CORDIS - EU research results

European Asthma Research and Innovation Partnership

Final Report Summary - EARIP (European Asthma Research and Innovation Partnership)

Executive Summary:
There is an urgent need to develop better medicines, diagnostic methods and effective self-management tools for asthma. Over 30million people live with asthma in Europe which is associated with considerable morbidity and an estimated annual cost of >€72.2 billion. The global prevalence of asthma is expected to grow to over 400million by 2025. Recent scientific breakthroughs and technological advances present a unique opportunity to transform asthma outcomes with the right focus and investment.

To capitalise on this opportunity, Asthma UK was commissioned by the European Commission Framework Programme 7 to define the research priorities for asthma through coordination of the European Asthma Research and Innovation Partnership (EARIP). EARIP brings together researchers, industry representatives, patient groups and policy-makers in order to undertake a comprehensive analysis of asthma research, including basic biology, new treatments, health and care systems, self-management and diagnostic tools, to develop a ‘roadmap’ for investment based on unmet need in asthma.

Eight expert working groups comprising world-leading researchers, clinicians, pharmaceutical company personnel and people with asthma have carried out reviews of the scientific literature and identified research priorities in key areas of basic, translational and applied asthma science through large scale surveys and e-Delphi consensus-building exercises. Representatives from each group then met to agree a single, coordinated agenda for asthma research and development (R&D).

Priorities fall into four broad priority areas; personalised medicine, triggers and risk factors for asthma and exacerbations, self-management and adherence and primary care and public health. Underpinning this is an urgent need for greater understanding of basic asthma mechanisms to drive the development of new treatments in the ~50% people who respond poorly to steroids (McGrath AJRCCM 2012); development of novel diagnostic technologies to allow the development of personalised intervention strategies; and to maximise the potential of digital platforms to transform problems associated with adherence and self-management.

This ‘roadmap’ forms the basis of plans to revolutionise the way that asthma is investigated and treated in Europe by attracting significant public and private investment as well as prioritising asthma research in the European medical research agenda. With targeted and focussed investment, this research would have dramatic implications for the lives of over 30million people living with asthma in Europe, whilst reducing healthcare costs, improving competitiveness, and providing a framework through which to solve other long term conditions.

People with asthma have played a central role in shaping the direction of the project from its development and throughout its implementation; indeed the project was co-ordinated by a UK-based patient organisation working alongside two pan-European patient groups (European Federation of Allergy and Airways Diseases Patients’ Associations (EFA) and the European Lung Foundation (ELF). In this regard, EARIP brings together research from around Europe in order to address a patient-defined need. We will now work with the European Commission and individual European member states to explore models for investment in asthma R&D that will drive innovation, health and wealth and have clear value for European and international research bodies, industry and collaboration.

Project Context and Objectives:
Asthma outcomes in Europe are unacceptably poor; fourteen EU countries feature in the top 20 worst countries globally for asthma prevalence in adults . Over 30million people live with asthma in Europe which is associated with considerable morbidity and an estimated annual cost of >€72.2 billion . The global prevalence of asthma is expected to grow to over 400million by 2025 . Between now and 2020, if no major breakthroughs in research and the management of asthma are made, about 120,000 people in Europe will die as a result of asthma attacks, and 4 million will be hospitalised. Two thirds of these are probably preventable. A lack of coordination and persistent gaps within the asthma innovation pathway mean that there are no effective treatments for about 5% of people with asthma and treatments are not always appropriate for the breadth of symptoms and sub-types of asthma. Coupled with poor adherence to prescribed treatment in a large sub-group of asthmatics, the result is poor health, and millions of days off work for the millions of people in Europe who have asthma, and thousands of deaths a year in Europe from asthma attacks.
Asthma also has one of the highest socio-economic impacts of any European disease because it often begins 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 affected people continues to be high throughout the whole period of adult life.
Additionally, there is a high social cost to individual asthma 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 for health services is high because the large volume of asthma patients constantly require medication, the attention of physicians, and the resources of hospitals.
The European Asthma Research & Innovation Partnership (EARIP) project started in September 2013 and consisted of eight work streams, which have worked together to define the research priorities for asthma that are needed to develop the treatments, diagnostic and companion diagnostic tools, self-management tools and healthcare systems necessary to improve asthma outcomes in Europe and worldwide. EARIP has identified critical gaps in our understanding of asthma as a chronic, episodic and highly variable condition and this work will continue the search for a cure and its ultimate prevention. Following this work it is agreed that a high level, well-funded more comprehensive and integrated partnership to tackle asthma is vital to share expertise, improve co-ordination, remove duplication, fund the research priorities identified, and define the opportunities to deliver outstanding asthma management success at scale. EARIP has set the scene for galvanising collective expertise and fast-tracking a solution to the immense social and economic burden of asthma in Europe.
The EARIP project has developed key recommendations for asthma researchers and healthcare professionals. A ‘roadmap’ for the future of asthma research has been developed detailing the key priority areas for future investment in asthma research and care. This has been based on the work of all of the EARIP work packages and the expertise of the researchers, healthcare professionals, industry representatives, patient representatives and patient organisations that supported the work. We are calling for research funders and commissioners to adopt this roadmap will be used by when drafting calls for funding, based on which areas are most likely to provide answers to the challenges of preventing, treating and managing asthma.

