Respiratory conditions - quality prescribing strategy: improvement guide 2024 to 2027

Respiratory conditions are a major contributor to ill health, disability, and premature death – the most common conditions being asthma and COPD. This quality prescribing guide is designed to ensure people with respiratory conditions are at the centre of their treatment.

Clinical Foreword

Promotion of appropriate prescribing of medicines to treat asthma, chronic obstructive pulmonary disease (COPD), bronchiectasis and idiopathic pulmonary fibrosis (IPF) is essential to optimise treatment outcomes and achieve the best care for the individual, while minimising harm.

We aim to achieve better disease control and outcomes for the individual by:

  • placing an emphasis on the person-centred review of medicines
  • optimising care for respiratory conditions in adults
  • using effective pharmaceutical and non-pharmaceutical treatment options

This guide promotes a person-centred approach to care and the 7-Steps approach to medicine reviews in the management of respiratory illness, embedding shared decision-making throughout the process.

This document also takes into account environmental considerations. We envisage that better control of respiratory conditions can be achieved through:

  • promotion of good person-centred care
  • improved preventative treatment plans
  • promotion of correct use of metered dose inhalers where necessary
  • use of environmentally sustainable inhalers where appropriate - including considering a switch from metered dose inhalers (MDI) to dry powder inhalers (DPI) or soft mist inhalers (SMI) where clinically appropriate

Improved disease control will also lessen environmental impact by preventing admissions to hospital and unplanned contact with healthcare providers, and this will ultimately aid NHS Scotland in achieving net zero carbon emissions.

This guide highlights clinical recommendations for respiratory prescribing practices and utilises data for improvement and benchmarking across NHS boards in Scotland. This will help optimise therapy and drive improvement according to current national guidance.

This guide builds upon the previous 2018-21 strategy and has been written by Scottish Government and NHS Scotland, supported by individuals with lived experience, patient organisations and the multidisciplinary team across primary and secondary care. It is aimed at primary and secondary care clinicians, Managed Clinical Networks and Board Medicines Management Teams. The guide is also endorsed and will be adopted in the respiratory care pathway by the Centre for Sustainable Delivery.

An Equality Impact Assessment for this guidance has been completed and will be available on If you would like to see a copy of this, please contact

David Anderson


Respiratory Consultant,

NHS Greater Glasgow & Clyde

Tom Fardon


Respiratory Consultant,

NHS Tayside

Alpana Mair


Head of Effective Prescribing & Therapeutics Division

Dr Philip Korsah

National Associate Clinical Director

National Centre for Sustainable Delivery

Professor Sir Gregor Smith

Chief Medical Officer for Scotland

Alison Strath

Chief Pharmaceutical Officer

Alex McMahon

Chief Nursing Officer

Jason Leitch

National Clinical Director



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