Scaling up strategies of the chronic respiratory disease programme of the European Innovation Partnership on Active and Healthy Ageing (Action Plan B3: Area 5)
Clinical and Translational Allergy volume 6, Article number: 29 (2016)
Action Plan B3 of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) focuses on the integrated care of chronic diseases. Area 5 (Care Pathways) was initiated using chronic respiratory diseases as a model. The chronic respiratory disease action plan includes (1) AIRWAYS integrated care pathways (ICPs), (2) the joint initiative between the Reference site MACVIA-LR (Contre les MAladies Chroniques pour un VIeillissement Actif) and ARIA (Allergic Rhinitis and its Impact on Asthma), (3) Commitments for Action to the European Innovation Partnership on Active and Healthy Ageing and the AIRWAYS ICPs network. It is deployed in collaboration with the World Health Organization Global Alliance against Chronic Respiratory Diseases (GARD). The European Innovation Partnership on Active and Healthy Ageing has proposed a 5-step framework for developing an individual scaling up strategy: (1) what to scale up: (1-a) databases of good practices, (1-b) assessment of viability of the scaling up of good practices, (1-c) classification of good practices for local replication and (2) how to scale up: (2-a) facilitating partnerships for scaling up, (2-b) implementation of key success factors and lessons learnt, including emerging technologies for individualised and predictive medicine. This strategy has already been applied to the chronic respiratory disease action plan of the European Innovation Partnership on Active and Healthy Ageing.
Health and care services in Europe are undergoing changes to adapt systems to the growing demands caused by the expansion of chronic diseases and ageing. This restructuring involves the development and testing of innovative solutions as well as the implementation of the most successful pilots. The multitude of good practices developed throughout the European Union favours a comprehensive and multi-dimensional scaling-up strategy at European level .
The European Commission DG Santé (Directorate General for Health and Food Safety) and DG CNECT (Directorate General for Communications Networks, Content and Technology) launched the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) to enhance European Union competitiveness and to tackle societal challenges through research and innovation (Table 1) .
Chronic respiratory diseases are the pilot for chronic diseases of the EIP on AHA Action Plan B3 [3, 4]. Several effective plans exist in Europe for chronic respiratory diseases, but they are rarely deployed to other regions or countries. There is an urgent need for scaling up strategies in order to (1) avoid fragmentation, (2) improve health care delivery across Europe, (3) speed up the implementation of good practices using existing cost-effective success stories and (4) meet the triple win of the EIP on AHA:
Enabling European citizens to lead healthy, active and independent lives while ageing.
Improving the sustainability and efficiency of social and health care systems.
Boosting and improving the competitiveness of the markets for innovative products and services, responding to the ageing challenge and creating new opportunities for businesses.
This paper presents the scaling up strategy for chronic respiratory diseases strictly following the five-step framework scaling up strategy of the EIP on AHA. It may be used as a model for scaling up activities in other areas of the EIP on AHA and other chronic diseases.
AIRWAYS ICPs, the pilot for chronic diseases of the EIP on AHA
Chronic respiratory diseases include a variety of diseases such as airway diseases (allergic and non-allergic asthma, rhinitis, rhinosinusitis and COPD), occupational lung diseases, sleep apnoea syndrome, interstitial diseases, pulmonary vascular diseases and genetic diseases such as cystic fibrosis [5, 6]. Over 1 billion people in the world suffer from chronic respiratory diseases. They represent one of the priorities of the European Union (3053rd and 3131st Conclusions of the European Union Council, 2010 and 2011) [7, 8], World Health Organization (WHO 2013–2020 Noncommunicable Disease Action Plan) and the United Nations (High Level meeting on Non-Communicable Diseases, 2011) . The 2011 Polish Presidency of the European Union Council made the prevention, early diagnosis and treatment of asthma and allergic diseases a priority for the European Union’s public health policy in order to reduce health inequalities . The early determinants of chronic respiratory diseases were reinforced during the Cyprus Presidency of the European Union Council . The 2014 Italian Presidency of the European Union Council has prioritized chronic respiratory diseases. Chronic respiratory diseases represent a model of chronic diseases due to their prevalence, burden (e.g. 3 million annual deaths due to COPD), and comorbidities with other chronic diseases .
The initiative AIRWAYS ICPs (Integrated care pathways for airway diseases)  has been approved by the EIP on AHA as the model of chronic diseases of the B3 Action Plan. It is a GARD (Global Alliance against Chronic Respiratory Diseases, World Health Organization) Research Demonstration Project . It was launched by NHS England (National Health Service, Newcastle, February 2014)  and has been endorsed by the EIP on AHA Reference Site Network.
The objectives of AIRWAYS ICPs are to launch a collaboration to develop practical multisectoral care pathways (ICPs) to reduce chronic respiratory disease burden, mortality and multimorbidity. AIRWAYS-ICPs proposes a feasible, achievable and manageable project from science to guidelines and policies using existing networks and stakeholders committed to the Action Plan B3 of the EIP on AHA and GARD . It is implemented and scaled up in Europe by the EIP on AHA and globally with GARD.
AIRWAYS-ICPs has strategic relevance to the European Union Health Strategy and the World Health Organization Noncommunicable Diseases Action Plan (2013–2020). It adds value to existing public health knowledge (Table 2).
Five-step framework scaling up strategy of the EIP on AHA
Scaling up is often considered as a continuous process of change and adaptation that can take different forms . The EIP on AHA has proposed a 5-step framework for developing an individual scaling up strategy. Area 5 has already used all these steps (Table 3). The scaling up process of AIRWAYS ICPs has already been initiated, during an Action Plan B3 meeting in Brussels (March 2014).
