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Breathe Easy

It is estimated that 30 million Europeans – from babies to the very old – have asthma, and as many as six million of these suffer symptoms that are characterised as severe (1,2).

Asthma is a common, chronic infl ammatory disorder of the lungs. It leads to widespread airfl ow limitation and airway hyper-responsiveness. The resulting symptoms include coughing, wheezing, breathlessness and, occasionally, fatal respiratory arrest. The pathogenesis of the disorder is highly complex and still not completely understood.

The Facts

Although many past and current achievements have been made in asthma research on a national and European level, about 15,000 Europeans still die from asthma attacks each year, and hundreds of thousands more are hospitalised. A lack of coordination, and persistent gaps within the asthma innovation pathway, mean there are no effective treatments for about five per cent of people with asthma, and treatments are not always appropriate for the breadth of symptoms and sub-types. Coupled with poor patient adherence to prescribed treatment in a large sub-section of asthmatics, the result is poor health, millions of days off work, and thousands of deaths a year.

Asthma outcomes in Europe are unacceptably poor; 14 EU member states feature in the top 20 worst countries for prevalence in adults. Between now and 2020, if no major breakthroughs in the research and management of asthma are made, about 120,000 people in Europe will die as a result of attacks, and four million will be hospitalised. Asthma UK believes the majority of these are preventable.

Asthma also has one of the highest socioeconomic impacts of any disease in Europe. While not as deadly as cancer or heart failure, nor as signifi cant as diabetes in the amount of hospital care its patients require, its high socioeconomic impacts arise because it presents in infancy; it is the most common chronic disease in childhood across Europe (and much of the rest of the industrialised world); and the number of people affected continues to be large throughout the whole period of adult life.

Severe Condition

Researchers from the European Network for Understanding Mechanisms of Severe Asthma (ENFUMOSA) project have estimated that about six million patients have ‘severe’ asthma, with more than a million of them gaining no benefi t from the glucocorticoid-based preventative inhalers that have improved the lives of many other patients (3). The 2006 Strategic Research Agenda of The Innovative Medicines Technology Platform summarised the position as follows:

“A survey of asthma severity in Europe (Rabe et al, 2000) found that 18 per cent of asthma patients had severe persistent, 19 per cent moderate persistent, 19 per cent mild persistent and 44 per cent intermittent asthma. Severe asthma is a term that encompasses patients with steroid-resistant, irreversible, refractory, brittle, near fatal and poorly controlled asthma. Although some asthmatics have been severely affected for most of their lives, there appears to be a second group of mainly female, non-atopic adults that develop severe disease in adulthood (ENFUMOSA, 2003).

“Asthma is a disease with a moderate-to-high level of unmet need; the high prevalence, extraordinary economic burden to society and signifi cant rate of hospitalisation are balanced somewhat by the availability of effective treatments which, when used properly, are generally successful at controlling the disease. Despite the availability of successful treatments, there is considerable demand for more effective, more convenient medicines. Combined with the high patient population of this chronic disease, the R&D unmet need in asthma creates a signifi cant opportunity for advancing more efficacious treatments.”

A High Price

There is also a high social cost to individual patients trying to manage their persistent and recurrent breathing problems, as they face restrictions on work and family life, alongside the physical and emotional distress of the illness itself. We also know that the economic cost for patients and health services is high because a large volume of asthmatics constantly require medication, the attention of physicians and hospital resources.

Furthermore, because diagnosing, treating and supporting self-management in asthma patients can be costly, the condition represents a high ‘opportunity cost’ for other diseases, as health budgets are relatively fixed in EU states, and ageing populations are demanding increased treatments for more age-related, degenerative diseases. Until resources can be freed up from treating diseases which, like asthma, impact on large sections of the population, it will be increasingly difficult to find additional resources to respond to age-related needs or new threats to health.

Finding a Solution

There is a lot of excellent work and strong partnerships that have been developed to tackle asthma. But it is also important to note that Europe’s asthma research communities are still considered fragmented; working at national levels on discrete and complex sub-areas of asthma.

A more comprehensive and integrated partnership to tackle the condition is needed – and the European Asthma Research and Innovation Partnership (EARIP) is now under way, which will share expertise, improve coordination, remove duplication, agree on the priority research needed, and defi ne the causes and dimensions of outstanding asthma management success, at scale. This will set the stage for galvanising collective expertise and fast-tracking a solution to the immense social and economic burden of asthma in Europe.

