Vienna welcomed 18,719 participants at the largest conference in pulmonary medicine worldwide.

Dear Colleagues,

In September, 18.719 participants and more than 200 media representatives came to Vienna to an exciting 19th Annual Congress of the European Respiratory Society. The ERS is proud to announce the new record of over 10.000 members in over 100 countries. Committed not only to lung health but to environmental preservation, the ERS stand at Congress, as a minor contribution, used 100% recycled cardboard assembled with velcro & minimum industrial glue, fully recycled after use. The ERS Environmental Committee is fully committed to implementing measures of sustainability in line with the principles of the ERS.

The new ERS president is Professor Nikolaos Siafakas (Interview), MD, PhD, FCCP, Department of Thoracic Medicine, Medical School, University of Crete, Greece. Prof. Siafakas is working closely with the European Lung Foundation on different initiatives to bring the importance of lung diseases to the attention of the public and policy makers.

This year’s European Lung Foundation Award 2009 went to Yvo de Boer as a result of his consistent commitment towards reducing the problem of global climate change, protecting the environment and setting the example for lung health.

Opening Press Conference/ Scientific Highlights

From left to right: Prof. T. Welte, Prof. L. Fabbri, Prof. G. Rohde, Prof J. Riedler, Prof E. Bateman

Breathomics: The e-Nose

Among the newsworthy and exciting developments in the field of respiratory medicine presented at the ERS Opening Press conference was the e-nose, which is a highly sensitive device that measures volatile substances in exhaled air. Since these substances are produced by cancer cells, the e-nose holds promise as a tool for cancer detection in lung-related malignancies, like lung cancer or malignant mesothelioma, or even unrelated malignancies, such as breast cancer, explained Dr. Ildiko Horvath, Semmelweis University Budapest, Hungary.

Another potential use of breathomics is for asthma monitoring during pregnancy, when physical and molecular changes increase the risk of uncontrolled asthma, one of the most important risk factors for premature delivery and underweight newborns. New data shows that measuring exhaled nitric oxide provides a safe and easy tool for close disease monitoring.

Highlights at a glance

H1N1-Influenza

A new strain of influenza known as Swine flu is responsible for an outbreak first identified in Mexico, which progressed to the current pandemic. When other cases were identified in North America, researchers recognized it as a new strain of the H1N1 (nH1N1) influenza virus that has changed its properties to act differently from previous strains.

Current flu vaccines are not likely to protect people against the Mexican strain because it is entirely new, and the new virus is easily transmissible between humans. The lack of immunity, easy transmission, and capacity to cause human disease make H1N1 a pandemic virus, explaining the rapid world-wide spread. On June 11, the WHO raised the worldwide pandemic alert level to Phase 6. The pandemic virus does not appear to be severe either in terms of the attack rate in communities or in the virulence of the virus itself.

A comprehensive computational search of all available sequences of the surface proteins of H1N1 swine influenza isolates found that a similar strain to nH1N1 appeared in Thailand in 2000. The earlier isolates caused infections in pigs but only very few human cases.

However the current pandemic has caused global alarm. Influenza viruses have the potential to be among the deadliest of all known pathogens. At the moment, there is growing concern that in the southern hemisphere, seasonal Influenza and nH1N1 may infect people simultaneously, giving birth to a more virulent reassortant virus.

“The H1N1 virus seems to be particularly dangerous for healthy, young patients”, said Professor Gernot Rohde, University Hospital Bergmannsheil, Bochum, Germany.

In these patients, the virus directly infects the lung, causing severe respiratory failure. Highly specialized care in intensive care units, usually with long and costly stays is needed for these patients. During the winter season in the southern hemisphere, several countries have viewed the need for intensive care as the greatest burden on their health services.

  H1N1 Influenza - Pandemic or panic ?

Malignant Mesothelioma: New diagnostic markers and therapeutic targets

Malignant pleural mesothelioma (MPM) is an aggressive asbestos-related tumor affecting the membrane that surrounds the lungs. It carries a dismal prognosis: the median survival rate is less than one year. The long latency period between asbestos exposure and tumor presentation, and the continued use of asbestos in developing countries, mean that mesothelioma will remain a worldwide health issue for decades to come.

Mesothelioma will peak in 2020 as people exposed to asbestos in the 1950s–1970s continue to be diagnosed, said Professor Geoff Laurent, Director of the Centre for Respiratory Research at University College London, UK.

New research into monocyte chemoattractant protein (MCP)-1 may lead to new therapeutic targets that are desperately needed, added Professor Laurent. Recently, different serum biomarkers have emerged that have the potential to aid in the diagnosis of malignant pleural mesothelioma and in the monitoring of the disease.

According to data presented at ERS, two such markers, soluble mesothelin (SM) and megakaryocyte potentiating factor (MPF), both measured in serum, seem to be the most promising.

Asthma out of control?

Prof. Eric Bateman, Groote Schuur Hospital, Cape Town, South Africa, discussed the current trend in monitoring disease control in patients suffering from asthma.

