Asthma is a chronic inflammatory respiratory disease often associated with comorbidities. Among cardiovascular comorbidities, arterial hypertension seems to create an additional health burden in asthmatics. However, evidence on this relationship is lacking.
Our study aims to evaluate the characteristics of hypertensive asthmatics, focusing on the role of inflammation as a possible link between these diseases.
We conducted a monocentric retrospective analysis consecutively including asthmatics who underwent induced sputum (IS) at our asthma referral center. Patients were divided in two groups according to presence or absence of history of hypertension. Clinical, functional, and inflammatory (airway and systemic) data were collected.
Our data suggest that neutrophilic airway inflammation (as evaluated by induced sputum) is strictly associated with hypertension. In clinical practice, phenotyping asthmatic patients with comorbidities like hypertension could be useful also from a therapeutic point of view. Additional studies are mandatory to further elucidate the role of neutrophilic airway inflammation in asthma with cardiovascular diseases.
Volume 11 - 2024 | <a class="ArticleLayoutHeader__info__doi" href="https://doi.org/10.3389/fmed.2024.1451625">https://doi.org/10.3389/fmed.2024.1451625</a>
Introduction: Asthma is a chronic inflammatory respiratory disease often associated with comorbidities
arterial hypertension seems to create an additional health burden in asthmatics
Objective: Our study aims to evaluate the characteristics of hypertensive asthmatics
focusing on the role of inflammation as a possible link between these diseases
Methods: We conducted a monocentric retrospective analysis consecutively including asthmatics who underwent induced sputum (IS) at our asthma referral center
Patients were divided in two groups according to presence or absence of history of hypertension
and inflammatory (airway and systemic) data were collected
Results: Data on two hundred and sixty asthmatic patients were analyzed
Seventy-nine (30.4%) of them had a diagnosis of hypertension requiring a specific pharmacological treatment
Asthmatics with hypertension were more frequently male (p&#x2009;=&#x2009;0.047)
and with higher body max index (BMI) (p&#x2009;&#x0003C;&#x2009;0.001) when compared to normotensive patients
severity and pharmacological treatment was observed between the two groups (all p&#x2009;&#x0003E;&#x2009;0.05); distribution of comorbidities and lung function impairment (forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC); all p&#x2009;&#x0003C;&#x2009;0.05) were statistically different between groups
Mixed granulocytic airway inflammation was prevalent in the hypertensive asthmatics (p&#x2009;=&#x2009;0.014)
a multivariable analysis revealed that age&#x2009;&#x02265;&#x2009;65&#x2009;years and an increased percentage of sputum neutrophils (&#x02265;61%) were independent predictors of hypertensive status (p&#x2009;&#x0003C;&#x2009;0.001)
Conclusion: Our data suggest that neutrophilic airway inflammation (as evaluated by induced sputum) is strictly associated with hypertension
phenotyping asthmatic patients with comorbidities like hypertension could be useful also from a therapeutic point of view
Additional studies are mandatory to further elucidate the role of neutrophilic airway inflammation in asthma with cardiovascular diseases
Population-based studies reported that asthmatic patients are over 40% more likely to have hypertension than patients without bronchial asthma (<a href="#ref11">11</a>&#x2013;<a href="#ref13">13</a>). Moreover, it has been demonstrated that arterial hypertension in asthma patients is associated with enhanced disease morbidity and worse disease control (<a href="#ref14">14</a>, <a href="#ref15">15</a>)
most of the pathophysiological features of their relationship are still unclear
A key role in the development of both asthma and hypertension is therefore played by inflammation
Despite different studies have investigated this inflammatory link by analyzing the role of neutrophils and different cytokines in blood
the role of bronchial inflammation has been poorly investigated and
the induced sputum in bronchial asthma with hypertension was never investigated
Phenotyping asthma patients, especially from an inflammatory point of view, has become crucial to better understand the disease and optimize treatment. In clinical practice, blood eosinophils, fractional exhaled nitric oxide (FeNO), and serum total IgE are the most used biomarkers to discriminate between T2-high and T2-low asthma (<a href="#ref1">1</a>)
induced sputum (IS) is the gold standard to non-invasively assess central airway inflammation
