Asthma Outcomes — [Steve McCabe in the Chair]

Part of the debate – in Westminster Hall at 10:30 am on 7th December 2021.

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Photo of Feryal Clark Feryal Clark Shadow Minister (Health and Social Care) 10:30 am, 7th December 2021

It is a pleasure to serve under your chairmanship, Mr McCabe.

I thank Jim Shannon for securing this Backbench Business debate on improving asthma outcomes and for setting out so comprehensively the issues and challenges faced by the UK’s asthma sufferers. He said there are not many families in the UK who are not affected by asthma—his own son is an asthma sufferer—and I absolutely agree with him. I have a cousin currently in hospital who is a severe asthma sufferer; his covid was made worse by his severe asthma. It is a condition that affects many of us.

The hon. Member also set out some sobering statistics about asthma, which should shame us all. He made three asks and set out the areas where he believes the Government need to do more, which was echoed by many other speakers. They relate mainly to the overuse of blue inhalers, the conflicting guidelines and the need to improve them, and biologic therapy, which I will touch on.

We also heard from Margaret Ferrier, who raised the issue of air quality and air pollution. We know that air pollution exacerbates asthma. Most Members will know the case of Ella Kissi-Debrah, the nine-year-old asthma sufferer who died, and the coroner said air pollution was a factor in her death. We know that air pollution affects asthma sufferers really badly and more needs to be done about it.

Jane Hunt set out very well the great work being done by businesses and the university in her constituency, and also raised the important issue of prescription charges and the need to have a medical exemption from them. Others raised that issue, too, and I absolutely agree.

Finally, my hon. Friend Liz Twist set out the facts and statistics—the really terrible statistics—that the UK has on asthma and the challenges around gaining access to biological medicines. She also told the stories of some asthma sufferers.

We have heard today that severe asthma is the most debilitating, even life-threatening, condition that does not respond to conventional treatment. As has been said, it is estimated that about 200,000 people in the UK have severe asthma, and without specialist treatment and support people with severe asthma end up in a never-ending cycle of emergency trips to hospitals, relying on toxic oral steroids that have nasty side effects; we heard real-life stories about those from my hon. Friend the Member for Blaydon. She also said that four out of five people with suspected severe asthma who should be referred to a specialist do not receive the care they need, and that 46,000 people are missing out on life-changing biological treatment, an issue that was raised by almost all hon. Members who spoke today.

Today’s debate is important because currently there is no cure for asthma; it is only possible to manage the condition so that symptoms are kept under control. We must ensure that asthma treatments and outcomes are of the highest quality. The UK has one of the worst mortality rates for asthma in Europe, with a death rate almost 50% higher than the average death rate for the EU. That should embarrass us all. Despite initiatives such as the 2014 national review of asthma, asthma deaths rose by more than 33% in England and Wales between 2008 and 2018. Some 5.4 million people in the UK are receiving treatment for asthma, leading to 41,000 hospital admissions last year for asthma-related concerns, and 1,300 deaths.

If those figures are not enough to show that we must improve asthma outcomes, we should note that two thirds of asthma deaths are preventable. Three people die from asthma attacks every day. That number must be lowered.

The disruption caused by the pandemic has had a huge impact on asthma care and outcomes. Basic asthma care is an annual review, an inhaler technique check and a written asthma action plan. Members have discussed how that care is not enough. Last year, the number of people receiving even that basic level of care dropped for the first time in eight years, with more than 3.5 million people missing out on potentially life-saving treatment—that is 3.5 million people with asthma who were put at risk. However, even before the pandemic, respiratory care was lagging behind care for other conditions. Basic care levels for asthma were stalling. Recent research by Asthma UK shows that 75% of people with chronic obstructive pulmonary disease were also missing out on fundamental care.

We must understand the challenges of asthma treatment in our country and look at what we might do differently to save lives and improve patient outcomes. There are several areas for the Government to improve. Many excellent suggestions have been made today. I want to focus on the restoration of the normal delivery of care, prescription charges and air pollution. The Government’s work should not be limited to these areas and I urge the Minister to explore other avenues, such as early diagnosis and promoting the take-up of covid booster vaccinations for asthma patients.

In England, the NHS long-term plan included respiratory diseases as a national clinical priority, with the objective of improving outcomes for people with respiratory diseases including asthma. I urge the Government to therefore commit to restoring the normal delivery of care for people with respiratory diseases, so that everyone with asthma receives at the very least the most basic level of care and that 3.5 million people are not denied the basic care they deserve.

Many Members have referred to the Asthma UK survey that found that 76% of people with asthma struggle to afford their prescriptions, 57% skip their medication because of the cost, and 82% say their symptoms worsen as a result. People on lower incomes are already nearly twice as likely to have had an asthma attack than those on higher incomes. The inability to afford prescription charges is highly likely to be a contributing factor. It is putting lives at risk. People should not be forced to choose between paying for a prescription or risking their lives.

Health inequality is one of the major drivers of poor health outcomes that we see today, and asthma is no exception. We know that asthma symptoms are exacerbated by breathing polluted air, as well as from smoking. Air pollution can worsen existing health inequalities and the people living in the poorest areas are often the most exposed to polluted air, reinforcing unequal health outcomes for deprived communities. We need to make sure that air pollution is reduced across the country and must adopt into law enforceable targets set out by the World Health Organisation to bring air pollution down to below harmful levels.

In November 2020, the APPG on respiratory health produced its report on improving asthma outcomes in the UK, which we have heard about today, and I look forward to its forthcoming one-year-on report. I urge the Minister to consider those reports and reflect closely on the recommendations and issues raised by the hon. Member for Strangford.