In order to achieve a successful outcome for scaling up of innovative practice, the workforce should be appropriately educated in disease management, the necessary skills (e.g. spirometry, inhaler technique) should be present, and sufficient capacity made available both for training and the extra time necessary in consultation with the individual patient. These were critical factors in achieving success in the Finnish asthma and COPD ten year plans . Clinical recording systems need to be integrated to facilitate audit and appropriate sharing of clinical records.
Application of the EIP on AHA scaling up strategy to chronic respiratory diseases
Good practices in chronic respiratory diseases
Six commitments for action were submitted to the EIP on AHA to support AIRWAYS ICPs. Their good practices are complementary for the scaling up strategy (Table 4).
Governments of countries (e.g. Lithuania, Poland, Portugal, Turkey) or regions (e.g. Emilia-Romagna) are involved in AIRWAYS ICPs. One of the commitments for action (Norway) is a joint action between the Ministry of Health of Finland and Norway .
Other international, national or regional projects
Many guidelines, ICPs and national plans exist for the most common chronic respiratory diseases (asthma, COPD, rhinitis).
The Finnish plans for asthma , allergy  and COPD , considered to be the prototypes of national plans for chronic respiratory diseases . Polastma (Poland) is, in particular, derived from the asthma plan . A review on the European asthma plans based on the Finnish Asthma Plan is available .
The Portuguese National Programme for Respiratory Diseases (PNDR), the first national programme including all respiratory diseases .
In the Netherlands, the SMART-formulated collaborative National Action programme against Chronic Lung Diseases (NACL) aims to improve the cost-effectiveness of respiratory prescribing, while reducing hospitalisation days, productivity loss, adolescent smoking, and mortality due to asthma and COPD. Both the Ministry of Health and the collective Health Insurers Netherlands are funding the programme .
Several national or regional plans on asthma, COPD, other chronic respiratory diseases and allergy.
Care pathways provided by national institutions (e.g. NICE in the UK, National Institute for Health and Care Excellence or the Haute Autorité de Santé in France, ICP for acute asthma in children in Northern Ireland).
The World Health Organization guidelines for asthma and COPD in low-income settings (WHO PEN) .
Management plans already successfully tested in low and middle-income countries .
In Spain, Polibienestar Research Institute is developing a Multi-Agent Simulator for people requiring prolonged mechanical ventilation based on the validated LTCMAS  and following the Canadian model , which is easily replicable and transferrable to other healthcare systems and to other diseases. Moreover, this tool offers great possibilities for scaling-up and for supporting the decision-making process of health professionals and policy-makers.
Multimorbidity guidelines for chronic respiratory diseases do not exist, except for rhinitis and asthma .
The risk for developing a COPD has only been studied in Italy and represents a chart risk applicable to the entire Europe.
Palliative approaches to care in chronic respiratory disease, and planning end-of-life decisions and care/advanced care.
Guidelines with a specific target on old age adults do not exist. A Delphi process is ongoing.
Guidance documents for primary care
Some guidance documents are specifically directed to primary care—where most patients with chronic respiratory diseases are managed—such as COPD-Australia (Lung Foundation Australia with Thoracic Society of Australia and New Zealand) and Asthma Management in Australia (National Asthma Council Australia). IPCRG (International Primary Care Respiratory Group) has undertaken a mapping on national guidelines used by primary care for COPD, asthma, rhinitis, obstructive sleep apnea and stop smoking (https://www.theipcrg.org/display/ResMapping).
A centralized repository of evidence is developed to preserve data throughout the lifecycle of the project. The repository is under development by the Commission.
Assessment of viability of the scaling up of good practices
The members of AIRWAYS ICPs, ARIA and GARD [6, 13, 48] have experience in working together and have already scaled up several chronic respiratory disease good practices. Scaling up for ARIA and GARD follows the 7 key characteristics of the CORRECT features: Credible, Observable, Relevant, Relative advantage, Easy and Compatible [66, 67]. The success of the scaling up strategy and its long-term viability (over 15 years for ARIA and 8 years in GARD) has been demonstrated. GARD has been scaled up in several countries at governmental levels [13, 46–48].
Members of 13 EIP on AHA Reference Sites have agreed on the AIRWAYS ICPs concept and are co-authors of the paper . A meeting of all EIP on AHA Reference Sites was co-organised by the Région LR, North England and the EIP on AHA Reference Site Collaborative Network to scale up AIRWAYS ICPs in all Reference Sites (October 21, 2014).
The viability of ARIA and GARD has been demonstrated. The viability of AIRWAYS ICPs will be analysed according to the set of parameters provided by the Commission in the near future. The analysis will be carried out within 6 months by an AIRWAYS ICPs expert panel and revised by an independent expert panel (6 additional months). The meeting for the analysis of the viability took place in Lisbon (Directorate General of Health of Portugal), July 1-2, 2015 in collaboration with the World Health Organization GARD .
Classification of good practices for replication
Feasibility has been reviewed for the Finnish Asthma Plan (Table 6). It is expected that AIRWAYS ICPs following the expertise raised in ARIA and GARD will have a similar feasibility.
Facilitating partnership for scaling up
The ARIA programme includes over 300 members and AIRWAYS ICPs includes 445 members. The paper describing the AIRWAYS ICPs proposal is co-authored by 250 members (all stakeholders: health care professionals, social carers, patients, government officers, methodologists, etc.) . All of the members are very committed to the implementation of AIRWAYS ICPs. National and regional groups have been initiated in all but 2 European Union countries. In countries where health care is regionalised , many regional groups are in place.
