pleased, as always, to see the Minister in her place. I will come to my request to her later. My speech has been given to her staff and, I understand, to the shadow Minister, the hon. Member for Hinckley and Bosworth (Dr Evans), and to the Lib Dem spokesperson, the hon. Member for Chichester (Jess Brown-Fuller).

I am pleased and privileged to be the chair of the all-party parliamentary group for respiratory health. I have a deep interest in respiratory health. It is probably because my second son was born with asthma. From a very early age, he was on medication. He had some psoriasis as well; there is an association between the two. He seems by and large to have grown out of it, but even now, at the age of 34, he depends upon the inhaler. Therefore, I have a personal interest in the issue, as most people do when they talk about asthma.

I am delighted to sponsor the debate for this year’s World Asthma Day, which was on 6 May. This year’s theme, set by the Global Initiative for Asthma, is “Make inhaled treatments accessible for all”. GINA emphasises the need to ensure that everyone, regardless of their global location or socioeconomic status, has access to the inhaled medications that they need to control the underlying disease and to treat asthma attacks. I will be looking at that and other aspects of asthma care and treatment today. It is a pleasure to do so, and to see other Members who have been able to turn up to participate in the debate.

This may be my first occasion where the Minister has responded specifically to my debate. I wish her well in her role, I wish her well personally—she knows that—and I wish her well in the debate.

I am indebted to Asthma + Lung UK for its outstanding help and ongoing support. It has been enormously helpful to me and to the APPG. I welcome the work it does to serve the needs of people living with respiratory ill health. I also put on record my special thanks to Jonathan Fuld, the national clinical director for respiratory disease in England, for his expert advice, counsel and wisdom. I pay tribute to our expert stakeholder groups, which comprise senior clinicians, industry, professional bodies and other experts, for their ongoing work. The APPG has regular Zoom meetings, and Jonathan Fuld is always there to guide us and help us through the process.

The APPG has welcomed the improvements in inhaler technology, specifically the move to combination inhalers, which will ultimately eliminate the use of twin inhalers. That is a significant step and one that we should welcome. As highlighted in the National Institute for Health and Care Excellence asthma guideline and by the Medicines and Healthcare products Regulatory Agency in its safety warning, SABAs—short-acting beta 2 agonists—should not be used by people with a diagnosis of asthma. Therefore, there are and will always be treatments that we need to be careful with for safety reasons. Combination inhalers combine two kinds of medicine in one device, helping to keep inflammation in the lungs at bay while giving relief from symptoms such as breathlessness and tight chest.

I will come on to some figures later on, as we need to be reminded in this debate that, with asthma, it is not just that the inhaler saves someone and they are okay. There have been a number of deaths, which I will refer to later on.

The availability of inhalers in the UK ensures that people with asthma get the most clinically effective treatment and also allows the NHS to take a step towards its net zero targets, given that they are low carbon. It is therefore right to acknowledge that the first inhaled respiratory medicine using next-generation propellant with near-zero global warming potential was approved this week. That is a step in the right direction. Although it is for chronic obstructive pulmonary disease, the technology offers great promise for other inhalers in the future.

It is wonderful to look back at all the advances made over the years in cancer treatments, or on diabetes or cardiovascular disease. They are trying to find a cure for dementia and for Alzheimer’s, and there are some ideas for how that could be progressed, so there have been advances.

I am sure we have all seen the latest statistics on respiratory conditions and asthma—I will touch on them briefly. Lung conditions are the third biggest killer in the UK. Hospitalisations have doubled in the last 20 years and there has been little improvement over that time. I mentioned some of the improvements with inhalers, but there is still a long way to go.

Some 7.2 million people in the UK live with asthma; 2 million children live with asthma. That represents one in nine adults and one in eight children. The UK has a higher death rate due to respiratory illnesses than the OECD average, and we have the highest death rate in Europe. Asthma kills four people in the UK every day and someone has a potentially life-threatening asthma attack every 10 seconds. These are the stats, but they are not just stats—they are families and individuals, and people who deal with this every day. The children and the parents worry, the adults worry and the families worry.

Over the past 10 years, more than 12,000 people have died from asthma. Almost all of those deaths were preventable. The National Review of Asthma Deaths report, “Why asthma still kills”, published by the Royal College of Physicians in 2014, found that two thirds of asthma deaths were preventable. If they are preventable, why can we not do more and make that happen? That is one of my requests to the Minister.

Some 66% of people are not getting an appointment with a GP or an asthma nurse within the recommended 48 hours after an emergency admission. Between 2012 and 2020, deaths from asthma have increased by 26%. The number of people who have died due to asthma attacks is very cruel.