The aim of this study is to compare clinical
and inflammatory characteristics of asthmatic patients with and without hypertension and investigate whether airway inflammation may help to identify a subgroup of patients at high risk of having hypertension
This retrospective observational study was performed at an Italian referral asthma center (Istituti Clinici Scientifici (ICS) Maugeri
Demographics, clinical and biological data, on asthmatic (<a href="#ref1">1</a>) outpatients with or without hypertension (20) attending the clinic between 2017 and 2023
were collected in a de-identified database
The study was performed according to the Declaration of Helsinki and approved by the Internal Review Board of ICS Maugeri of Tradate Institute (Identifier: p3/16)
All participants gave written informed consent for their participation in the research
All stable asthmatic patients with at least one IS examination were consecutively included in the analysis. The history of other acute cardiovascular diseases and asthma exacerbations in the month prior to the visit were considered as exclusion criteria. Patients on biological treatment for severe asthma were excluded. Asthma with hypertension (AwH) patients were on stable treatment for hypertension according to the ESC/ESH guidelines (<a href="#ref20">20</a>)
We reviewed patients&#x2019; electronic medical records to collect the following data: baseline characteristics (age, sex, body mass index (BMI), smoking history), atopy, symptoms control (Asthma Control Questionnaire-6 (ACQ-6)) (<a href="#ref21">21</a>&#x2013;<a href="#ref23">23</a>)
according to the World Allergy Organization definition
was assessed by prick tests and/or specific IgE in serum for the most common inhalant allergens
Exacerbations were defined by a course of systemic corticosteroids (OCS) for at least 3&#x2009;days in case of asthma symptoms worsening
Healthcare utilization was defined as admission to Emergency Department or additional visits due to asthma in the previous 12&#x2009;months
Lung functional evaluation was performed through spirometry test (MIR MiniSpir, MIR, Italy) according to the American Thoracic Society (ATS)/European Respiratory Society (ERS) guidelines (<a href="#ref24">24</a>, <a href="#ref25">25</a>) and the Global Lung Function Initiative (GLI) reference equations adopted immediately for spirometry standardized lung function values (<a href="#ref26">26</a>)
Both FEV1 and FVC were recorded; these measurements were expressed as either absolute value (liters (L)) or percentage of their predicted value (% predicted)
The FEV1/FVC value was recorded as a % ratio
and lung volumes variability were assessed during each spirometry test
The bronchodilator test was also conducted to determine the reversibility of airflow limitation after administration of an inhaler short-acting bronchodilator drug (salbutamol 400&#x2009;&#x03BC;g) as a part of lung function tests
Inflammatory data were also collected: blood and sputum samples were collected on the same day
Blood eosinophils and neutrophils (expressed as cells/mm3 and as % of white blood cells) were measured as part of the complete blood and differential cell count
An ad hoc electronic form was created to collect all study variables
Qualitative variables were described with absolute and relative (percentages) frequencies
whereas quantitative variables were shown based on their normal or non-normal distribution as mean (standard deviations: SD) or median (interquartile ranges: IQR)
The Kolmogorov&#x2013;Smirnov test was used to assess the normality of distribution for all variables
Comparisons between the two groups for qualitative and quantitative variables were assessed with the &#x03C7;2 or Fisher&#x2019;s exact test when appropriate
while Student T-test and Mann&#x2013;Whitney were used in case of parametric or nonparametric distribution
Predictors of hypertension were evaluated using univariate and multivariable logistic regression analysis (reporting odds ratio [OR] and 95% CI)
A p-value &#x0003C;0.05 was considered statistically significant
USA) was used for every statistical computation
Two hundred and sixty asthmatic patients were consecutively included in the study
The study population was subsequently divided into two groups based on the presence or absence of history of hypertension: 79 patients (30.4%) with diagnosis of hypertension requiring a specific pharmacological treatment were included in the asthma with hypertension group (AwH) and 181 (69.6%) in the asthma no hypertension (AnH) group
The clinical and demographic characteristics of all patients are listed in <a href="#tab1">Table 1</a>