Role of scientific societies
AIRWAYS ICPs is in line with the mission and vision of scientific societies which aim to (1) promote research, (2) collect, assess and diffuse scientific information, (3) represent a scientific reference body for other scientific, health and political organisations and an advocate towards political organisation and the general public, (4) encourage and provide training, continuous education and professional development and (5) collaborate with patients and lay organisations in the area of their field in order to lead the way towards better understanding, prevention, management and eventual cure of diseases. The European Academy of Allergy and Clinical Immunology (EAACI), the European Respiratory Society (ERS), the European Rhinology Society (ERS), the European Union Geriatric Medicine Society (EUGMS), the International Academy of Pediatrics and the International Primary Care Respiratory Group (IPCRG) are the major societies in Europe of their respective field and are all members of AIRWAYS ICPs. A recent meeting on precision medicine in airways and allergic diseases was held at the European Union Parliament with these societies [77, 78]. The activities of IPCRG are summarized in Additional file 1.
Role of patient’s organisations
The goal and rationale of patient involvement in medical decisions is patient empowerment. Empowered patients know their disease. Patient empowerment commences with the initial consultations at the primary care level encompassing discussions about the patient’s ideas, concerns and expectations coupled with patient education about the specific disease process, what can be done to ameliorate the disease and ultimately self-management. Patients have the skills and motivation to take good care in their everyday life, to adjust their treatment, and are prepared for new or potentially exacerbating situations. They are able to detect side-effects, contact healthcare professionals when necessary and they adhere to the treatment regime. Many tools support empowerment, shared decision making models and patient education. Patient empowerment should be included in the health care professional’s curriculum. For an optimal dissemination of good practices, there is a need for patient involvement and empowerment.
EFA (European Federation of Allergy and airways diseases patient’s association), the major patient’s organisation for respiratory and allergic diseases in Europe, has been very active for AIRWAYS ICPs [77, 78].
Diffusion of good practices
All European Union countries should be included.
The European Geriatric Medicine, the official organ of the European Union Geriatric Medicine Society (EUGMS), has initiated a column of the EIP on AHA to publish important activities of the EIP on AHA in order to inform the medical community . Several papers have already been published [2, 29, 44, 81–85].
Reference Site Network: The Reference Site Network is already committed to AIRWAYS-ICPs (decision taken during the Montpellier meeting).
Action Groups: Area 5 of Action Group B3 is leading AIRWAYS ICPs.
Event and dedicated scaling up/twinning sessions: Several events have already taken place (Table 7).
Network of excellence centres in respiratory and allergic diseases: It includes the Commitments for Action (EIP on AHA action Plan B3), Reference Sites of the EIP AHA, the Global Allergy and Asthma European Network (GA2LEN) and members of AIRWAYS ICPs. GA2LEN, a Sixth European Union Framework Programme for Research and Technological Development (FP6) Network of Excellence, was created in 2005 as a vehicle to ensure excellence in research bringing together research and clinical institutions to combat fragmentation in the European research area and to tackle allergy in its globality . The GA2LEN network has benefited greatly from the voluntary efforts of researchers who are strongly committed to this model of pan-European collaboration. The network was organized in order to increase networking for scientific and clinical projects in allergy and asthma around Europe.
Implementation, key success factors and lessons learnt
Planning and initiating the service
Needs for AIRWAYS ICPs, in particular in elderly adults and co-morbid diseases, are clear. AIRWAYS ICPs was developed following the research priorities set by the World Health Organization on chronic respiratory diseases .
The strategy, the road map and the first implementation results have been published .
ICPs for asthma have been shown to be highly cost-effective in different settings [15, 35]. Studies in developed and developing countries have shown a cost-effective reduction of hospitalisations and mortality.
Setting up a system for change
Good understanding: The members of ARIA, GARD and AIRWAYS ICPs have perceived the need for innovation, and consider it beneficial and congruent with central ideas and concepts. Deployment has been made to all stakeholders including patients and citizens. The results of the ARIA and GARD initiatives are clear [13, 46, 91–98]. Since the same methodology is used for AIRWAYS ICPs enhanced by the EIP on AHA scaling up strategy, there is no reason for a lack of understanding. The present paper is co-authored by over 450 authors from 72 countries in order to enhance understanding for different cultures, settings, health systems and languages.
Implementation of emerging technologies for predictive and personalised medicine. Systems medicine is an emerging discipline [18, 77, 78, 99]. It combines high-throughput analyses of all human genes and their products with computational, functional and clinical studies. The aim is to gain detailed understanding of disease mechanisms, and how they vary between different patient groups. This understanding can be exploited for predictive and personalised medicine, according to guidelines proposed by the European Commission (https://www.casym.eu). The first implementations may reach the clinic within the next five years for serious diseases that require costly treatments .
Political endorsement: Several meetings have been organised by the European Union. In particular, the Polish Priority of the Council [7, 8] which “WELCOMES existing networks and alliances, such as the Global Allergy and Asthma European Network (GA2LEN) and Global Alliance against Respiratory Diseases (GARD)”. There are recommendation: (i) to give appropriate consideration to prevention, early diagnosis and treatment, (ii) to strengthen cooperation with relevant stakeholders, (iii)to exchange best practices, (iv) to support national centres and existing international research networks (v) to find cost-effective procedures by using health technology assessment, (vi) to improve health care system standards relating to chronic respiratory diseases, (vii) to consider the use of e-Health tools and innovative technologies for prevention, early diagnosis and treatment of chronic respiratory diseases, and finally (viii) to support Member States by the “Commission developing and implementing effective policies, improving networking among institutions responsible for the implementation of programmes.”
