The Scottish Health Survey 2024 - volume 1: main report

4. Respiratory

Jack Terris

4.1     Introduction

Infectious respiratory disorders and long-term respiratory conditions, such as asthma, chronic obstructive pulmonary disease (COPD), and sleep apnoea are a considerable challenge for the individuals that live with them and for health services in Scotland, particularly in light of an ageing population[i]. Many respiratory conditions are currently incurable, however, treatment can help to improve symptoms and quality of life[ii].

The UK has one of the highest rates of asthma in the world[iii]. Asthma is a long-term condition characterised by variable and recurring breathlessness, wheezing, coughing and chest tightness. The reasons for the high prevalence of asthma in the UK are not certain; however, risk factors include infections/viruses, hormones, environmental, lifestyle (including smoking, diet and obesity), occupational and genetic disposition[iv],[v],[vi]. An estimated £500 million is spent by the NHS in Scotland each year on this and other respiratory diseases[vii].

COPD is the fourth leading cause of mortality worldwide[viii]. The ageing population, along with the additional complication of older COPD patients being more likely to have other long-term conditions, presents a further challenge in managing COPD in Scotland[ix]. Smoking is the main cause of COPD with an estimated 9 in 10 of those with the condition in the UK having either smoked or continuing to smoke[x].

Sleep apnoea is a respiratory condition characterised by pauses or shallow breathing during sleep[xi]. Around 1.5 million adults in the UK are estimated to have the condition, however up to 85% are undiagnosed. It is linked to other health problems including hypertension and heart disease.

Long COVID refers to symptoms that develop during or after a COVID-19 infection that continue for 4 weeks or more and are not attributed to another condition/diagnosis. The overlapping long COVID symptoms that are sometimes experienced can affect body systems including the respiratory system[xii]. The ongoing impact of long COVID can be debilitating for some with impacts on daily activities and quality of life reported to include fatigue, breathlessness, anxiety, depression and cognitive impairment[xiii].

4.1.1     Policy background

The Respiratory care – action plan: 2021 to 2026[xiv] sets out the vision for improvement in the prevention, diagnosis, care, treatment and support of people living with respiratory conditions in Scotland. This is supported by other key policy initiatives including the Specialty Delivery Group within the Centre for Sustainable Delivery[xv], which aims to improve patient journeys through sustainable changes that facilitate person-centred care and the Framework for supporting people through Recovery and Rehabilitation during and after the COVID-19 Pandemic[xvi].

The Quality Prescribing Strategy for Respiratory - A Guide for Improvement: 2024-2027[xvii] focuses on delivery of safe person-centred care through the promotion of safe prescribing and practical review of medications to ensure their effective use in clinical practice. It also aims to promote shared decision making and involving patients in all steps of their treatment.

In September 2021, the Scottish Government published Scotland’s Long COVID Service[xviii] paper. The paper sets out four key elements that underpin the approach to care and support for people with long COVID: supported self-management, primary and community-based support, rehabilitation support and secondary care investigation and support.

The Scottish Government established a £10 million long COVID Support Fund in September 2021 to support NHS Boards and partners increase the capacity of existing services providing support to people with long COVID, develop these into more clearly defined pathways and to provide a more coordinated experience for those accessing support[xix]. The Scottish Budget 2025-26 commits to provide an additional £4.5 million to deliver new specialist support across the country for long COVID, Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) and other similar conditions[xx].

4.1.2     Reporting on respiratory conditions including COVID-19 in the Scottish Health Survey

In this chapter, the following data are presented:

• Self-reported doctor-diagnosed asthma for adults and children
• Self-reported wheezing (ever and in last 12 months) for adults and children
• Self-reported doctor-diagnosed COPD for adults
• Self-reported sleep apnoea prevalence for adults
• Self-reported long COVID for adults and children and its day-to-day impact on adults 

Figures are reported by age and sex.

An interactive data dashboard is also available presenting key indicators for Scotland, NHS Boards and local authority areas.

For detailed definitions of terminology used in this chapter and for details on the data collection methods for respiratory conditions and long COVID, please refer to the Scottish Health Survey 2024 - volume 2: technical report.

4.1.3     Comparability with other UK statistics

The latest asthma prevalence estimates for both adults and children in England are available in the Health Survey for England 2021 dataset [xxi]. The survey has a different sampling methodology to the Scottish Health Survey, so asthma prevalence estimates across the surveys are only partially comparable. There are no comparable statistics collected in Wales or Northern Ireland.

