European Federation of Allergy and Airways Diseases Patients Associations

Advocacy is widely recognized as a catalyst for equity in health, yet its conceptual foundations, operational forms, and evaluative criteria remain fragmented. In health systems, advocacy is expected to amplify marginalized voices, address structural determinants, and promote participatory governance, but there is limited consensus on its definition and implementation. This scoping review systematically maps how advocacy has been conceptualized, practiced, and evaluated across public health and healthcare domains in democratic societies, with particular attention to its role in advancing equity. We conducted a scoping review across four databases (PubMed, Scopus, Web of Science, CINAHL) including peerreviewed literature from health, legal, political, and social domains. Eligible studies explicitly addressed advocacy in health and care contexts, providing conceptual definitions, theoretical frameworks, or descriptions of practice, education, and evaluation. Thematic synthesis was applied to identify recurrent dimensions, strategies, and values. A total of 146 documents were included. Advocacy was consistently framed as a deliberate, value-driven practice oriented toward systemic change, social justice, and equity, despite considerable conceptual and operational variability. Applications spanned clinical care, public health promotion, community mobilization, and policy reform. Relational and communicative skills were widely emphasized as enabling factors, but evaluation remained limited: only 6 studies (4%) reported the use of specific measurement instruments, none of which were standardized. From this synthesis, we developed a preliminary blueprint for equity-oriented public health advocacy, structured around six components: normative grounding; multilevel orientation; relational and communicative practices; critical and systemic literacy; reflexive professionalism and civic agency; and evaluation and accountability mechanisms. Advocacy emerges as both a professional competency and a civic practice essential for equity-driven health systems. This review provides a conceptual foundation and a translational framework to guide integration of advocacy into policy, training, and practice. Sustained collaboration between academia, civil society, and health systems is required to institutionalise advocacy as a driver of just and inclusive health governance. OSF: https://doi.org/10.17605/OSF.IO/MEJHX

<bold>Rationale:</bold> The randomised, double-blind, placebo-controlled Phase IIb ALIENTO trial (<ext-link>NCT05037929</ext-link>) evaluated efficacy and safety of astegolimab (anti-ST2) in COPD. <bold>Methods:</bold> Participants (current/former smokers, aged 40–90 years, history of frequent exacerbations) were randomised 1:1:1 to astegolimab SC 476 mg Q2W or Q4W, or placebo, for 52 weeks. Efficacy and safety endpoints were evaluated. <bold>Results:</bold> 1301 participants were treated (Q2W, n=433; Q4W, n=437; placebo, n=431; 79% on ICS/LABA/LAMA at baseline). Annualised rate of moderate/severe COPD exacerbations (primary endpoint) was significantly lower with astegolimab Q2W vs placebo (adjusted rate reduction 15%; <italic>P</italic>=0.0494), but not Q4W vs placebo (Figure). There were numerical decreases with astegolimab Q2W in moderate/severe COPD exacerbation rate in participants with baseline EOS <300 cells/µL (RR 0.87 [95% CI 0.73, 1.04]; <italic>P</italic>=0.1210), severe exacerbation rate (RR 0.71 [95% CI 0.49, 1.05]; <italic>P</italic>=0.0883), and change from baseline to Week 52 in SGRQ-C (difference in adjusted mean –1.87 [95% CI –4.01, 0.26]; <italic>P</italic>=0.0857). No differences were seen in other secondary endpoints (Week 52). Adverse events were balanced between treatment arms. <bold>Conclusions:</bold> Astegolimab Q2W decreased annualised COPD exacerbation rate by 15% (<italic>P</italic>=0.0494) vs placebo in the overall ALIENTO population (irrespective of smoking status or EOS level), with trends for improvement in some other clinical outcomes. <fig><object-id>erj;66/suppl_69/RCT1116/F1</object-id><object-id>F1</object-id><object-id>F1</object-id><graphic></graphic></fig>

Emphysema's significant morbidity and mortality underscore the need for reliable outcome metrics in clinical trials. However, commonly accepted chronic obstructive pulmonary disease outcome measures do not adequately capture emphysema severity or progression. Computed tomography (CT) metrics have been validated as accurate indicators of pathological emphysema and predictors of chronic obstructive pulmonary disease progression, exacerbations, and mortality. This position paper reviews the evidence supporting CT densitometry as a biomarker for emphysema, establishes implementation standards, and highlights areas for future research. A systematic literature review addressed three key questions: whether CT densitometry can be used as a diagnostic biomarker of emphysema, whether CT densitometry can be used as a prognostic biomarker, and whether longitudinal change in densitometry can be used as a disease progression monitoring biomarker. Emphysema metrics, such as the percentage of low attenuation areas below -950 Hounsfield units, are validated, highly reproducible diagnostic and prognostic biomarkers. Volume-adjusted lung density is recommended for disease monitoring. Both metrics demonstrate a scan-rescan intraclass correlation coefficient of 0.99 with proper technique. The paper also discusses relevant CT physics, techniques, and sources of variation, including technical factors, physiological changes, and software analysis. Key recommendations for clinical trials include using standardized CT techniques, proper subject selection, and longitudinal evaluation with volume-adjusted lung density.

In April 2024, the European Summit "Raising the bar in respiratory care" was organized by the European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA) in the European Parliament and hosted by Members of the European Parliament Dorien Rookmaker and Mislav Kolakušić. The aim of the Summit was to respond to the need of European patients suffering from chronic respiratory diseases (CRDs) by joining forces with European and global organisations in the management of the epidemics of CRD, recognising the weaknesses of current care models and focussing on collaboration to improve care and prevention. Participants belonging to International and National Societies and Committees from the European Rhinologic Society (ERS), International Rhinologic Society (IRS), Belgian Respiratory Society (BeRS), Global Initiative for Asthma (GINA), Global Initiative for Chronic Obstructive Lung Disease (GOLD), Global Alliance against Chronic Respiratory Diseases (GARD), and from the European Federation of Allergy and Airways Diseases Patients Associations (EFA) and the EUFOREA's Patient Advisory Board (PAB) described their vision and action plan to work in partnership to raise the bar in respiratory care. This report summarizes the contributions of the representatives of different European stakeholders in the field of CRDs.

Abstract Aging is a major driving force for many diseases but the relationship between age, aging processes and age-related diseases is not fully understood. Fragmentation and loss of ultra-long-lived elastin are key features in aging and several age-related diseases leading to increased mortality. By comparing the relationship between age and elastin turnover with healthy volunteers, we show that accelerated elastin turnover by age-disease interaction is a common feature of age-related diseases.