A meeting at the European Union Parliament under the leadership of the Cyprus Presidency of the European Union Council  and a GARD meeting at the Italian Ministry of Health during the Presidency of the Council both reinforced the importance of chronic respiratory diseases for their early detection and management to improve AHA. The present document was presented at a meeting in Lisbon, Portugal (July 1–2, 2015) organised by the Reference Site Network of the EIP on AHA in collaboration with European Union regions and the Directorate General of Health.
MACVIA-LR is supported by a strong political endorsement at the regional level. ARIA has been adopted by several governmental policies. AIRWAYS ICPs has been launched in collaboration with NHS England, Scotland, Northern Ireland, the Ministry of Health of Portugal, Poland and Lithuania and several governments of regions (e.g. Emilia Romagna, Basque Country).
Engagement of relevant stakeholders: In ARIA, GARD and AIRWAYS ICPs, all relevant stakeholders have been included and are highly motivated: health care professionals (physicians, pharmacists, nurses, physiotherapists and others), social workers, policy makers. A special effort has been made for patient empowerment. A European Union Parliament session led by EFA, the largest European patients’ organisation in asthma and airway diseases, has been organised in collaboration with MeDALL (Mechanisms of the Development of Allergy, FP7 project) [36, 37], in May 2015. Professional societies and groups should be enlisted as active collaborators in order to enhance and even drive uptake at the country level.
Financial viability and business model: It has been shown that the implementation of the Finnish national plans, ARIA and GARD does not require large resources. However, AIRWAYS ICPs will require arrangements for the reimbursement of the services.
Organisational process and design choices
Investing in human capital: Training and reskilling the work force is an essential and fundamental component of AIRWAYS ICPs. This may require initial and continuing investment to ensure that the workforce possesses the appropriate knowledge, skills and equipment to fulfil its roles, as show by some very successful ARIA and GARD initiatives. AIRWAYS ICPs should shall go a step further, however, and be fully implemented countrywide. The EIP on AHA Reference Site Network has offered its help. The present paper has been co-authored by many professional leaders from over 70 countries to build a global momentum.
Integrating ICT solutions: Telemedicine represents a possible specific advanced tool of ICT in chronic respiratory disease management and secondary prevention. ICT solutions are integrated to support AIRWAYS ICPs implementation and the MACVIA–ARIA Sentinel NetworK has been launched in Copenhagen (June 9, 2014). A clinical decision support system (CDSS) is being built and should be available at the end of the year. This system may form the prototype for a more complex one for asthma, COPD, other chronic respiratory diseases and co-morbidities.
Organisational changes: Currently under discussion but will require flexibility in order to adapt to the needs of different areas.
Monitoring, evaluation and dissemination
These activities have been initiated by ARIA and GARD at the international level, but they are also part of the national and regional plans for chronic respiratory diseases. The Area 5 programme on chronic respiratory diseases will benefit from previous expertise, successes and failures to propose refined and updated activities.
Assessment indicators: In asthma and COPD, hospitalisation rates and mortality are two indicators of interest and are responsive to change within 2–3 years. In rhinitis, these indicators cannot be used. Control is applicable to asthma, COPD and/or rhinitis and quality of life is applicable to all 3 diseases. An economic evaluation was found to be effective in asthma in many countries [40, 74].
Mutual learning: Learning Networks for learning and sharing best practices are in place for chronic respiratory diseases. Scientific societies and patient’s organisations are of importance in the process.
Dissemination activities: One of the strengths of ARIA and GARD, and also already AIRWAYS ICPs, is the great ability to disseminate information and guidelines in countries of the European Union and globally.
Scaling up of the new good practices: Another strength of ARIA and GARD is the capacity to scale up good practices in countries of the European Union and elsewhere.
The scaling up strategy of AIRWAYS ICPs confirms that the proposed strategy of the EIP on AHA is simple and easy to follow. It may be used as a model for the scaling up strategies of other projects of the EIP on AHA.
- AIRWAYS ICPs:
integrated care pathways for airway diseases
Allergic Rhinitis and its Impact on Asthma
chronic obstructive pulmonary disease
- EIP on AHA:
European Innovation Partnership on Active and Healthy Ageing
Global Allergy and Asthma European Network (FP6)
WHO Global Alliance against Chronic Respiratory Diseases
integrated care pathway
International Primary Care Respiratory Group
Contre les MAladies Chroniques pour un VIeillissement Actif (Fighting chronic diseases for active and healthy ageing)
MACVIA–ARIA Sentinel NetworK
National Health Service
World Health Organization
visual analogue scale
Uvin P. Fighting hunger at the grassroots: paths to scaling up. World Dev. 1995;23(6):937–9.
Bousquet J, Michel J, Standberg T, Crooks G, Iakovidis I, Gomez M. The European Innovation Partnership on Active and Healthy Ageing: the European Geriatric Medicine introduces the EIP on AHA column. Eur Geriatr Med. 2014;5(6):361–2.
Bousquet J, Addis A, Adcock I, Agache I, Agusti A, Alonso A, et al. Integrated care pathways for airway diseases (AIRWAYS-ICPs). Eur Respir J. 2014;44(2):304–23.
Bousquet J, Barbara C, Bateman E, Bel E, Bewick M, Chavannes N, et al. AIRWAYS ICPs (European Innovation Partnership on Active and Healthy Ageing) from concept to implementation. Eur Respir J. 2016;47(4):1028-33. doi:10.1183/13993003.01856-2015.