The costs to the country associated with asthma are substantial. Asthma and COPD cost the NHS some £9.6 billion in direct costs each year, representing 3.4% of total NHS expenditure, and they cause wider reductions in productivity due to illness and premature deaths, totalling £4.2 billion a year, with an overall impact of £13.8 billion on the economy. In my country, my region of Northern Ireland, asthma costs £178 million a year alone. These costs cannot be ignored.

I will put forward some ideas that the Government and the Minister can hopefully take on board to reduce the expenditure and the death toll. Adding up the cost to the NHS and direct costs from the loss of productivity and the monetary value of people suffering lung conditions, the cost to the UK economy is some £188 billion a year. The annual estimated cost of asthma and COPD to the NHS is £4.9 billion, with an estimated 12.7 million lost workdays per year. There is a financial cost, a loss of workdays and a cost to the productivity of our nation.

The impact of asthma on the NHS is considerable. Respiratory conditions are a major cause of avoidable hospital admissions. If we can avoid hospital admissions, that is a strategy and a way forward. There were some 56,853 admissions due to asthma in 2022-23. Waiting lists for respiratory care have risen by 263% over the past 10 years. Those are worrying figures. There is a need to have this debate, and today is the opportunity to do that and to look forward.

Lung conditions, including COPD, asthma and respiratory infections, place a huge burden on the NHS, especially in the winter months, when it is always worse: respiratory admissions increase by some 80%. Breathing issues are the leading cause of all emergency admissions in England, and in common with other respiratory illnesses, asthma is hit hard by inequalities and deprivation.

There is a link between poverty and asthma, so I hope that the Minister can give some encouragement in relation to that. The burden of respiratory disease disproportionately affects the most deprived. Those from the poorest communities are three times more likely to die from asthma, compared with those in the richest—that is another worrying trend. Children living in the most deprived 10% of areas are four times more likely to require emergency admission to hospital due to asthma than those living in the least deprived areas. Again, there is a clear statistical difference between those who live in deprived areas and those who do not.

The findings of the national child mortality database report on child deaths expose the inextricable link between poor lung health and deprivation, with more than half—56%—of the children who died in the period that the report covers coming from the poorest communities. I know that when the NHS was set up, this would not have been the policy of the Government, but if there are more deaths among children who just happen to live in deprived areas, we really need to address that.

I welcome and support the Government’s commitment to reducing inequalities and deprivation—in particular, inequitable asthma outcomes. We hope to run local meetings in the most deprived areas of the country to try to determine some of the causes of the variation in asthma outcomes. I would like to offer the Minister our support in any way that we can help. We are pleased to have here today representatives who carry out the admin for the APPG on respiratory health. We thank both of them, and others, for their contributions.

There have been some welcome developments in respiratory health recently, including the introduction of a new integrated guideline for asthma, which was a joint collaboration by NICE, the Scottish Intercollegiate Guidelines Network and the British Thoracic Society. It is being rolled out across the country. They are good steps in the right direction to try to do even better, but I urge the Minister to make sure that there is no implementation hesitancy across the integrated care boards, with uneven take-up. I also ask what steps she will take to ensure that it is rolled out equally across the country. That is one of our requests.

The APPG also welcomes and supports the three shifts announced by the Secretary of State: analogue to digital, hospital to community, and treatment to prevention. I suggest that respiratory health outcomes could benefit significantly from all three of those commitments from him. I also welcome the upcoming neighbourhood health services, in principle. Although we do not know all the details yet, there is an agreement in principle for that work to happen. I ask the Minister what future she sees for the community diagnostic centres, following the transition to the abolition of NHS England?

The APPG has already sent a submission for the 10-year plan, which we hope will deliver what we all wish to see. I welcome the Government’s commitment to investing £26 billion of extra money for health. I welcome the positive stance that the Secretary of State and the Minister have taken in relation to that. However, we feel that respiratory health should be key and in the centre of the 10-year plan. I understand that that plan is likely to have cancer and cardiovascular disease plans associated with it, and I hope that respiratory health conditions will be prioritised in the same way. Could the Minister ensure that respiratory health will be prioritised in national strategies and NHS guidance, including in the 10-year plan and the life sciences sector plan, which are in development, and in future winter resilience guidance?

One major issue that we see every year in the NHS is winter pressure. We cannot deny it, and it is not anybody’s fault; it is a fact of life. Vaccines for flu and other respiratory infections are enormously helpful, of course, but ensuring that patients are on the right treatment can also contribute to reducing these pressures. The transitions from hospital to community and sickness to prevention are essential to making this happen. The question is, how best can it happen? Again, I hope that the Minister can give us some thoughts on that.