Long COVID prevalence estimates from the Winter Coronavirus (COVID-19) Infection Study Scotland and England should be fully comparable.

No comparable statistics for sleep apnoea are available for England, Wales or Northern Ireland.

4.2     Results

Summary points

In 2024:

• Prevalence of doctor-diagnosed asthma amongst adults reached 18%, the highest proportion recorded since the timeseries began in 2003.
• The age-standardised proportion of adults with doctor-diagnosed asthma varied by smoking status, from 25% of non or occasional smokers to 56% of adults who smoked 20 or more cigarettes a day.
• Almost one in ten (9%) of adults aged 65 and over had been diagnosed with COPD, compared to less than 1% of adults aged 16-44.
• Seven per cent of adults reported currently having long COVID, consistent with 2023 (8%) and remaining higher than in 2021 (5%).
• Almost three in five adults (59%) who reported having long COVID felt that their symptoms worsened after physical and/or mental effort.
• A small proportion of adults (2%) reported having doctor-diagnosed sleep apnoea, with prevalence most common among males aged 55-64 (7%).

4.2.1     The proportion of adults with doctor-diagnosed asthma reached a new high in 2024

In 2024, almost one in five adults (18%) reported having doctor-diagnosed asthma, the highest proportion in the timeseries which has remained between 16%-17% since 2017.

The proportion of adults who had wheezed in the last 12 months was 17%, the same proportion as in 2022.

Just under a third of adults (29%) reported ever having wheezed in their lifetime, a proportion that has remained in the range 25% - 31% since 2003.

The proportion of children that had wheezed in the last 12 months, that had ever wheezed and reported doctor-diagnosed asthma all remained at the same level as in 2022 (13%, 21% and 10% respectively).

Male children aged 0-15 were more likely than females of the same age to have ever wheezed (24% and 17% respectively) and/or to have doctor-diagnosed asthma (12% and 7% respectively).

Figure 4A, Table 4.1

4.2.2     Adults who currently smoked 20 or more cigarettes a day reported the highest prevalence of doctor-diagnosed asthma

In 2024, the age-standardised proportion of adults with doctor-diagnosed asthma varied by smoking status, with 25% of non or occasional smokers reporting doctor-diagnosed asthma compared with 56% of adults who smoked 20 or more cigarettes a day.

Differences by sex were not significant.

Table 4.2

4.2.3     Older adults were more likely to report having doctor-diagnosed COPD

In 2024, 4% of adults reported having doctor-diagnosed COPD. This proportion increased with age, from less than 1% of those aged 16-44 to 9% of those aged 65 and over.

Figure 4B, Table 4.3

4.2.4     The prevalence of long COVID and its constraints on the ability to carry out day-to-day activities remained consistent with 2023

In 2024, 7% of adults reported currently having long COVID, consistent with 2023 (8%) and remaining higher than in 2021 (5%). Females were more likely than males to report having long COVID in 2024 (8% and 6% respectively).

The proportion of adults who reported that they have long COVID which has reduced their ability to carry out day-to-day activities either ‘a little’ or ‘a lot’ remained the same as in 2023 (3% and 2% respectively).

Table 4.4

4.2.5     Almost three in five adults’ symptoms of long COVID worsen after mental and/or physical effort

In 2024, almost three in five (59%) adults who reported having long COVID also reported that their symptoms would worsen after mental and/or physical effort. There was not a significant difference between males and females.

Table 4.5

4.2.6     Older males were more likely to have been diagnosed with sleep apnoea than older females

A small proportion of adults (2%) reported having doctor-diagnosed sleep apnoea in 2024. Prevalence was most common among adults aged 55-64 (5%), particularly among males (7%) compared with females (3%) in this age group.

Table 4.6

Table List

Table 4.1  Doctor-diagnosed asthma, wheezed in last 12 months, and ever wheezed, 2003 to 2024, by sex

Table 4.2  Doctor-diagnosed asthma (age-standardised), 2024, by smoking status and sex

Table 4.3  Doctor-diagnosed COPD, 2024, by age and sex

Table 4.4  Whether currently has self-reported long COVID and whether current long COVID limits ability to carry out day-to-day activities, 2021, 2023 and 2024, by sex

Table 4.5  Whether long COVID symptoms worsen after mental and/or physical effort, 2024, by sex

Table 4.6  Sleep apnoea prevalence, 2024, by age and sex