Bousquet J, Dahl R, Khaltaev N. Global alliance against chronic respiratory diseases. Allergy. 2007;62(3):216–23.
Bousquet J, Khaltaev N. Global surveillance, prevention and control of chronic respiratory diseases. A comprehensive approach. Global alliance against chronic respiratory diseases. World Health Organization. ISBN 978 92 4 156346 8. 2007; 148 pp.
Samolinski B, Fronczak A, Wlodarczyk A, Bousquet J. Council of the European Union conclusions on chronic respiratory diseases in children. Lancet. 2012;379(9822):e45–6.
Samolinski B, Fronczak A, Kuna P, Akdis CA, Anto JM, Bialoszewski AZ, et al. Prevention and control of childhood asthma and allergy in the EU from the public health point of view: Polish Presidency of the European Union. Allergy. 2012;67(6):726–31.
Beaglehole R, Bonita R, Alleyne G, Horton R, Li L, Lincoln P, et al. UN high-level meeting on non-communicable diseases: addressing four questions. Lancet. 2011;378(9789):449–55.
Bousquet J, Tanasescu CC, Camuzat T, Anto JM, Blasi F, Neou A, et al. Impact of early diagnosis and control of chronic respiratory diseases on active and healthy ageing. A debate at the European Union Parliament. Allergy. 2013;68(5):555–61.
Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012;380(9836):37–43.
Wilson N, Bewick M, Dziworski W. Maintaining health despite chronic illness in the elderly: a multi-disciplinary study visit to the north of England region. Eur Geriatr Med. 2015;6(4):396–400.
Yorgancioglu A, Cruz AA, Bousquet J, Khaltaev N, Mendis S, Chuchalin A, et al. The Global Alliance against Respiratory Diseases (GARD) Country report. Prim Care Respir J. 2014;23(1):98–101.
Package of essential noncommunicable (PEN) disease interventions for primary health care in low-resource settings. Cancer, diabetes, heart disease and stroke, chronic respiratory disease. WHO, editor, 2010.
Fairall L, Bateman E, Cornick R, Faris G, Timmerman W, Folb N, et al. Innovating to improve primary care in less developed countries: towards a global model. BMC Innov. 2015;1(4):196–203.
Bousquet J, Dahl R, Khaltaev N. GARD (Global Alliance against chronic Respiratory Diseases). Rev Mal Respir. 2006;23(4 Pt 2):10S73–5.
Bousquet J, Mantzouranis E, Cruz AA, Ait-Khaled N, Baena-Cagnani CE, Bleecker ER, et al. Uniform definition of asthma severity, control, and exacerbations: document presented for the World Health Organization Consultation on Severe Asthma. J Allergy Clin Immunol. 2010;126(5):926–38.
Bousquet J, Jorgensen C, Dauzat M, Cesario A, Camuzat T, Bourret R, et al. Systems medicine approaches for the definition of complex phenotypes in chronic diseases and ageing. From concept to implementation and policies. Curr Pharm Des. 2014;20(38):5928–44.
Bousquet J, Anto JM, Demoly P, Schunemann HJ, Togias A, Akdis M, et al. Severe chronic allergic (and related) diseases: a uniform approach—a MeDALL–GA2LEN–ARIA position paper. Int Arch Allergy Immunol. 2012;158(3):216–31.
Bousquet J, Schunemann HJ, Bousquet PJ, Bachert C, Canonica GW, Casale TB, et al. How to design and evaluate randomized controlled trials in immunotherapy for allergic rhinitis: an ARIA–GA2LEN statement. Allergy. 2011;66(6):765–74.
Bousquet J, Schunemann HJ, Samolinski B, Demoly P, Baena-Cagnani CE, Bachert C, et al. Allergic rhinitis and its impact on asthma (ARIA): achievements in 10 years and future needs. J Allergy Clin Immunol. 2012;130(5):1049–62.
Bousquet J, Schunemann HJ, Zuberbier T, Bachert C, Baena-Cagnani CE, Bousquet PJ, et al. Development and implementation of guidelines in allergic rhinitis—an ARIA–GA2LEN paper. Allergy. 2010;65(10):1212–21.
Brozek JL, Baena-Cagnani CE, Bonini S, Canonica GW, Rasi G, van Wijk RG, et al. Methodology for development of the Allergic Rhinitis and its Impact on Asthma guideline 2008 update. Allergy. 2008;63(1):38–46.
Brozek JL, Bousquet J, Baena-Cagnani CE, Bonini S, Canonica GW, Casale TB, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: 2010 revision. J Allergy Clin Immunol. 2010;126(3):466–76.
Bousquet J, Cruz A, Robalo-Cordeiro C. Obstructive sleep apnoea syndrome is an under-recognized cause of uncontrolled asthma across the life cycle. Rev Port Pneumol. 2006;22(1):1–3. doi:10.1016/j.rppnen.2015.12.006.
Bousquet J, Schunemann HJ, Fonseca J, Samolinski B, Bachert C, Canonica GW, et al. MACVIA–ARIA Sentinel NetworK for allergic rhinitis (MASK-rhinitis): the new generation guideline implementation. Allergy. 2015;70(11):1372–92.
Bousquet J, Anto JM, Berkouk K, Gergen P, Antunes JP, Auge P, et al. Developmental determinants in non-communicable chronic diseases and ageing. Thorax. 2015;70(6):595–7.
Bousquet J, Kuh D, Bewick M, Strandberg T, Farrell J, Pengelly R, et al. Operational definition of active and healthy ageing (AHA): framework concensus. J Nutr Health Aging. 2015;19(9):955–60.
