The European Respiratory Roadmap

It is clear by now that health policy makers did not devote the deserved attention to respiratory diseases in the last decades. The five most important respiratory diseases (COPD, asthma, lung cancer, pneumonia and tuberculosis) are now responsible for 20% of the mortality worldwide [1,2]. The annual cost associated with these diseases amounts to €100 billion in Europe. Worldwide there are presently about 300 million people with asthma and 210 million persons with COPD and millions more with a host of other lung diseases [3]. COPD is now the fourth cause of death and is predicted to become the third cause of death by 2030. Respiratory diseases are also very important causes of disability and reduction in health related quality of life. Moreover, the mortality due to COPD has doubled during the last three decades, whereas the mortality due to cardiovascular disease and stroke has decreased significantly [4]. Why did we deal better with cardiovascular diseases and stroke in the last decade than with respiratory disease? A host of reasons can probably be offered as an explanation. For the purpose of the present editorial, we will just present two. The first and foremost reason is that although the major risk factors for respiratory disease, i.e. smoking and air pollution, have been known for a long time, we did not really combat these risk factors vigorously. Indeed, the recent Eurobarometer survey on smoking [5] found that smoking prevalence is still high in most European countries, with only Sweden approaching the presently optimal prevalence of about 15% while the prevalence in other countries like Spain and Greece still exceeds 35% and more. Although the European Commission and the European parliament have played a pivotal role in triggering smoke-free legislation in the member states, 2011 is only the first year in which the growth of tobacco will not be subsidized by the European Union. The second reason that I would like to mention here is the deficient funding of research on respiratory disease. In 2002 in the UK, only 2.8% of the Medical Research Council budget was dedicated to respiratory research, while respiratory diseases represented 13% of the causes of death [6]. Similarly, although the 7th Framework Programme for Research and Technological development, FP-7, devoted 4.3% of its budget to respiratory disease, only 0.5% of the budget was spent on research on asthma and COPD, quantitatively the most important of the respiratory diseases. For these reasons, the ERS participated last year in the “Year of the Lung” proclaimed by all international respiratory societies and organized several events at the European Parliament in this context, to raise awareness of respiratory diseases. One of them was the first high level conference on Chronic Respiratory Disease, under the Belgian Presidency, which was held in Brussels in October last year [7]. These efforts have been successful as awareness of respiratory disease with health policy makers is now rising. Hence the time has now come to think of the next steps: to identify the real issues, to define appropriate responses and to integrate these responses into the existing action plans like the Europe 2020 plan. This is exactly why we took the initiative to develop the European Respiratory Roadmap [8], a set of recommendations, guidelines and action plans, which we offer to health policy makers in Europe in order to deal better with respiratory diseases and to substantially improve their outlook in future. This document comprises four sections: prevention, clinical medicine, research and education. It was developed with the help of the entire Society: all Assemblies, the Scientific School, Advocacy, Tobacco control, and Environment committees, etc. Its perspective was widened during a Summit held in Leuven in March 2011 and, finally, all of the almost 12,000 members of our Society were invited