The Home of Clinical Physiology in the European Respiratory Society

1Secretary of Assembly 4, European Respiratory Society. 2Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy.

Assembly 4: the home of clinical physiology in the European Respiratory Society

Cite as: Aliverti A, Assembly 4: the home of clinical Meet the Assemblies physiology in the European Respiratory Society. Breathe 2015: 11: 317–318.

During the second half of the 20th century, respi- Is it a combination of these factors? Are we miss- ratory physiology has been one of the core dis- ing something in the complex series of phenom- ciplines in respiratory medicine. Undoubtedly, ena wherein ventilation, gas exchange, blood flow, clinical and basic physiologists were crucial to haemoglobin, muscle oxygen/carbon dioxide creating the European Respiratory Society (ERS) transport and oxygen utilisation/carbon dioxide 25 years ago. What does “respiratory physiology” production all contribute? Or do we need to better mean today? And what does respiratory physiology characterise structural alterations in the lungs of mean to ERS? our patient by imaging? Let’s take a patient with chronic obstructive This is just an example of the interesting prob- pulmonary disease (COPD) who has serious lim- lems in the integrative physiology of disease that itation in performing exercise. Although this is have important practical implications; under- not a surprise, it is not obvious how to answer to standing which mechanisms underlie a clini- a simple question like “what causes this limita- cal feature helps to better tailor treatment, for tion?”. Is it because the patient’s end-expiratory example. At ERS, Assembly 4 is the right place for volume, already abnormally high at rest, progres- debating these kinds of questions. It is the place sively increases during exercise due to expiratory where physicians and physiologists meet. It is the flow limitation leading to intolerable dyspnoea place for clinical physiology. associated with the lack of inspiratory reserve? More than 1200 ERS members with these Is it because the lower limb muscles in our COPD kinds of interests are organised into three groups: patient are atrophied, weak, fatigable and met- “Clinical respiratory physiology, exercise and func- abolically inefficient? Is it because lung hyperin- tional imaging” (group 4.1), “Sleep” (group 4.2) flation and excessive use of respiratory muscles and “Pulmonary Circulation” (group 4.3). Clinical adversely affect cardiocirculatory function and physiology spans many different areas, so there thus ventilatory/locomotor muscle interactions? are many points of contact not only between these

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http://doi.org/10.1183/20734735.010615 Breathe | December 2015 | Volume 11 | No 4 317 Meet Assembly 4

three groups but also with groups of other Assem- The Group carries out educational and scientific blies. These continuous links and contacts lead to activities in cooperation with the European Sleep a large number of initiatives, such as successful Research Society and respiratory sleep medicine symposia at annual ERS meetings, research and is a HERMES (Harmonised Education in Respira- education projects, Task Forces, research semi- tory Medicine for European Specialists) project. nars and awards. In the future, the Group will reinforce and better Group 4.1, formed by about 400 members, was coordinate the activities in the paediatric field, in established few years ago by merging the groups addition to adult respiratory sleep medicine, and “Gas exchange and exercise” and “Respiratory in pathophysiological and translational science. structure and function”. The Group, which is very The objectives of Group 4.3 (about 300 mem- active, is formed of a heterogeneous and multi- bers) are multiple. Firstly, the Group aims to pro- disciplinary set of members who have a strong vide a link between basic research with strong interest in different aspects of applied respiratory physiological background and the physiopathology physiology, and study the mechanisms underlying of pulmonary arterial hypertension. The Group also alterations in respiratory structure and function. develops postgraduate training in the physiology of Lung and airway mechanics, lung ventilation, lung pulmonary circulation and the diagnosis and treat- perfusion, gas exchange, respiratory and periph- ment of pulmonary vascular disease, and promotes eral muscle function, control of breathing, and pulmonary circulation as a physiological and clin- dyspnoea are typical topics covered by the Group. ical topic among members of the ERS and outside The study of exercise physiology and pathophys- the society, with a special emphasis on joint meet- iology, in particular the factors limiting exercise ings with other learned societies (e.g. the American in the different respiratory diseases, represents a Thoracic Society, the American Heart Association core area of initiatives, which include very popular and the European Society of Cardiology (ESC)). and successful courses on exercise testing. More Finally, the group is working to generate consen- recently, the Group has also covered the area of sus statements and recommendations that will respiratory functional imaging, which is the mod- be endorsed by the ERS (in conjunction with other ern way of performing functional evaluation of air- learned societies) on pulmonary vascular disease. way and lung function, traditionally dominated by The group is also actively collaborating and joining tests like spirometry, which are of course useful efforts with the ESC, namely its working group on but limited in their specificity. A Task Force organ- Right Ventricular Function. ised by the Group is working to create a compre- Assembly 4 is highly active and motivated. Just hensive flow chart of up-to-date lung function to give an example, in the last ERS International testing, where all techniques, both traditional and Congress in Amsterdam, the Netherlands, 517 recent, are positioned relative to each other. In the abstracts (12.8% of the total) were presented in future, the Group is going to further strengthen its several sessions, together with a large number of links and initiatives with other scientific groups, symposia, challenging clinical cases, Educational such as those dealing with physical activity and Skills Workshops, Grand Rounds, Lunchtime Ses- rehabilitation. sions, Meet the Expert sessions and Postgradu- Group 4.2 is the largest in Assembly 4 (over ate Courses. A strength and, at the same time, a 600 members). The Group represents an oppor- weakness of the Assembly is that the Groups are tunity for those scientists and clinicians who are quite heterogeneous, and this will be an issue to interested in understanding the mechanisms be faced in the next future. Nevertheless, there through which breathing is regulated during are no doubts that Assembly 4 plays a crucial role wakefulness and sleep. Major interests include within the ERS. Applying clinical physiology to the nature of disordered respiratory control in dis- respiratory disease not only leads to new insights ease, and the causes and consequences of sleep into how the respiratory system works when it is disordered breathing. By organising a specific Task stressed but also helps to identify new areas where Force, the Group has recently focused its activities diagnosis and treatment is going to transform the on raising the awareness of sleep and breathing lives of large numbers of people suffering respi- problems at the level of the European Commis- ratory problems. That’s why there will always be sion, to identify sleep-related disorders as a major a home for clinical physiology at the ERS and this priority in European Union health policies, and to home’s door will always be open to those willing campaign for greater research funding in this area. to contribute!

318 Breathe | December 2015 | Volume 11 | No 4