The APPG will hold a roundtable in the next few weeks to discuss how good respiratory health measures can help to ease winter pressures. It might be helpful to consider those at this time of the year, long before we get to that stage in the latter part of the year. The APPG will report its findings to the Minister directly. A previous Minister agreed to a meeting with us, and I am quite sure that the Minister today will do the same, so I ask whether we could have that in the diary.

Severe asthma affects up to 5% of people with asthma, and is associated with frequent exacerbations, hospital attendances and steroid use. Biologics have been described by leading clinicians as lifesaving for severe asthma patients, yet an Asthma + Lung UK report suggested that in June 2020 only 23% of eligible patients were receiving a biologic for their severe asthma. Those figures worry me. I understand that that was five years ago, but again I seek some positivity in relation to it.

A recent poster at the European Respiratory Society congress showed that the uptake of biologics for severe asthma is low and variable in the UK. That has to be addressed, and I seek the Minister’s thoughts on it. The national median uptake of biologics by patients with severe asthma in England between 2016 and 2023 was 16%. ICBs are not maximising the uptake, which varies widely between 2% and 29%, against a target of 50% to 60%. That does not cut the cake. Based on current regional use of biologics in England, modelling forecasts that it will take 37 years for only 50% of eligible patients to be on biologic therapy. That cannot be satisfactory. We must do better.

At present, with the existing severe asthma service specification, patients can wait years for access to these treatments. There is limited awareness of severe asthma and insufficient capacity in the system, and unnecessarily complicated multidisciplinary teams hinder timely access. This must not be ignored. We must not have a postcode lottery, with some parts of the United Kingdom providing the correct standard of asthma care and other parts falling behind.

We await the publication of the new service specification, which I hope will minimise delays for patients who really need the biologics. In other areas, such as dermatology or rheumatology, secondary care clinicians can prescribe biologic medicines to patients who fit the relevant criteria without the patient requiring assessment at tertiary level, so can secondary care prescribing be introduced for severe asthma? I have had a lot of asks of the Minister, but they are positive, constructive asks that seek to move us forward, save lives and help those with asthma.

Time is going far too fast, but the facts are clear: too many people living with lung conditions are missing out on the treatments that they desperately need to live and stay well at home. Current access is limited, patchy and being held back by workforce shortages. Severe asthma accounts for only around 4% of the total asthma population, but this is still almost 5,000 people, and they are probably the ones who will contribute the most to asthma deaths in a year. Such is the severity of their symptoms that this group is estimated to account for at least half of all expenditure on asthma—some £38 million a year.

I want to give an example of what we are doing in Northern Ireland and show what it would mean here on the mainland. I know that this is not the Minister’s responsibility, but thousands of people across Northern Ireland are missing out on key diagnostic tests because of disagreements between primary and secondary care about who should deliver the services. If, for example, fractional exhaled nitric oxide were made available to all GPs across Northern Ireland, its use could save £4 million by optimising asthma treatment. An uptake in spirometry testing in primary care to just 40% of eligible patients would result in £1.7 million in direct health service cost savings in reduced COPD exacerbations —a reduction of 1,778 hospital bed days, of which 605 would be winter bed days.

I used an example from Northern Ireland because I have access to those figures, but were we to replicate that for each healthcare trust or board in the United Kingdom of Great Britain and Northern Ireland, the improvement to health and freedom from financial weight would be massive. It is not just about the money saved, or the lives saved; it is about the care of those with asthma. If we can make it better in any way through today’s debate, it will have been worth while. I look forward to everyone’s contributions. I believe that changes can and must be made. I look to the Minister to begin that process today.

--- Later in debate ---

[Ashley Dalton]

Yes, I confirm that I will write to the shadow Minister on FeNO at a later date. NHS England is also piloting a digital annual asthma check.

I am sorry, Dr Huq, this is highly irregular, but I am feeling extremely unwell; I need to go and make myself okay. [Interruption.] Thank you for your forbearance, Dr Huq. Crohn’s is not something that we have debated in this Chamber; if we did, no doubt I would be the responding Minister, and I can assure you that I would be able to speak from personal expertise.

[Jim Shannon]

I used to have close contact with a guy called Simon Hamilton, who was an MLA for the constituency that I represent. He had Crohn’s disease—my knowledge of it came through him—and he was caught short many a time, if that is the way to put it.

May I ask the Minister a wee question? I asked about CDCs once NHS England is abolished—[Interruption.] I can see that she is coming to that. That is grand.

[Ashley Dalton]

Yes, I will come to many of those issues.

As I was saying, NHS England is piloting a digital annual asthma check, which, if successful, will mean that fewer people miss that valuable check and will keep the monitoring of their asthma up to date.