No differences concerning asthma severity (according to GINA document) (<a href="#ref1">1</a>) and asthma therapy were observed between the two groups
There were no statistically significant differences in smoking habits or asthma control (number of exacerbations per year
and healthcare utilizations in the previous year) between AnH and AwH
The majority of AwH patients were male (51.9% vs
p&#x2009;=&#x2009;0.047) older (median (IQR): 64.5 (56&#x2013;72) vs
56 (46&#x2013;63) in AnH p&#x2009;&#x0003C;&#x2009;0.001)
had higher BMI (median (IQR) 27 (24.5&#x2013;32) vs
24 (22.0&#x2013;27.3) in AnH p&#x2009;&#x0003C;&#x2009;0.001)
Comorbidities in asthmatic patients with or without hypertension
&#x0002A;p-value &#x0003C;0.05; &#x0002A;&#x0002A;p&#x2009;&#x0003C;&#x2009;0.01; &#x0002A;&#x0002A;&#x0002A;p&#x2009;&#x0003C;&#x2009;0.001
Airway inflammation was similar in the two groups in terms of cellular percentage; however, in the AwH group, the percentage of sputum neutrophils was &#x02265;61% (cut-off to define sputum neutrophilia) (<a href="#ref28">28</a>) in 55.7% patients vs. 39.2% in the AnH group (p&#x2009;=&#x2009;0.014) (<a href="#tab2">Table 2</a>)
neutrophils count was not significantly associated with age or male sex (all p&#x2009;&#x0003E;&#x2009;0.05)
No differences were found in terms of total cell counts when comparing: patients with sputum neutrophils &#x02265;61% vs
&#x0003C;61% in the entire cohort of 260 asthmatics (p&#x2009;=&#x2009;0.420); patients with sputum neutrophilia in AwH group vs
AnH group (p&#x2009;=&#x2009;0.299); patients with sputum neutrophils &#x02265;61% vs
&#x0003C;61% in AwH group (p&#x2009;=&#x2009;0.864); patients with sputum neutrophils &#x02265;61% vs
&#x0003C;61% in AnH group (p&#x2009;=&#x2009;0.321)
this association was not influenced by obesity (p&#x2009;=&#x2009;0.172) and eosinophils in induced sputum (p&#x2009;=&#x2009;0.250)
Factors associated with hypertension: effects of older age and higher neutrophils count (and their combinations) on the risk of having hypertension
Predictors of hypertension were reported as odds ratio (OR) and 95% confidence interval (CI)
The association between asthma and arterial hypertension, well documented by several studies (<a href="#ref14">14</a>, <a href="#ref15">15</a>) is also supported and strengthened by our findings
The prevalence of hypertension in asthmatic patients is still debated, ranging from around 20&#x2013;45%, up to about 75% when actively searched (<a href="#ref9">9</a>, <a href="#ref12">12</a>, <a href="#ref13">13</a>, <a href="#ref15">15</a>). An observational study by Di Raimondo et al. reported that the prevalence of hypertension is higher in asthmatic patients than controls when blood pressure is monitored (75% and up to 80.8% in severe asthma) (<a href="#ref9">9</a>)
In the present study, the prevalence of hypertension in our population is in line with previous studies being 30.4%, and as reported by Panek et al., it did not significantly increase with asthma severity (31.0, 28.4 and 32.0%, respectively, in mild, moderate, and severe asthma) (<a href="#ref15">15</a>)
Asthma (especially in T2 low asthma) and hypertension share some immune mechanisms (<a href="#ref39">39</a>) involving higher expression of interferon-&#x03B3;, activation of macrophages, and IL-6 (<a href="#ref19">19</a>) resulting in metabolic dysfunction that increases the morbidity associated with both hypertension and asthma (<a href="#ref17">17</a>)
Blood and sputum neutrophils play an important role in T2 low asthma (<a href="#ref40">40</a>, <a href="#ref41">41</a>)
neutrophilic airway inflammation has been poorly investigated in asthma with hypertension
Additional studies are needed to clarify the role of each comorbidity (obesity
GERD and diabetes mellitus) on airway inflammation and hypertension in asthmatic patients
Although the systemic inflammatory characteristics in hypertension have been previously described
to the best of our knowledge bronchial inflammation in asthmatic patients with hypertension has been poorly investigated with no previous evidence on induced sputum
According to a recent retrospective study conducted by Pignatti et al., a significant prevalence of hypertension was found in asthmatic patients aged &#x02264;65&#x2009;years with mixed granulocytic pattern in the airways (<a href="#ref57">57</a>)
Our results confirm that patients with a mixed granulocytes inflammation as well as a percentage of neutrophils equal or above 61% were more common in the AwH group
Asthmatic patients with a neutrophilic pattern (sputum neutrophils &#x02265;61%) usually have higher sputum total cell count (<a href="#ref57">57</a>). This increase is mainly due to infection/colonization of the airways while the increase of sputum neutrophils is often associated with corticosteroids treatment (<a href="#ref58">58</a>, <a href="#ref59">59</a>)
