Promoting respiratory health in Europe

The mission of the European Respiratory Society to alleviate suffering from respiratory diseases necessitates many activities including the promotion of scientific excellence, education and the exchange of best clinical practice. Key to all these activities is advocacy for lung health in Europe and beyond. The ERS has produced this new edition of the White Book because doctors, scientists, patients and policy- makers need a comprehensive basis on which to reach decisions and formulate policies about health, particularly in the complex and wide- ranging respiratory field.

A decade has now passed since the publication of the first White Book – the first ever comprehensive survey on respiratory health. In 2003, we had 15 members of the European Union; today, we have 28. The decade has seen not just the expansion of the EU but also the expansion of health and research initiatives benefiting Europe’s citizens. Many of these developments have impacted positively on respiratory health.

In research, health funding by the EU has increased steadily and the importance of basic and translational (“bench to bedside”) medical research has been enhanced with the creation of a European Research Council and a dedicated, cross-cutting health theme in research framework programmes – including the latest, known as Horizon 2020 – the main EU funding instrument for research. Europe has been the driving force behind the first ever international public health treaty, the WHO Framework Convention on Tobacco Control. Its implementation across Europe has seen many positive developments, such as smoke- free areas, which have led to immediate improvements in respiratory health. The EU has also adopted ambitious air quality legislation, which has begun to reduce premature deaths from respiratory disorders. In the area of respiratory infections, we have seen better coordination  in Europe with the setting up of the European Centre for Disease Prevention and Control (ECDC) and increased efforts by the WHO to tackle tuberculosis.

In all these areas, the ERS has been at the forefront in providing evidence-based proposals for greater action in science, research, control and prevention of lung disease. It commissioned the first comprehensive study on the impact of passive smoking in Europe, and will soon launch a dedicated web portal on the existing and emerging health effects of smoking. The ERS has presented the evidence on  the serious health effects of indoor and outdoor air pollution and climate change, and led the call for improved air quality legislation in the EU. The ERS has been involved in many research framework projects, such as the innovative medicines initiative (IMI) and Marie Curie actions, and is a founding member and leader in the Alliance for Biomedical Research in Europe, which for the first time brings  together the leading European specialist clinical societies. The ERS has developed high European standards of postgraduate education through its School and the HERMES initiative.

While major progress has been made, we must not rest on our laurels. The ERS has reflected on what must be done to prevent the rise of respiratory diseases in the future and produced a forward-looking European Respiratory Roadmap (www.ersnet.org/roadmap) outlining the necessary action. This White Book provides the disease burden and socioeconomic case for actions laid out in the Roadmap, and we must act now if we are to protect future generations. There are five areas that need investment if we are to curb the rise in respiratory conditions in Europe: prevention, clinical care, research, education and data collection.

In the field of prevention, we need to step up efforts to minimise health inequalities. Health inequalities have significant economic implications for the EU and social inequality contributes to a higher proportion of deaths from respiratory disease than in any other specialty. We face many challenges, not least the impact of recent crisis-driven austerity measures. All those involved need to do more to promote and protect health, particularly for the most vulnerable segments of the population, and to ensure that a basic level of appropriate care and medical support is available to all those who are ill, regardless of income or demographics. In tobacco control, we must gradually phase out tobacco use completely, but in the interim, higher taxes, 100% smoke-free areas and plain standardised packaging with health warnings should all help to prevent young people from taking up the habit. Here, the strongest possible EU Tobacco Products Directive is crucial. In environment policy, we need to step up efforts to implement the WHO guidelines on air quality; Europe is falling far behind levels that are safe for our respiratory health.

As outlined in the concluding chapter of this book on recommendations and policy, we must see real implementation of the EU and United Nations commitments to take action on chronic diseases. This is particularly important with an ageing population, a declining labour force and the economic crisis in Europe. New approaches to clinical care are needed in order to ensure we can provide for future needs and eliminate health inequalities. We need to develop robust and simple methods to screen for sleep breathing disorders, lung cancer, chronic obstructive pulmonary disease and other chronic respiratory conditions as well as respiratory infections, as these will remain significant challenges at the clinical level. More effective screening would enable us to anticipate respiratory health burdens of the future.

Shifts from hospital-centred medicine to home care, from physician care to nurse care and from nurse care to self-management are inevitable. We must be prepared for this shift – training and education for professionals and patients will be fundamental. The use of managed clinical networks, multidisciplinary teams and collaborative efforts across the lines of healthcare can offer significant advantages in the treatment of complex conditions. In this way, patient treatment will focus on treating the patient, not just the disease.

Research and innovation are crucial to our understanding, optimal management and future treatment of respiratory disease. Presently, collaboration in Europe lacks a strong strategic framework for tackling chronic diseases, which is why the formation of the Alliance for Biomedical Research is important. Cross-fertilisation between clinical disciplines is vital.
It can serve to accelerate the translation of basic science (which may be common to many disease processes) into clinical practice. We need a scientific platform in Europe to consolidate expertise and resources across borders, providing significant added value. This would address the currently fragmented research landscape in Europe and help accelerate the translation of discoveries into applications that will impact healthcare delivery in the future.

Most importantly, we hope that eventually there will be no need for a White Book! The most effective action that European governments supported by the European Commission could and should take is to standardise surveillance and data collection on all respiratory diseases; this would make a major contribution to efforts to save lives and to improve the care of patients.

We have achieved a lot – but Europe has much more to do to secure our future health and prosperity and give our lungs breathing space. The ERS is in an excellent position to continue playing a major role in improving the health of Europe.

Francesco Blasi

Francesco Blasi

peter barnes

Peter Barnes

rabe

Klaus Rabe

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