The Lib Dem spokesperson, the hon. Member for Chichester (Jess Brown-Fuller), asked about the public health grant. The grant has been increased and local directors of public health are best placed to identify where to target resources in their communities. As I have said, the 10-year health plan will be published next month. It will cover all conditions and will consider lung health. I have talked about the stakeholder engagement that was really important in that, and I can guarantee that, with the 10-year strategic plan for the NHS, we will look right across the board at how we can make sure that all conditions get due consideration.

During our short interruption, I was able to get a little more information for the shadow Minister on FeNO. Wessex Academic Health Science Network has created a FeNO rapid uptake product delivery toolkit, which is providing downloadable tools and resources to support NHS organisations with the adoption and implementation of FeNO testing to improve outcomes. Anyone can access that toolkit, which contains case studies of best practice identified through the programme. I hope that is helpful.

On the changes to NHS England, we are abolishing NHS England in itself, but none of its functions is disappearing. We are working really closely across the Department and NHS England, as well as with our ICB colleagues, to ensure that all services are transferred in an appropriate way. The purpose of the changes is to make things as efficient and targeted as possible and to ensure that they get to the people who need them the most.

Ensuring that community diagnostic centres are supported is really important to the Government, as it is very much part of one of our three shifts: from hospital to community. Those shifts—the other two are from sickness to prevention and from analogue to digital—are at the very heart of the 10-year plan.

I thank the hon. Member for Strangford for bringing forward the debate. I am sure that he would agree that World Asthma Day is not just for raising awareness; it should also be a celebration of the great things that people with asthma have accomplished. I did not know this until I saw the research for this debate, but past asthmatics have included Dickens, Disraeli and Beethoven. If those examples seem archaic, I can also point to Harry Styles, Jessica Alba and David Beckham, as well as to many prominent Olympic medallists. People with asthma achieve great things. It is our job in this place to help them to reach their full potential, with a particular focus on addressing how respiratory conditions affect people in deprived communities.

[Jim Shannon]

I thank all hon. Members for participating in the debate. The hon. Member for Birmingham Perry Barr (Ayoub Khan) referred to the fact that someone dies every six hours—four people in a day—from asthma. He also talked about young George Coller, and the Minister kindly agreed to meet the hon. Gentleman and the family. That is very positive; I would not expect anything other than positivity of the Minister, but I thank her for that. Such meetings help us to represent our constituents in a positive fashion.

The hon. Member for Bournemouth West (Jessica Toale), who is an asthma sufferer—I know about asthma only through my son, but the hon. Lady has lived experience—talked about how asthma affects her life, and I understand that her sister also suffers from it. She also referred to the Tobacco and Vapes Bill and the Renters’ Rights Bill, which are relevant to issues that contribute to asthma. Asthma goes way outside the remit of Health Ministers alone; Ministers in other Departments have to be part of addressing it.

The hon. Member for Chichester (Jess Brown-Fuller) always brings her knowledge to the subject matter. She referred to air pollution and the Lib Dems’ commitment to addressing that issue. She mentioned poor housing and healthier homes, and said that the increase in children’s asthma needs to be addressed. Again, lung conditions are the third biggest killer in the UK, as others have mentioned.

I have lost count of the number of debates that my friend, the hon. Member for Hinckley and Bosworth (Dr Evans), and I have been in together—it is like a tag team here on a Thursday afternoon—and I thank him for his personal story about asthma. He referred to the work of charities and to primary and secondary care, which the Minister referred to positively in her contribution. He mentioned smoking cessation, the passage of the Tobacco and Vapes Bill, and preventable deaths. I thank him for bringing his knowledge as a doctor to add to the debate.

I thank the Minister; I think that we are all impressed by her replies. She did her utmost to answer all our questions in a positive fashion. I thank her for agreeing to the meeting, which we will look forward to. It will give the APPG a chance to talk more insightfully, if that is the way to put it, about the issues.

The commitment to asthma shines out across the nation. The Minister referred to the Government’s commitment to improving air quality, which we are all pleased about, and she referred to the national bundle of care—I hope I got that right—as well as regional funding. She also referred to spirometry diagnostic tests, which is an issue that the hon. Member for Hinckley and Bosworth and I were trying to pursue.

The Minister also mentioned action for those with severe asthma—biologics—and the training of staff; her positive replies to our questions were an example of how other Ministers should reply. She mentioned the moves from sickness to prevention and from analogue to digital. She discussed ensuring, first of all, that we prevent the deaths, but also that we help those who have asthma.

It has been a positive debate. It may be a few weeks after World Asthma Day, but none the less it has been World Asthma Day for this hour or so. I thank everyone for their contributions and look forward to meeting the Minister.

Question put and agreed to.

Resolved,

That this House has considered World Asthma Day.