in our population we did not find differences in terms of total cell count when considering neutrophilic or non-neutrophilic patients among the entire cohort
No differences were found in the two groups also as concerns ICS or mOCS treatment
These results suggest that neutrophilia may be due more to comorbidities
we indeed selected patients free of exacerbation and on stable disease for at least one month before the assessment as described above
we decided to evaluate if the presence of neutrophils could lead to a different risk of hypertension
To the best of our knowledge, our study is the first one to show that neutrophils percentage in induced sputum is a determinant of hypertension after adjustment for the confounding effect of age. This observation supports that T2 low inflammatory pathways may provide a pivotal link between these two diseases (<a href="#ref46">46</a>, <a href="#ref60">60</a>)
we report the retrospective design from a single reference center
the lack of a control group of non-asthmatic patients with hypertension
although with a relatively large cohort of patients
considering the high prevalence of hypertension in asthma
the clinical relevance of IS in phenotyping asthmatic patients with cardiovascular comorbidities
additional studies are needed to better identify airway inflammation in asthmatics with hypertension in order to improve clinical practice and optimize pharmacological treatment
considering that neutrophilic airway inflammation is less responsive to the inhaled and systemic pharmacological therapy available
our results show that a more in-depth evaluation of airway inflammation in patients with asthma allows the identification of patients at increased risk of hypertensive disease
The role of airway cellularity as a linkage with hypertension remain largely unknown and needs to be more deeply investigated
as to ensure early diagnosis and implementation of effective treatment when needed
Our data suggest that neutrophilic airway inflammation is significantly associated with the presence of hypertension
Induced sputum evaluation is the only non-invasive methodology to assess neutrophilic airway inflammation and might be used to identify hypertensive patients requiring a closer surveillance program
Additional studies are needed to better understand the role of neutrophilic airway inflammation in asthma with cardiovascular diseases
The raw data supporting the conclusions of this article will be made available by the authors
The studies involving humans were approved by Institutional Review Board of ICS Maugeri
The studies were conducted in accordance with the local legislation and institutional requirements
The participants provided their written informed consent to participate in this study
The author(s) declare that financial support was received for the research
It has been partially funded by the Ricerca Corrente scheme of the Ministry of Health
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest
The author(s) declared that they were an editorial board member of Frontiers
This had no impact on the peer review process and the final decision
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations
Any product that may be evaluated in this article
or claim that may be made by its manufacturer
is not guaranteed or endorsed by the publisher
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Angeli F and Spanevello A (2024) Asthma and hypertension: the role of airway inflammation
Received: 19 June 2024; Accepted: 30 September 2024; Published: 10 October 2024
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&#x0002A;Correspondence: Dina Visca, <a id="encmail">ZGluYS52aXNjYUBpY3NtYXVnZXJpLml0</a>
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A group of temporary Jewish residents of the Villa Mayer (in the background) enjoying the fresh air Image by Courtesy: Rivka Greenberg
a small town in Northern Italy located in the Varese region
I spent the first two years of my life at Villa Mayer
a beautiful mansion surrounded by acres of lush orchards and a beautiful flower garden located in Abbiate Guazzone
As a psychoanalyst I am well aware of the fundamental role the first years play in one’s identity
even though most people do not have conscious memories of that period
While the story must have been idealized because the villa was crowded with people
my parents used to look back at their three years in Italy with great fondness
And although Italy was grappling with the recent dark past of fascism during the war
liveliness and good spirit of the Italian people
