The European Respiratory Society (ERS) is the main scientific society in the respiratory field in Europe. ERS mission is to promote lung health and to drive globally standards for respiratory medicine. ERS aims at consistently achieving its core mission by supporting the forefront of basic and translational research. Since 1997, ERS has operated a successful programme of international exchange of researchers in respiratory science. Under the FP7 COFUND scheme, ERS launched RESPIRE 1 and RESPIRE 2 fellowship programmes. Here, ERS proposes RESPIRE 3, a new fellowship programme that capitalises on the success of the previous programmes and presents innovative features, taking into consideration the results of the independent evaluation of the RESPIRE 2 programme. First, RESPIRE 3 funds both European and global fellowships, expanding the international dimension to Third Countries. Second, RESPIRE 3 places major attention to inter-sectoral exposure: fellows have the possibility to undertake a secondment to industry, fully funded by the programme. Third, RESPIRE 3 complements the host institutions’ programme by proposing training activities aimed at strengthening the professional development of the fellows. Fourth, RESPIRE 3 sets the frame for the establishment of international contacts by offering dedicated networking opportunities, namely during the annual ERS congress. Fifth, with an increased living allowance and by introducing a family allowance, RESPIRE 3 provides competitive working conditions to attract the best talents and guarantee them a right balance between career ambitions and personal development. Therefore, the proposed RESPIRE 3 programme, by training post-doctoral fellows in Europe and globally, will enhance research in the respiratory field, increase the human resources potential in Europe, and contribute to the overall objective and impact of COFUND.

Bacterial pneumonia is a leading cause of morbidity and mortality worldwide. Antibiotics constitute the standard of care but are faced with the emergence of antimicrobial resistance (AMR) and the curative failure. The FAIR consortium aims at assessing an adjunct to antibiotic therapy as an emerging concept of overcome AMR in pneumonia. The project leverages (i) a unique immunomodulatory flagellin that enhances airway epithelial innate immune defences and increases the therapeutic outcome relative to antibiotic alone, and (ii) airway-specific aerosol delivery by nebulization. FAIR’s objectives are to: • develop nebulization modalities for optimal airway targeting and rapid action at the infection site • demonstrate that nebulized flagellin strengthens the response to antibiotics in relevant preclinical models of antibiotic-resistant pneumonia • identify host immune factors required for the gain of protection with systems biology • implement pharmacokinetics/pharmacodynamics model-based design and simulation for clinical validation • assess nebulized flagellin’s safety in a Phase I clinical trial. • analyze the acceptability and economic relevance of the therapy • identify stratification markers that predict the course of pneumonia and treatment in antibiotic-treated cohorts. Expected outcomes include the enrichment of the pipeline of novel treatments against pneumonia, reinforcement of EU capacity to control AMR and infections, the Phase I safety report on nebulized flagellin, recommendations for future trials, and acceptability by the stakeholders and cost-effectiveness for public health. FAIR will develop new avenues of research on mechanisms of action of the adjunct flagellin, and will define (for future trials) the subpopulation of patients that might benefit most from this treatment. Our industrial partnerships and exploitation plan will enable straightforward development of drug and nebuliser device, and bring innovation to the patients.

The BETTER-B consortium tests whether mirtazapine, currently used as an antidepressant, is an effective treatment to reduce chronic or refractory breathlessness (CB) in patients with advanced chronic obstructive pulmonary or interstitial lung disease (COPD or ILD) needing palliative care or at the end of life. Our focus is on breathlessness that persists despite optimal treatment of the underlying condition. This widespread and frightening symptom has a major detrimental impact on patients’ quality of life and distresses their family, friends and carers. It is associated with physical and psychosocial morbidity and results in high use of health care services, including emergency care. There are no licenced medicines for CB in the world. It is a major challenge to clinical management, care quality and patient wellbeing. We have completed a feasibility trial in 60 patients, reviews and case studies that suggest mirtazapine is a promising treatment. To assess if mirtazapine is effective, we conduct a randomised double blind clinical trial of mirtazapine versus placebo in patients with CB and COPD or ILD. The trial recruits 324 patients over 18 months across respiratory, palliative care and community services in Poland, Ireland, Italy, Germany and the UK. We study the effects of treatment over time on patients, their family or caregivers and care costs. We survey clinicians and produce accessible European guidance on treating CB. The consortium unites a unique multi-disciplinary group of clinician scientists from respiratory, palliative, geriatric and rehabilitation fields, alongside statisticians, trialists, health economists, health care researchers, patient and consumer groups and a European Society. This ensures the optimal design and operation of the trial and the widest impact from its results. Using an existing medicine for a different purpose offers a highly cost-effective approach for treatment that can be implemented and sustained internationally.

The European Respiratory Society (ERS) is the largest society of lung clinicians and scientists in Europe, with a growing international membership (more than 30,000 currently) in more than 160 countries. Its mission is to promote lung health and to drive globally standards for respiratory medicine. Since 1997, ERS has operated a wide portfolio of fellowships, promoting transnational mobility and career development of researchers within respiratory science. This included three Marie-Sklodowska Curie COFUND programmes (two under FP7 and one under Horizon2020). ERS is now proposing to build on the success and best practice developed during previous RESPIRE programmes and on an already established network of more than 100 host centres, through a new, next-generation RESPIRE4 scheme. The latter introduces further added value and innovative elements compared to the past, building on fellows' feedback and the external evaluation of the previous RESPIRE programmes. First of all, RESPIRE4 places major attention to flexibility for fellows via tailored secondment and extension schemes, notably in the non-academic sector. Second of all, the outreach and patient involvement components have been further strenghtened to enhance the impact of the programme. Third, a country coefficient criteria has been introduced to continue to attract the most promising researchers. Lastly, the programme integrates returnees from a career break as well as less represented countries (COFUND 2018 list) in its planning. RESPIRE Marie Sklodowska-Curie fellows will also benefit from extensive opportunities in terms of training and networking, notably via the ERS flagship events (Lung Science Conference & International Congress) and wider ERS network. Therefore, the proposed RESPIRE4 programme will contribute to foster the European Research Area by training the next generation of leaders in respiratory research, which remains significantly underfunded at European level.