The future of asthma research and development: a roadmap from the European Asthma Research and Innovation Partnership (EARIP)

Primary care and public health

Regional and national asthma programmes can be hugely valuable. However, there is currently only published literature available for programmes in Finland, France, Ireland, Italy, the Netherlands, Poland, Portugal and Turkey [20]. The successes and challenges of these programmes should be used as a basis for new regional and national programmes [21]. Alongside this, simple and quick tools are needed to assess the implementation of new programmes, especially in primary care settings.

Effective care pathways are an essential component of asthma programmes, with lung function testing and measuring airway inflammation key to ensuring accurate diagnosis and monitoring from childhood. In the consensus workshop, primary care professionals stressed the importance of developing an accurate, low-cost tool that can diagnose and give information on treatment effectiveness and adherence quickly in primary care settings. This tool would have application worldwide, especially in low-middle income countries [22, 23].

The disparity between lung function and the patient's experience (how they feel, if they notice any changes in their asthma, etc.) should be considered an assessment and monitoring need, and connecting patient-reported symptoms with their clinical condition presents an opportunity to develop a valuable clinical tool [21].

Triggers and risk factors for asthma and exacerbations

Environmental factors are a major problem in patients' daily lives, both in terms of quality of life and productivity; therefore, environmental factors, exacerbations and strategies to control exposure should be priority topics in both basic science and implementation research. Investigation is needed into the daily interactions between patients' asthma and their environment, and the role of environmental factors in infections and long-term asthma management in both adults and children. Specific factors identified were smoking, the impact of smoking on childhood development and pollution (especially air quality) [19].

Personalised medicine

Research into different asthma phenotypes and methods of stratifying and better understanding these phenotypes could have the greatest long-term impact of all the priorities. This should be coupled with companion diagnostics and an understanding of how different treatments can affect children in the long term, such as anti-inflammatory and anti-viral treatments and vaccines. Biomarker research is a vital component in the development of new treatments; in particular, identifying biomarkers for exacerbations, which would also enable greater understanding of the links between increased exacerbation risk and comorbidities [23–25].

Research and funding is needed to build on current work in this field, such as the big data project U-BIOPRED (2010–2015), which made major advances in our understanding of asthma by recruiting and characterising a large pan-European cohort of people with severe asthma [15, 16]. Although advancements are being made in drug development, major challenges remain in securing funding for implementation studies, and bringing new drugs to market and being prescribed for patients [24]. Workshop participants highlighted the difficulties in progressing personalised medicine and making big clinical differences, such as adequate drug options for rarer and less-controlled types of asthma, and adequate delivery of inhaler treatment [21, 23]. In order for this to happen the differences between asthmas and their phenotypes, and their impact on the airways and immune system must be fully understood.

Breakthroughs in asthma treatment are not easy and take a long time. They are also hampered by the lack of routine information sharing between primary and secondary care settings and pharmacological companies, with no requirement for clinicians to keep comparable records of a drug's performance in their patients. Current and new drugs in circulation should be evaluated for their efficacy within real-world clinical practice, with a wide range of patients over time. There should also be more data sharing between studies, with potential for structures such as the European Respiratory Society Research Agency to do this.

Self-management and adherence

The role of primary care professionals in promoting self-management brings a need for specific training on how to empower and motivate self-management in patients, especially in communicating the effectiveness of existing drugs for the majority of people with asthma when taken correctly [21]. Research would help HCPs better understand how to assess a patient's level of health literacy, engage patients with variable levels of interest in self-management, and adapt oral and written communications to meet each patient's needs and preferences. Other key areas for investment are research into the differences in access to healthcare services and treatment, and the impact of asthma on different patient populations [23].

Advances and breakthroughs in new drugs and supported self-management must be underpinned by real-world evaluation with people with different types of asthma and, importantly, with patients with a range of adherence issues (behavioural, complex drug regimes, age-related issues, poor inhaler technique, etc.) [20, 23, 25]. Asthma-specific self-management research is essential to better understand this, as generic non-condition specific research risks overlooking the influence of aspects such as medicine regimes, inhaler technique and triggers for exacerbations [18].

New technologies have an important role to play in primary prevention; research is needed to develop new and effective public awareness initiatives on asthma and air quality (indoor and outdoor), smoking and allergies [13]. For example, further innovations in mobile and electronic health platforms have the potential to revolutionise self-management by providing support and enabling professionals to assess/monitor their patient's self-management remotely [21].