because their faces would light up and pleasant memories would be told
such as my father’s admiration for the way Italian peasants would sing entire operas by heart
or his good-natured imitations of the locals loudly playing cards on the sidewalks of Tradate
Those memories stood in striking contrast to the sadness their faces conveyed any time memories of Poland would come up
because everything was overshadowed by the Holocaust
Having spent years in an attempt to deal with my parents’ tragic Holocaust trauma
the Italian chapter of our family history was set aside for a later time
I was only two years old when my parents immigrated to British-Mandate Palestine
so my first conscious memories are about life in Israel
But the joy of life my parents experienced during the first couple of years after the Holocaust
living in total freedom in a welcoming and sunny place — documented by numerous photos — must have been transmitted to me
They both survived four-and-a-half years in the Lodz ghetto and then were taken to Auschwitz
they returned to Lodz separately to search for relatives
and had dreamed of going to Mandatory Palestine even before the war
he was convinced that there was no other place for him
my father had taken thousands of pictures in Poland that he had hidden together with his Laika camera
Typical to the way survivors related memories to their children
the stories were never told in any particular order and were filled with gaps
By the time I was fully ready to hear the entire story and ask specific questions
and there seemed no way to fill those gaps
my husband and I made two trips to Tradate and were able to locate Villa Mayer in Abbiate Guazzone
What we found was a deserted and dilapidated structure sitting on a large plot of overgrown trees surrounded by a wall
we were able to go inside and find remnants of what must have been an elegant mansion with a beautiful marble fire place
But despite our attempts to look for some old locals who knew anything about the villa’s past
The information I found in these books were invaluable to me
They helped confirm many of the stories that my parents had shared with me over the years
The years following WWII were years of chaos in Europe
It was at this time that an underground organization emerged in Eastern Europe called Bricha — “flight,” in Hebrew
The organization began with the ghetto fighters Aba Kovner
They joined with the partisans to form the United Partisan Organization while the war was still raging
and after liberation to help Jewish survivors flee from the displaced persons camps
Their plan was to smuggle Jewish survivors out of East European countries and bring them to Greece or Italy in order to ultimately settle them in Mandatory Palestine
the British shut the Mandate’s border to Jewish refugees
leaving the survivors only one option: Illegal immigration
the Bricha expanded to become part of what is known as the Mossad LeAliyah Bet
That underground multi-operational organization
members of which were the founders of the present-day Mossad
the national intelligence agency of Israel
was in charge of the massive exodus of 250,000 refugees from Europe to Mandatory Palestine
the Mossad LeAliyah Bet brought together fighters of the Hagana — the underground army in Palestine — Jewish residents of Palestine and members of the Jewish Brigade who fought with the British
and gradually spread its wings throughout Europe
Together with members of the Bricha in Europe
that coalition helped Jewish survivors travel through Czechoslovakia
Greece and Italy in order to eventually arrive in Mandatory Palestine
Their operations were initially funded by meager donations from the mandate’s preexisting Jewish population
but grew after the war to include funding from the United Nations as well as the American Jewish Joint Distribution Committee
as hundreds of thousands of refugees from Syria and Africa are moving through Europe
and refugees from Central America are arriving illegally to the U.S
Italy became a coveted destination for Jewish refugees
both because it was surrounded by numerous ports by which they could leave covertly by boats
and also because the Jewish Brigade was stationed in Italy and would become highly instrumental in carrying out the operation
my parents participated in a long and arduous journey
They were instructed to say that they were Greeks traveling back to their homeland
and they were constantly in danger of getting caught by anti-Semitic train conductors
my parents would run out and lay down on the rail road tracks until the train started to move again
at which point they’d jump onto the moving train
I used to think to myself: “My small and anxious mother had the courage to do that?”
