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“Respiratory diseases will probably be the leading cause of death in the next ten years”

24 October 2024

« Les maladies respiratoires seront probablement la cause principale de décès dans les dix ans à venir »

A specialist in respiratory diseases, the RespirERA University Hospital Institute (IHU), based in Nice, wants to prevent the ailments that atmospheric pollution and climate change will transform into a major public health problem tomorrow. Between screening campaigns, therapeutic innovation, AI and greening of cities, there are numerous ways to make progress on the subject. Interview with its director, Professor Paul Hofman.

LA TRIBUNE – Labeled in May 2023, the IHU RespirERA presents itself as a laboratory for anticipating the respiratory health issues of tomorrow with, as a land of experimentation, the territory of Nice Côte d’Azur. What exactly does this include?

PAUL HOFMAN – If we project ourselves into the future and associate global warming, air pollution and the aging of the population, one observation emerges: that of a continued increase in respiratory diseases, not only lung cancers, but also other infections such as COPD (chronic obstructive pulmonary disease, Editor's note) or pulmonary fibrosis. All these respiratory diseases will probably be the main cause of death in the next ten years. However, in the South, and more particularly in the territory of Nice Côte d'Azur, where we are located, the ecosystem proves ideal for this theme, between an aging population, more prone to developing these pathologies, a rate of hospitalization linked to these diseases more important than elsewhere and certain atmospheric pollution due to its geographical configuration. As a result, we are one step ahead of tomorrow's epidemiology in France and Europe.

A first series of actions to raise awareness and prevent respiratory diseases has been launched, including a pilot project for lung cancer screening, supported by the National Cancer Institute. Where are we?

This is a widely watched project, because in France, if we detect breast, colon or cervical cancer well, we are still at the PoC stage for lung cancer whereas elsewhere in Europe its screening is covered by the public authorities. Hence our desire to move the lines. Thus, for a year, pulmonologists and general practitioners have been crisscrossing the territory of the Alpes-Maritimes, in particular disadvantaged areas and the hinterland, to set up in supermarket car parks or in shopping centers and go to meet of the target population. Namely, people aged 50 to 74, long-term smokers, who have little or no access to information, to whom we offer to carry out on-site spirometry (breathing measurement test, Editor's note) before to invite them to have a scan.

You are not limiting yourself to this specific population. Younger people are also targeted. How do you proceed?

Our goal is prevention, so the sooner we intervene, the better. From then on, we set up an awareness campaign within the department's vocational high schools, with Staps students who will preach the good word. We also launched a tobacco-free university project. This consists on the one hand of the installation of smoking airlocks, as in airports, within university premises, on the other hand, of the development of interactions with students to explain and dispel certain preconceived ideas. on the subject of cannabis, shisha or even electronic cigarettes, the impact of which on the pulmonary alveoli is insidious and the cause, in the years to come, of a potential development of fibrosis. Finally, we are working to expand this awareness in the hospital that we also want to be tobacco-free. It seems to me that a person dressed in white smoking under the windows of a lung cancer patient is no longer admissible today.

In terms of therapeutic innovation, RespirERA is also positioning itself in the field of prevention with the cancer interception project. What exactly is it?

It is a niche, that of extremely early treatments, that we are working on in partnership with the MD Anderson Cancer Center in Houston, the world's leading center for the treatment of lung cancer. The aim is to intercept the development of cancer by detecting precancerous lesions via a radiomics approach, combining imaging, artificial intelligence algorithm and blood testing. The idea is to offer a specific treatment to prevent the development of this precancerous disease into a cancerous disease. Only two centers in the world will offer it. In Houston therefore, and in Nice, where we are getting into working order with the objective of starting the program in June 2025.

What place does artificial intelligence represent in the work of the IHU?

A very important place. One of the founding members of the IHU, alongside the University of Côte d'Azur, Inserm and the Nice University Hospital, is Inria with which we have been working for ten years already on the development of prediction and detection algorithms by aggregating the different data that comes to us from thoracic, histological and genomic imaging. It is on this historic foundation that RespirERA was built.

Concerning the allocations, the first tranche of which was delivered in June 2024, you hoped for 49 million euros, you obtained 20 million euros. Is this enough?

We would certainly have preferred to start with a more substantial nest egg, but this 20 million euros produces an interesting leverage effect, a sort of starting investment for launching fundraising appeals. Several are already underway. We are also developing partnerships with the private sector, the pharmaceutical industry with whom we are developing new therapeutic response biomarkers, but also biotech companies whose technologies we are challenging.

What about relations with local authorities?

They are obviously essential, particularly in the context of the decarbonization and greening strategies that cities are implementing. In this regard, we have a car equipped with sensors which crisscrosses the city of Nice and continuously records atmospheric data to define pollution peaks according to times and neighborhoods and thus identify sites where decarbonization campaigns can be implemented. This is a pilot initiative that we wish to duplicate in the future in other metropolises.

Is urban greening really effective?

In any case, it’s always better than concrete! Wearing green, we know, has a certain psychological impact. The population feels better. Afterwards, at the atmospheric level, there is still an emergency. The path taken is the right one but we always come up against political or budgetary barriers. Take the example of the ski resorts in the Nice hinterland. We notice that in winter, at the height of the season, there are more polluting atmospheric particles up there than on the Promenade des Anglais. The cause is known, it is the continuous flow of cars going to these resorts, the answer too, namely the creation upstream of park-and-ride stations that electric shuttles would connect to the ski areas. The effect would be immediate. However, it remains very complicated. This is where we enter the realm of politics, which should not, however, prevent us, as doctors and IHUs, from saying what we observe in complete transparency. It is then up to the population to decide and take up the subject.

Par Gaëlle Cloarec
Photo credit: DR