Bousquet J, Kuh D, Bewick M, Strandberg T, Farrell J, Pengelly R, et al. Operational definition of active and healthy ageing (AHA): report of the meeting held in Montpellier October 21,22-2012. Eur Geriatr Med. 2015;6(2):196–200.
Bousquet J, Malva J, Nogues M, Rodriguez-Mañas L, Vellas B, Farrell J, et al. Operational definition of active and healthy ageing (AHA): the European Innovation Partnership (EIP) on AHA Reference Site questionnaire. J Am Med Dir Assoc. 2015;16(12):1020–6.
Malva JO, Bousquet J. Operational definition of active and healthy ageing: roadmap from concept to change of management. Maturitas. 2016;84:3–4.
Nogues M, Jeandel C, Touchon J, Pinto N, Blain H, Leglise M, et al. Living Lab Fragilité MACVIA-LR. Presse Med. 2015;44(Suppl 1):S6–S22.
Samolinski B, Raciborski F, Bousquet J, Kosiniak-Kamysz W, Radziewicz-Winnicki I, Kłak A, et al. Development of Senioral Policy in Poland. Eur Geriatr Med. 2015;6:389–95.
Bourret R, Bousquet J, Mercier J, Camuzat T, Bedbrook A, Demoly P, et al. MASK rhinitis, a single tool for integrated care pathways in allergic rhinitis. World Hosp Health Serv. 2015;51(3):36–9.
Kupczyk M, Haahtela T, Cruz AA, Kuna P. Reduction of asthma burden is possible through National Asthma Plans. Allergy. 2010;65(4):415–9.
Bousquet J, Anto J, Auffray C, Akdis M, Cambon-Thomsen A, Keil T, et al. MeDALL (Mechanisms of the Development of ALLergy): an integrated approach from phenotypes to systems medicine. Allergy. 2011;66(5):596–604.
Bousquet J, Anto JM, Wickman M, Keil T, Valenta R, Haahtela T, et al. Are allergic multimorbidities and IgE polysensitization associated with the persistence or re-occurrence of foetal type 2 signalling? The MeDALL hypothesis. Allergy. 2015;70(9):1062–78.
Hartmann A, Linn J. Scaling up: a framework and lessons for development effectiveness from literature and practice. Brookings: Wolfensohn Center for Development; 2008.
Kinnula VL, Vasankari T, Kontula E, Sovijarvi A, Saynajakangas O, Pietinalho A. The 10-year COPD Programme in Finland: effects on quality of diagnosis, smoking, prevalence, hospital admissions and mortality. Prim Care Respir J. 2011;20(2):178–83.
Haahtela T, Tuomisto LE, Pietinalho A, Klaukka T, Erhola M, Kaila M, et al. A 10 year asthma programme in Finland: major change for the better. Thorax. 2006;61(8):663–70.
Haahtela T, von Hertzen L, Makela M, Hannuksela M. Finnish Allergy Programme 2008–2018—time to act and change the course. Allergy. 2008;63(6):634–45.
Selroos O, Kupczyk M, Kuna P, Lacwik P, Bousquet J, Brennan D, et al. National and regional asthma programmes in Europe. Eur Respir Rev. 2015;24(137):474–83.
Lodrup Carlsen KC, Haahtela T, Carlsen KH, Smith A, Bjerke M, Wickman M, et al. Integrated allergy and asthma prevention and care: report of the MeDALL/AIRWAYS ICPs meeting at the ministry of health and care services, Oslo, Norway. Int Arch Allergy Immunol. 2015;167(1):57–64.
Bousquet J, Kowalski M, Michel J. The senioral policy in Poland uses the expertise of the European Innovation Partnership on Active and Healthy Ageing. Eur Geriatr Med. 2015;6:293–94.
Portuguese National Programme for Respiratory Diseases 2012–2016. Portugese Directorate General of Heatlh. 2012.
Yorgancioglu A, Turktas H, Kalayci O, Yardim N, Buzgan T, Kocabas A, et al. The WHO global alliance against chronic respiratory diseases in Turkey (GARD Turkey). Tuberk Toraks. 2009;57(4):439–52.
Yorgancioglu A, Yardim N, Ergun P, Karlikaya C, Kocabas A, Mungan D, et al. Integration of GARD Turkey national program with other non-communicable diseases plans in Turkey. Tuberk Toraks. 2010;58(2):213–28.
Laurendi G, Mele S, Centanni S, Donner CF, Falcone F, Frateiacci S, et al. Global alliance against chronic respiratory diseases in Italy (GARD-Italy): strategy and activities. Respir Med. 2012;106(1):1–8.
Boulet LP, FitzGerald JM, Levy ML, Cruz AA, Pedersen S, Haahtela T, et al. A guide to the translation of the global initiative for asthma (GINA) strategy into improved care. Eur Respir J. 2012;39(5):1220–9.
Reddel HK, Bateman ED, Becker A, Boulet LP, Cruz AA, Drazen JM, et al. A summary of the new GINA strategy: a roadmap to asthma control. Eur Respir J. 2015;46(3):622–39.
Reddel HK, Levy ML. Global Initiative for Asthma Scientific C, Dissemination, Implementation C. The GINA asthma strategy report: what’s new for primary care? NPJ Prim Care. Respir Med. 2015;25:15050.
Bousquet J, Humbert M. GINA 2015: the latest iteration of a magnificent journey. Eur Respir J. 2015;46(3):579–82.
Vestbo J, Hurd SS, Agusti AG, Jones PW, Vogelmeier C, Anzueto A, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2013;187(4):347–65.