Project Results:
This roadmap has been one of the most important elements of the Partnership. The internationally ratified list of research objectives of greatest potential added value in the treatment and management of asthma have been supplemented with the development of key research questions, using the Population, Intervention, Comparison, and Outcome (PICO) method, which can easily be used by researchers or research funders . Priorities include the need to identify asthma sub-types and their stability over time; to understand the relevance and impact of childhood infection, and different therapeutic interventions on asthma outcomes; to develop new treatments for steroid-resistant asthma; and to optimise self-management and adherence.
This roadmap - relevant for individual stakeholders, national research programmes, and sub-themes of the Horizon 2020 Health research programme - will also be the foundation on which a future EU funding vehicle can build a broader strategic programme designed to transform asthma outcomes throughout Europe. The overarching aim here will be to address the need for a comprehensive effort to manage asthma much more effectively, through fast-tracking change and enhancing technological and research innovation for asthma, with inputs from leading European researchers, clinicians, and large pharmaceutical firms. We also want to use EARIP to encourage innovative collaborations between academic and industry scientists to discover and capitalise on new pathways and targets for treatment of asthma. This in turn would help foster growth of the companies and create jobs across Europe.
At this year’s European Respiratory Society congress the consortium launched the next stage of our campaign for greater investment in asthma research, where we called upon funders, institutions, European and national societies, researchers and academics to adopt and address the fifteen research priorities. This will improve collaboration and help us work more effectively towards common goals to improve the lives of the 300 million people living with asthma in Europe. We will be working with funders to adopt the roadmap in their funding decisions, and encouraging researchers to address the specific priorities using the funding offered in line with these priorities.

Potential Impact:
Throughout the project it is clear that Europe is ideally placed to capitalise on the research potential of this agenda. We need to improvement asthma outcomes, and in turn see improvements in the related impact on the overall European economy; these impacts are only achievable through a comprehensive and coordinated effort at an international level.
The Partnership’s specific recommendations and calls are:
• To develop a strategic research framework for asthma- a patient driven agenda developed with all relevant stakeholders, to ensure public and private resources are focused on research priority areas

• To get commitment to address asthma at a European level, through support from policy makers at a European, national and regional level, as well as the European Commission and national funders

• To encourage adoption and circulation of the asthma roadmap and recommendations that have been produced through the project in all European member states.

The over-arching ambition of the EARIP consortium for the future is to harmonise efforts to reduce mortality and morbidity from asthma by encouraging focus and prioritisation at a pan-European level. By coordinating asthma priorities and activities at this level, the asthma community will channel the collective expertise of world-leading asthma experts around a common goal.
A strategic research framework for asthma would help to build on the work in the EARIP project and Europe’s knowledge, strengthening the economy and its position as a world-leader in life science. By drawing public and private investment into medical research across the European Union, a strategic framework has the potential to boost European competitiveness in line with the strategic aims of the European Union.

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