Abstract
In August 2026, Scotland fundamentally changed its infection control guidance regarding how respiratory disease transmission risk is managed, by replacing the droplet-airborne dichotomy with the simpler concept of air transmission and entirely removing the aerosol-generating procedure (AGP) list. This evidence-informed approach is based largely on the findings of clinical aerosol studies undertaken during the coronavirus disease 2019 pandemic, which demonstrated that many procedures on the existing AGP lists, such as tracheal intubation, generate little or no respiratory aerosol (substantially less than talking or coughing). Removing the AGP list does not mean less protection; rather, it means that precautions are based on the likely pathogen, the patient's respiratory activity, practitioner exposure, and the environment. Scotland's revised guidance offers a timely opportunity to replace the inherited dogmas in international guidelines with rational and evidence-informed respiratory protection before the next respiratory disease pandemic.