Fokkens W, Lund V, Mullol J. EP3OS. European position paper on rhinosinusitis and nasal polyps. 2007. Rhinology. 2007;45(Suppl 20):1–139.
Chung KF, Wenzel SE, Brozek JL, Bush A, Castro M, Sterk PJ, et al. International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma. Eur Respir J. 2014;43(2):343–73.
Walker S, Khan-Wasti S, Fletcher M, Cullinan P, Harris J, Sheikh A. Seasonal allergic rhinitis is associated with a detrimental effect on examination performance in United Kingdom teenagers: case-control study. J Allergy Clin Immunol. 2007;120(2):381–7.
Morais-Almeida M, Pite H, Pereira AM, Todo-Bom A, Nunes C, Bousquet J, et al. Prevalence and classification of rhinitis in the elderly: a nationwide survey in Portugal. Allergy. 2013;68(9):1150–7.
Morais-Almeida M, Santos N, Pereira AM, Branco-Ferreira M, Nunes C, Bousquet J, et al. Prevalence and classification of rhinitis in preschool children in Portugal: a nationwide study. Allergy. 2013;68(10):1278–88.
Bousquet J, Van Cauwenberge P, Khaltaev N. Allergic rhinitis and its impact on asthma. J Allergy Clin Immunol. 2001;108(5 Suppl):S147–334.
Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, et al. Allergic rhinitis and its impact on asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy. 2008;63(Suppl 86):8–160.
Brozek JL, Akl EA, Alonso-Coello P, Lang D, Jaeschke R, Williams JW, et al. Grading quality of evidence and strength of recommendations in clinical practice guidelines. Part 1 of 3. An overview of the GRADE approach and grading quality of evidence about interventions. Allergy. 2009;64(5):669–77.
Padjas A, Kehar R, Aleem S, Mejza F, Bousquet J, Schunemann HJ, et al. Methodological rigor and reporting of clinical practice guidelines in patients with allergic rhinitis: QuGAR study. J Allergy Clin Immunol. 2014;133(3):777.e4–783.e4.
Glacy J, Putnam K, Godfrey S, Falzon L, Mauger B, Samson D, et al. Treatments for seasonal allergic rhinitis. AHRQ comparative effectiveness reviews. Rockville, 2013.
Grimaldo F, Orduna J, Rodenas F, Garces J, Lozano M. Towards a simulator of integrated long-term care systems for elderly people. Int J Artif Intell Tools. 2014;23:1–24.
Rose L, Fraser IM. Patient characteristics and outcomes of a provincial prolonged-ventilation weaning centre: a retrospective cohort study. Can Respir J. 2012;19(3):216–20.
Glaser E, Abelson H, Garrison K. Putting knowledge to use: facilitating the diffusion of knowledge and the implementation of planned change. San Francisco: Jossey-Bass; 1983.
Council Europa. Council conclusions on the Reflection process on modern, responsive and sustainable health systems. 2013. http://www.consilium.europa.eu/uedocs/cms_data/docs/pressdata/en/lsa/140004.pdf.
Bousquet J, Rosado Pinto J, Barbara C, Correira da Sousa J, Fonseca J, Pereira Miguel J, et al. Portugal at the cross road of international chronic respiratory programmes. Rev Port Pneumol. 2015;21(5):230–2.
Haahtela T, Klaukka T, Koskela K, Erhola M, Laitinen LA. Asthma programme in Finland: a community problem needs community solutions. Thorax. 2001;56(10):806–14.
Souza-Machado C, Souza-Machado A, Franco R, Ponte EV, Barreto ML, Rodrigues LC, et al. Rapid reduction in hospitalisations after an intervention to manage severe asthma. Eur Respir J. 2010;35(3):515–21.
Cruz AA, Bousquet PJ. The unbearable cost of severe asthma in underprivileged populations. Allergy. 2009;64(3):319–21.
Bousquet J, Bieber T, Fokkens W, Kowalski M, Humbert M, Niggemann B, et al. In Allergy, ‘A new day has begun’. Allergy. 2008;63(6):631–3.
Cruz AA, Souza-Machado A, Franco R, Souza-Machado C, Ponte EV, Moura Santos P, et al. The impact of a program for control of asthma in a low-income setting. World Allergy Organ J. 2010;3(4):167–74.
Franco R, Santos AC, do Nascimento HF, Souza-Machado C, Ponte E, Souza-Machado A, et al. Cost-effectiveness analysis of a state funded programme for control of severe asthma. BMC Public Health. 2007;7:82.
Masoli M, Fabian D, Holt S, Beasley R. The global burden of asthma: executive summary of the GINA Dissemination Committee report. Allergy. 2004;59(5):469–78.
Fischer GB, Camargos PA, Mocelin HT. The burden of asthma in children: a Latin American perspective. Paediatr Respir Rev. 2005;6(1):8–13.
Muraro A, Fokkens WJ, Pietikainen S, Borrelli D, Agache I, Bousquet J, et al. European symposium on precision medicine in allergy and airways diseases: report of the European Union parliament symposium (October 14, 2015). Rhinology. 2015.
Muraro A, Fokkens WJ, Pietikainen S, Borrelli D, Agache I, Bousquet J, et al. European Symposium on Precision Medicine in Allergy and Airways Diseases: report of the European Union Parliament Symposium (October 14, 2015). Allergy. 2015.
Eurobarometer qualitative study. Patient involvement. http://eceuropaeu/public_opinion/archives/quali/ql_5937_patient_enpdf. 2012.