She also told me how they climbed the Alps by foot from Austria to Italy
and that when they finally arrived at the beautiful villa in Tradate
philanthropist and Zionist leader who invited Jewish refugees to live there during their stays in Italy
Mayer had escaped to Switzerland with his family where he became the chairman of the Association of Jewish Communities
he helped absorb thousands of refugees from the displaced persons camps who had arrived in Italy
He became deeply involved in Aliyah Bet operations
collaborating with its leaders Yehuda Arazi and Ada Sereni and organizing financial
medical and living resources for the refugees
A gathering point for Holocaust survivors in the Austrian Alps
One of the people whose families stayed at Villa Mayer at the same time we did was Shmuel Atzmon
the founder of the Yiddish theater in Israel
my father chose to become a sound and lighting theater designer with Dzigan and Shumacher
and in the 1960s when they retired began to work with Atzmon
Atzmon was 17 years old when he and his family arrived to Villa Mayer
and has distinct memories of that experience
He recently told me that Mayer had been a religious man
and actually chose to donate his villa to members of the religious organization Tora ve Avoda
would obey the Jewish laws at the villa’s kosher kitchen
In the villa the Jewish survivors formed a kibbutz
a story that I listened to with wonder because I thought that kibbutzim had existed only in Israel
When the group with my parents arrived at the villa
the Jewish Brigade representative asked for a volunteer who would be willing to go back to Austria and lead another group
who had served in the Polish Army and loved hiking in the Carpathian Mountains
During 1946 and 1947 he was gone for a period of about eight months as he brought several groups through the Tyrol Mountains
The residents of Villa Mayer came from all over Eastern Europe and spoke a myriad of languages
But I never realized that the fluent Hebrew my parents spoke later in Israel developed from the training they had received by the shlichim
or emissaries from Israel working in Austria and Italy
The emissaries also provided vocational training in agriculture
the survivors organized their own cultural events; they sang Yiddish and Hebrew songs and some played musical instruments
would improvise comedy acts and recite Sholem Aleichem stories
When my father returned to Lodz after the war
he must have found out about the Bricha movement through the grapevine
and contacted their representative in Lodz
which led to his volunteering to organize a group
who were inseparable in the camps and the only survivors of their large family
soon found out about it and joined the group
which by then included about a dozen people
I assume that with the help of a Bricha guide they left Lodz
and without any papers reached a hidden path by the Polish border and crossed it at night into Czechoslovakia
They were led to a place to spend the night
and in the morning bordered a train heading to Bratislava
After a couple of days they boarded a train to Vienna
where they arrived at a displaced persons camp
I had known that they stayed in Austria for about six months
The first thing my father bought in Austria was a new camera
which fortunately helped document my parent’s journey through Austria and Italy
I keep looking at the photos of breathtaking views of the Austrian Alps
healthy and attractive travelers rather than refugees
travelled by train with recently acquired fake documents to Zalfelden
a small town on the border of Austria and Italy
they began a 10-hour climb on a 1,500-meter mountain until they reached the border between Austria and Italy
Some members of the group were older than 50
My mother was pregnant with me at the time
they slept until the border patrol arrived to arrest them and transfer them to the border
who must have orchestrated the entire operation with the help of Mayer
and by midnight they arrived at Villa Mayer
When my husband and I arrived in Italy last summer
the author of “Jews in the Province of Varese — Tradate 1938-1947” in Verona
who told us that he had recently met Mayer’s granddaughter
At our request he was able to connect us with Mayer-Modena
who agreed to meet with us in Milan a couple of days later
My emotional meeting with Mayer-Modena allowed me to close a meaningful chapter of my family story that took place 70 years earlier
Mayer-Modena is a linguistics professor who devoted her career to Jewish-Italian dialects in the Italian language
She seemed to be as excited and happy about meeting us as we were excited and moved about meeting her
Rivka Greenberg (right) and Maria Luisa Mayer-Modena
granddaughter of the late owner of the Villa Mayer
Mayer-Modena was about eight years old during the period of “Aliah Beth.” She shared with us some of her childhood memories of seeing in her house its leaders — Yehuda Arazi
“all of them.” But she also knew that the meetings were secretive and not to be talked about
