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Interview with ERS president Prof. Tobias Welte

Prof. Tobias Welte, Medical University Hannover, Germany
ERS 2019

Prevention is Better than Cure

Interview with Prof. Tobias Welte, MD, PhD, conducted October 2019 by Dr Susanne Kammerer

Prof. Tobias Welte is president of the European Respiratory Society (ERS) and head of the Clinic for Pneumology, Medical University Hannover, Germany.

Prof. Welte, why did you choose prevention as this year’s main theme for the ERS congress?

Simply said, in my opinion, the best disease is the one you will never get. As Hippocrates declared 3000 years ago, “prevention is always better than cure”. We are increasingly aware of the fact that many chronic respiratory diseases start in childhood and that early life events are predictors for later life. Hence, with this new perspective we have to invest in prevention to avoid damage. This is not only necessary during childhood, but also throughout the lifetime. Preventive measures are less expensive than treatment of advanced disease.

What are your focused activities with regard to prevention?

Of course, smoking cessation is still important as the rate of smokers all over the world remains stable at approximately 30%. It is a shame that we invest large sums into expensive treatments, but we do not invest in smoking cessation. In for example Germany, smoking cessation activities are not paid for by the health care insurance, while on the other hand a 100.000 euro medication in oncology is paid for without hesitation. We absolutely have to change this approach.

Secondly, every human being has to breathe air. Air pollution is a major risk factor for chronic lung disease, although the exact mechanisms of lung damage are not known. Therefore, we have to invest in research to better understand these mechanisms. Nonetheless, it is evident that a Respiratory Society has to advocate for cleaner air.

Thirdly, infectious disease plays a major role in lung diseases either as an acute disease like pneumonia or as a driver of nearly all chronic respiratory diseases. We know that vaccination is a very effective tool to reduce the number of infectious disease episodes and that vaccination is recommended for everyone suffering from chronic lung disease. However, thus far vaccination rates all over Europe are low and far away from what I would expect.

Concerning new drugs, what is the most interesting that you have heard at this congress?

There are a number of new developments in different fields of respiratory medicine. Long-term data about the efficacy of biologicals in severe asthma are presented here in Madrid, showing a tremendous effect on symptoms, exacerbation rate, and health-related quality of life. These drugs are certainly a game changer for numerous patients with severe asthma. Many of my patients tell me that they now have an entirely different life. This is truly exciting.

We also have new drugs for rare diseases, for example interstitial lung disease, for which no treatment was available for 50 years. Currently, an increasing number of new drugs are being developed for this disease and many new studies have been presented here, which is excellent.

Last but not least, new antibiotics are available. We certainly did not expect this ten years ago. At this time antibiotic resistance seemed to increase faster than new anti-infectives could be developed. This changed now that “designed” antibiotics are close to be introduced into the market, as a consequence of a better knowledge about pathogen biology. These very sophisticated products are presented here at the ERS congress. Moreover, new vaccines are presented here, some of them for diseases for which no treatment was available before, for instance RS virus infection or tuberculosis.

What are your future goals as ERS president?

My future goals are and will always be focused on better patient care. From a broader perspective, I believe that we have to listen to patients about their priorities in diagnostics and treatments. Likewise, we need to focus more on early life events to address diseases earlier after their initiation. In my opinion, we focus too much on late disease stages and advanced disease. In addition, the focus is too much on medical treatment, still non-pharmacological treatment like smoking cessation, exercise activity, and vaccination has to be implemented better into our clinical practice.

With many online possibilities these days, is it still worth to visit ERS in person?

Of course, I am really excited about all the new possibilities new media offer like webinars, online conferences and so forth. However, the ERS conference is more than solely a scientific and educational conference. It is an important communication platform. Once a year we have to meet each other, because direct inter-human communication is definitely not replaceable.

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