Sanna L. Assessing the involvement of the patient community in European commission co-funded health projects: the experience of the value + project. J Ambul Care Manage. 2010;33(3):265–71.
de-Manuel-Keenoy E, David M, Mora J, Prieto L, Domingo C, Orueta J, et al. Activation of stratification strategies and results of the interventions on frail patients of healthcare services (ASSEHS) DG Sanco Project No. 2013 12 04. Eur Geriatr Med. 2014;5(5):342–6.
Bousquet J, Bourquin C, Augé P, Domy P, Bringer J, Camuzat T, et al. MACVIA-LR Reference Site of the European Innovation Partnership on Active and Healthy Ageing. Eur Geriatr Med. 2014;5(6):406–15.
Blain H, Abecassis F, Adnet P, Alomène B, Amouyal M, Bardy B, et al. Living Lab Falls-MACVIA-LR: the falls prevention initiative of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) in Languedoc Roussillon. Eur Geriatr Med. 2014;5(6):416–25.
O’Caoimh R, Sweeney C, Hynes H, McGladea C, Cornally N, Daly E, et al. COLLaboration on AGEing-COLLAGE: Ireland’s three star reference site for the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA). Eur Geriatr Med. 2015;6(6):505–11.
Briggs R, Holmerová I, Martin FC, O’Neill D. Towards standards of medical care for physicians in nursing homes. Eur Geriatr Med. 2015;6(4):401–3.
Global Alliance against Chronic Respiratory Diseases (GARD). In: 9th general meeting, 14–16 August 2014, Salvador, Brazil. WHO/NMH/MND/CPM/14.1. wwwwhoint. 2014.
Global Alliance against Chronic Respiratory Diseases (GARD). In: 10th general meeting, 1–2 July 2015, Lisbon, Portugal. WHO/NMH/MND/CPM/15.1. wwwwhoint. 2015.
Bousquet J, Grouse L, Zhong N. The fight against chronic respiratory diseases in the elderly: the European Innovation Partnership on Active and Healthy Aging and beyond. J Thorac Dis. 2015;7(1):108–10.
Bousquet J, Burney PG, Zuberbier T, Cauwenberge PV, Akdis CA, Bindslev-Jensen C, et al. GA2LEN (Global Allergy and Asthma European Network) addresses the allergy and asthma ‘epidemic’. Allergy. 2009;64(7):969–77.
Bousquet J, Kiley J, Bateman ED, Viegi G, Cruz AA, Khaltaev N, et al. Prioritised research agenda for prevention and control of chronic respiratory diseases. Eur Respir J. 2010;36(5):995–1001.
Yorgancioglu A, Ozdemir C, Kalayci O, Kalyocu AF, Bachert C, Baena-Cagnani CE, et al. ARIA (Allergic rhinitis and its impact on asthma) Achievements in 10 years and future needs. Tuberk Toraks. 2012;60(1):92–7.
Agache I, Deleanu D, Khaltaev N, Bousquet J. Allergic rhinitis and its impact upon asthma–update (ARIA 2008). Romanian perspective. Pneumologia. 2009;58(4):255–8.
Bachert C, Jorissen M, Bertrand B, Khaltaev N, Bousquet J. Allergic Rhinitis and its impact on asthma update (ARIA 2008). The Belgian perspective. B-ENT. 2008;4(4):253–7.
Cagnani CE, Sole D, Diaz SN, Zernotti ME, Sisul JC, Borges MS, et al. Allergic rhinitis update and its impact on asthma (ARIA 2008). Latin American perspective. Rev Alerg Mex. 2009;56(2):56–63.
Kalayci O, Yorgancioglu A, Kalyoncu F, Khaltaev AN, Bousquet J. Allergic rhinitis and its impact on asthma update (ARIA 2008): the Turkish perspective. Turk J Pediatr. 2008;50(4):307–12.
Mullol J, Valero A, Alobid I, Bartra J, Navarro AM, Chivato T, et al. Allergic rhinitis and its impact on asthma update (ARIA 2008). The perspective from Spain. J Investig Allergol Clin Immunol. 2008;18(5):327–34.
Pali-Scholl I, Pohl W, Aberer W, Wantke F, Horak F, Jensen-Jarolim E, et al. Allergic rhinitis and its impact on asthma (ARIA update 2008) The Austrian perspective. Wien Med Wochenschr. 2009;159(3–4):87–92.
Pawankar R, Bunnag C, Chen Y, Fukuda T, Kim YY, Le LT, et al. Allergic rhinitis and its impact on asthma update (ARIA 2008)—western and Asian-Pacific perspective. Asian Pac J Allergy Immunol. 2009;27(4):237–43.
Canonica G, Bachert C, Hellings P, Ryan D, Valovirta E, Wickman M, et al. Allergen immunotherapy (AIT): a prototype of precision medicine. World Allergy Organ J. 2015;8(1):31.
Zhang H, Gustafsson M, Nestor C, Chung KF, Benson M. Targeted omics and systems medicine: personalising care. Lancet Respir Med. 2014;2(10):785–7.
All the authors participated in scaling up strategy of AIRWAYS ICPs. All authors read and approved the final manuscript.
The authors declare that they have no competing interests, except: Bousquet, Calverley, Carr, Custovic, De Carlo, Demoly, Fonseca, Gemicioglu, Howarth, Just, Klimek, Koppelman, MacNee, Mullol, Naclerio, Papadopoulos, Papi, Pedersen, Pin, Plavec, Pohl, Rosario, Siafakas, Similowski, Sterk, Valenta, VanHage, Vogelmeier, Yawn.