Recently asthma monitoring has shifted from the use of single endpoints, such as lung function, toward composite measures that also reflect symptoms and patient perspectives, and, in some cases supplemented by measures of airway inflammation. This new focus aids in preventing acute asthma attacks.

Although a cure for asthma remains elusive, improvements in the range and efficacy of controller treatments have resulted in the prospect of sustained control of asthma for a majority of asthma sufferers, free of attacks and the unpredictability that characterises the disease. This development prompted the European Respiratory Society and The American Thoracic Society to convene a Task Force to re-evaluate the concept of asthma control and how it should be assessed and measured, particularly in clinical trials. Asthma is a chronic disease, and, as in other chronic diseases both current needs (to control the manifestations of the condition) and future risk need to be considered.

Asthma out of control ?

COPD and lung cancer

“This is an exciting time for COPD research as we learn more and more about the underlying inflammatory mechanisms of the disease” said Professor Peter Barnes, FMedSci, FRS Imperial College London.

Not only are new therapeutic targets being identified with the new class of drugs of Phosphodiesterase-IV-inhibitors but by reducing inflammation in COPD we are hoping to improve symptoms and possibly reduce lung cancer risk in these patients. “There is a sixfold increase in lung cancer risk for patients affected by chronic obstructive pulmonary disease” (Interview with Prof. Peter Barnes).

New therapeutic options in COPD

The term “Chronic obstructive pulmonary disease” (COPD) refers to chronic bronchitis and emphysema, two commonly co-existing diseases of the lungs in which the airways become narrowed. COPD is one of the most important chronic diseases with high morbidity, limited long-term prognosis, and a high burden for the healthcare systems. With the introduction of long-acting bronchodilators, like the beta agonists Salmeterol and Formoterol (LABA) and the anticholinergic tiotropium bromide (LAMA), a significantly better symptom control was achieved.

Exacerbations have been recognized to be a major factor for accelerated deterioration of lung function and prognosis. Large clinical trials revealed that the previously mentioned bronchodilators, and especially inhaled corticosteroids (ICS), may reduce the exacerbation frequency. Whether all three treatment principles – beta agonists, anticholinergics, and ICS – act in an additive way was unclear until recently.

A new study, presented at the congress of the ERS in Vienna, showed the superiority of the triple therapy, especially with regard to reducing the frequency of exacerbations.

Because of its long half-life, the anticholinegic tiotropium bromide is applied only once daily. In contrast, the LABAs have to be inhaled twice daily. The recently introduced indicaterol is a LABA with a much longer half-life, and a European approval of this new substance is expected. Indicaterol produced convincing results in a number of large clinical trials due to its superior bronchodilating effects and its once-daily application mode. Patients’ symptoms and exercise capacity were significantly improved, and the need for relievers was reduced.

The rate of side effects observed was similar to that seen with the established substances. Theophylline has been used for decades to treat COPD. However, due to its side effects, the substance is no longer the treatment of choice today. With the selective phosphodiesterase-4 inhibitor roflumilast, a new substance will be available that acts directly on the pathomechanism of COPD  and has fewer undesirable side effects. Patients with symptoms of bronchitis in particular showed lower exacerbation rates and improvement in lung function.

In addition to the new drugs described above, for which approval is expected shortly, a number of other new substances are being tested in early clinical trials. The goal of developing new medications is to diminish the inflammation that underlies COPD, and to control the course of the disease.

“It becomes more and more clear that COPD is not a purely pulmonary disease, but that there are important consequences for other organ systems, such as the cardiovascular system. Influencing the systemic effects of COPD will be one of the most important topics in the research of future COPD treatments”, said Professor Tobias Welte, Hannover Medical School, Hannover, Germany.

Novel therapeutic options in COPD

Hot Topic: Bronchial Thermoplasty

For six million patients with severe asthma symptoms, a new, minimally invasive procedure called bronchial thermoplasty may become a new therapeutic option. The procedure applies controlled radiofrequency-generated heat to bronchial muscles. Thus it targets the hypertrophied airway smooth muscle directly, reducing its volume by thermal energy and thereby decreasing asthma symptoms, which result from bronchial constriction and narrowing.

Airway smooth muscle is not only hypertrophic in asthma, presenting a mechanical problem, but—according to new pathogenetic concepts—is itself a site of production for inflammatory cells. In conjunction with immunological and growth factors, it initiates an inflammatory cascade and perpetuates inflammation, explained Dr. Pallav Shah, Department of Respiratory Medicine, London, UK.

Reporting at a Hot Topic Session on Airway Transplantation and Thermoplasty, he said: “So far, results of the new technique are extremely encouraging. There does not seem to be any excessive collagen deposition or remodelling as a result of the procedure.”

Late-breaking news

A novel pharmacological approach to treating asthma and other allergic conditions may lie in the blockade of a prostaglandin receptor, suggests a late-breaking study presented at the 19th Annual Congress of the European Respiratory Society. The new compound, OCOOO459, an antagonist to the CRTH2 receptor on Th2 cells that mediates airway inflammation, improved lung function and quality of life in a phase II study of patients with moderate persistent asthma, said principal investigator Professor Neil Barnes, MD, of the London Chest Hospital, UK.