The overarching aim of EARIP is to harmonise efforts to reduce mortality and morbidity by encouraging focus and prioritisation at a pan-European level. By coordinating asthma activities and priorities at this level, the partnership will channel the collective expertise of world-leading asthma experts around a common goal.

EARIP will bring together competent and relevant academic and clinical researchers, pharmaceutical and healthcare technology companies, patient representative groups, healthcare systems organisers and deliverers, and government departments. Together, the group aims to develop a programme or ‘roadmap’ of research and innovative actions to reduce European asthma deaths and hospitalisations, through a research programme that directly addresses the significant number of knowledge gaps that have been identified by national and international reviews over the last few years.

Project Background

The concept underlying the development of EARIP arises from a set of pan-European and national research gap analyses – including that of the European Respiratory Society and Asthma UK (4-7).

Asthma UK’s own research gap analysis was compiled after discussions with researchers and clinicians in the UK’s Centre for Allergic Mechanisms in Asthma: a centre of excellence in basic and translational asthma research which it co-sponsors with the Medical Research Council, with professors in other centres it supports, and with some of the leading international researchers in the field. The analysis identified R&D and innovation gaps, along the whole knowledge development and supply chain in the UK – including the basic mechanisms of asthma, differentiation of asthma sub-types, the need for improved diagnostics, the importance of having better clinical protocols, and the requirement for new and better selfmanagement for individual patients.

EARIP requires the pan-European collaboration of all asthma stakeholders to work together across both biological and translational agendas, to share knowledge and expertise to drive down deaths and hospitalisations. This approach will ensure that where there has been success with reducing asthma impacts, this knowledge does not remain country-bound, but is shared across Europe, and that lessons are learnt and implemented.

Potential Benefits

The group is expected to have a significant impact on the management of asthma and its huge personal, social and economic costs, including the costs of healthcare amounting to 17.7 billion.

The project partnership also aims to put individual patients at the heart of asthma management and treatment, and determine how best to achieve improved asthma outcomes, by refocusing asthma research and innovation activities towards developing more efficient health and care systems.

Another exciting element of the partnership is that it will identify and internationally ratify a list of research objectives of greatest potential added value in the treatment and management of asthma, and produce a roadmap setting out priorities. The development of a European Asthma Roadmap – relevant for individual stakeholders, national research programmes and subthemes of the Horizon 2020 Health research programme – will also be the foundation on which a future European Innovation Partnership (EIP) can build a broader strategic programme, designed to transform the management of asthma throughout Europe. The aim of this EIP will be to address the need for a comprehensive effort to manage asthma much more effectively, with input from leading European researchers, clinicians and large pharmaceutical firms.

Furthermore, it is hoped that EARIP will lay a stronger foundation for Europe’s pharmaceutical and healthcare technology companies to grow – and create jobs – through the better identification of biological targets for new products, helping to boost competitiveness and accelerate innovations in healthcare systems and services.

High Hopes

The partnership has ambitious goals for what it might achieve for people with asthma. But the initiative could also allow Europe to become more globally competitive in the development of research and innovation to successfully tackle the condition across the world.

1. Global Initiative for Asthma, 2004
2. European Respiratory Society in conjunction with European Lung Foundation, European Lung White Book, November 2003
3. The ENFUMOSA Study Group, The ENFUMOSA crosssectional European multicentre study of the clinical phenotype of chronic severe asthma, Eur Respir J 22(3): pp470-477, 2003
4. European Respiratory Roadmap. Visit: www.ersroadmap. org/healthcare-professionals/research-chapter-3.html
5. Asthma UK, Clin Exp Allergy, 2006 and unpublished review of research gaps, 2011
6. International Primary Care Respiratory Group, Primary Care Resp J, 2010
7. European Academy of Allergy and Clinical Immunology

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About the author

Samantha Walker
is Executive Director, Research and Policy at Asthma UK, and Honorary Senior Lecturer in the Division of Community Health Sciences, University of Edinburgh. She has published extensively on allergy and asthma, and is responsible for directing and delivering Asthma UK’s research strategy, ensuring that answers are found for the most pressing questions about the causes and treatment of asthma, and that health outcomes are improved as a result. Samantha is committed to improving allergy and asthma services in primary and secondary care, and acting as a champion for people with asthma and allergies through quality policy analysis, as well as effective influencing and campaigning.

Samantha Walker
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