We exchanged childhood stories — mine conveying the gratitude of a family of survivors
who were generously taken in by her father and grandfather
and hers of growing up in a family of benevolent rescuers
We expressed a mutual wish to stay in touch and I felt fortunate to be able to close a meaningful circle in my family’s history
Rivka Greenberg is a practicing clinical psychologist and psychoanalyst in New York City
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shoe entrepreneur and former president of the Association of the Italian Shoe Industry (Assocalzaturifici)
Known to the shoe world as “Signore delle scarpe di lusso” (Lord of Luxury Shoes)
Artioli followed in the footsteps of his father Severino at an early age and successfully continued the company founded in 1945
Artioli shoes have been worn by personalities such as Pope Wojtyła
As president of the European association CEC
he was an important voice of the European shoe industry and campaigned in Brussels to defend “made in Italy” and against counterfeits
a promoter of international cooperation and a constant defender of European values; we will remember him as a colleague
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the Blizard Institute at Queen Mary University of London
in collaboration with the World Health Organization (WHO) Collaborating Centre in Tradate
held Queen Mary’s first international tuberculosis (TB) symposium
The symposium took place in the Graduate Centre at Queen Mary’s Mile End campus
and provided an update to around 150 participants on the clinical management of TB cases
evaluating new diagnostic and molecular techniques available for TB and providing an understanding of TB elimination
TB is the leading infectious disease killer and the ninth cause of death globally
affecting close to 11 million people a year with 1.4 million deaths
Multidrug-resistant TB (MDR-TB) affects half a million people annually and is a growing threat to public health and a significant obstacle to the elimination of the disease
Speaking at the event were a number of world-renowned national and international experts in the fields of TB
This included Raquel Duarte (Secretary of Health of Portugal) and Dr Masoud Dara (WHO Europe)
among many others from respected institutions and organisations
Highlighting some of the WHO European Region’s challenges in particular
Dr Dara said: “Europe’s TB burden is among the lowest in the world
but the rates of new MDR-TB cases is the highest
Europe has the fastest decline in new TB diagnoses and TB mortality
but MDR-TB and TB/HIV co-infection is growing; one in eight new TB patients in the WHO European Region in 2017 were also HIV positive
and every fifth new TB patient is found to have MDR-TB
This is a major challenge that we face in the region.”
Discussing a cooperative and multisectorial approach to TB elimination
Portuguese Health Secretary Raquel Duarte said: “It is important to address the vulnerable and hard-to-reach population
We know that if we could eliminate extreme poverty and expand social protection we could reduce the incidence of TB by around 84 per cent
“With a decreasing number of cases it becomes increasingly difficult to keep TB a high priority on the governmental agenda
Even in countries with low TB incidence and high-income
particularly when vertical TB control programmes have been dismantled because they are not cost-effective
“There is a recipe for eliminating TB using what we have
the problem is that the theory and practice are not the same
Elimination of TB in one country depends on the elimination of TB in every country
The symposium was designed for doctors including consultants
specialist trainees in respiratory medicine
as well as other allied health professionals working in the field of tuberculosis
Infectious Diseases Consultant and Honorary Senior Lecturer at Queen Mary and Barts Health NHS trust
and co-lead of Queen Mary’s new TB programme
said: “The first edition of our TB&nbsp;symposium was&nbsp;a success thanks to the contribution of&nbsp;world class&nbsp;speakers covering&nbsp;all aspects and fields of the tuberculosis landscape
This was also thanks to active participation from a large number of delegates from the UK and abroad
“Several different angles generally not covered in TB meetings&nbsp;were featured
including programmatic WHO efforts to end TB
as well as the real world challenges hampering elimination
and the view of a Secretary of State of Health
The symposium also covered areas such as vaccines
clinical trials,&nbsp;migrant health and screening&nbsp;and social aspects.”&nbsp;
Queen Mary recently launched the <a href="https://www.qmul.ac.uk/media/news/2019/smd/queen-mary-launches-worlds-first-postgraduate-certificate-in-tuberculosis.html">world’s first Postgraduate Certificate in Tuberculosis</a>
which will be delivered across the world through online distance learning from September 2019