An interview with Professor Thierry Troosters

By early career member Ana Lista

6 October, 2020

Today, as an early career member, I have had the great pleasure of interviewing the Past President of our society, Professor Thierry Troosters. My name is Ana Lista and I am a respiratory physiotherapist working as a lecturer and researcher at the University of A Coruña’s Faculty of Physiotherapy in Spain. We have spent time talking about the COVID-19 crisis, challenges in education and the future of rehabilitation programmes, among other things, and I would like to share with you Professor Troosters thoughts about these topics.

First of all, I want to thank you for taking the time to respond to this interview. It seems obligatory that we start this conversation talking about the COVID-19 crisis and its devastating consequences. I would like to ask you about the resources that ERS, as one of the largest respiratory societies, is investing in the fight against this pandemic. (Human resources, research projects, fellowships, courses, etc.)

As a respiratory society, ERS is investing quite a bit to inform and educate people on COVID-19. We are screening scientific literature to make sure that there is up-to-date information about COVID-19 online, so if anyone wants the latest information, you only have to go to the COVID-19 resources section of the ERS website. We have also invested a lot in education, sharing webinars with the main goal that, as quickly as possible, people inside the respiratory field, but also people outside the respiratory field, who had to convert to respiratory physicians quite rapidly, were informed about what they needed to know in COVID-19 related issues. Examples of topics covered include prevention of infections, treatments, protective equipment, and rehabilitation, among other things. Obviously, during the Congress we allocated a lot of resources, including a day’s worth of sessions dedicated to COVID-19 that is free-to-access to all. In terms of scientific resources, we have invested in a Clinical Research Collaboration. ERS has a tradition of organising Clinical Research Collaborations that bring together experts in different fields, so quite rapidly we were able to start a collaborative initiative and work together on different COVID-19 issues, and we have already been successful in attracting funding in the field of oncology in terms of how COVID-19 affects patients who have oncology problems. On the other hand, in terms of human interest, we have collaborated with the European Lung Foundation to develop patient-focused resources. As well as this, one early career member has developed a survey to get to know how the COVID-19 crisis has affected the development of their early careers.

Professor Troosters, you must agree with me that after each crisis new opportunities for improving and learning usually appear. From your point of view, could this situation be an opportunity for a bigger development of pulmonary rehabilitation programmes around the world, given that a significant percentage of post-COVID patients must need it?

Excellent question! Indeed, I think so, and not only will it be an impulse for pulmonary rehabilitation but also for other concerns, like for instance, vaccination campaigns. But in terms of pulmonary rehabilitation, certainly, it is a good advertisement to individualise treatment plans for patients in different settings; home-programmes, primary care centres, or in inpatients’ rehabilitation settings. I think rehabilitation has received good press from patients who have had severe COVID-19 when they talk publicly about the rehabilitation process. This is a new group of patients who potentially need pulmonary rehabilitation, but we cannot forget all the rest who needed these programmes already before the COVID-19 crisis, as people with COPD and other chronic pulmonary diseases do.

Let's talk about this year’s Congress. There is no doubt that the ERS community has shown the capacity to quickly adapt to these present difficulties with the organisation of its first virtual Congress. As leader of the society during this time, how did you approach this new challenge?

Well, with confidence, I would say! But also with a little bit of hesitation. It was a new thing, so it was great to see how the team, particularly the team in education and Congress management as well as marketing and corporate relations at ERS, were able to quickly adapt to this new format. Of course, we were confident that with very capable staff we would be able to cope with a 180-degree change. We quite rapidly decided that we need to go for a virtual Congress and I think it worked in our favour, as it gave us a little bit more time to prepare it well, and I think the net result was really something that could be seen as a success. Though of course, I am slightly biased.

Could you talk about the strengths and weaknesses of a virtual Congress. How has networking been facilitated, and which are the points for improvement?

There are definitely some strengths. The main one is its global reach; there were more than 30,000 people registered from all over the world making it the largest ERS Congress that we have ever organised. It has definitely been a greener conference too, with lower environmental footprint as nobody had to travel. It is also really good to know that we have had not only the largest Congress of ERS in terms of registration, but also in terms of participation, with bigger-than-expected audiences of thousands of people attending poster sessions and industry sessions. It is very affordable in terms of getting your education.

In terms of weaknesses, the main point is that this was ‘a congress’, but not really ‘a meeting’. We shared excellent scientific information and we discussed hot topics, but we did not have the chance to interact between us and have a chat or a glass of beer, or find again our friends from different parts of the world. And I think this is the part that I have missed the most. I was one of the privileged people that was in the studio with a few chairpersons and I felt that what we missed was that physical presence of an audience. Enabling conversation with the mentors in the virtual space is something that could be implemented by ERS for future events as well as developing the interaction in the poster session discussions. So, of course, there is space to improve, and anyone with other good ideas can write to me or the office and I am sure that we will take them on board. However, from the bottom of my heart, I hope that we will be able to meet again at the next event in person.

I would also like to have the opportunity of meeting you all in Barcelona, Professor Troosters. However, I was wondering if ERS is considering the possibility of combining both models (face-to-face and virtual) for future Congress?

I think we will definitely continue to build up the strength of having a virtual meeting, since, as I already highlighted previously, you can reach the whole world. However, the possibility to combine both models is more complicated than we initially thought. If you look carefully at this year’s ERS Congress, you will realise that the format also changed. For example, the time of sessions was shorter because you cannot expect people to stay for a long period of time in front of the screen. This is nice when you have the person in front of you, but it does not work in the virtual space. On the other hand, giving a ten-minute presentation when you have the audience in front of you is also not ideal. So, if you want to do a blended version it must be a smart one, where you have a virtual track and an in-person track, but I think to blend both in the same product is going to be really hard, since you cannot simply copy and paste what you already have done and broadcast it in the virtual space. Furthermore, from the society’s perspective, we must analyse the cost of organising both models for the same event. It could be very challenging, but we have time now to start to work on that.

Before we close this chapter on the Congress, Ana, I would like to give credit to the team in the office and all the people who were working around the clock, literally, who should be congratulated for their excellent work. There is a whole machinery behind it, and they made it happen.

I agree, Professor Troosters. I just want to add my own congratulations for this successful virtual Congress and thank you very much for the titanic efforts from you and all your team. Now, we are going to leave the present for a moment, since I would like to talk to you a bit about the future. From your perspective, which will be the main problems in this new decade that will affect respiratory health, where we should work harder as respiratory health professionals?

There are plenty of challenges, I think. We should not forget that there are a lot of patients suffering from other respiratory diseases and COVID-19 is not the only problem that we have to work on. For example, I am thinking of lung cancer patients who need an earlier detection, as well as people with chronic pulmonary diseases, which make the role of healthcare professionals very important and prominent. And also, as a scientific society, we have an important role to play to advocate for access to health care across the world, not only medical care but also non-pharmacological care, such as self-management programmes, rehabilitation, childhood asthma, etc. We should also emphasise the need to organise proper care in the areas of palliative care, rehabilitation, pharmacological care and others.

As a physiotherapist I have read the papers published by ERS entitled ‘Recommendations for a core curriculum in respiratory physiotherapy for adults and paediatric patients’. I would like to know whether beyond these recommendations there are further plans from ERS to homogenise the curriculum of respiratory physiotherapy in Europe both at bachelor’s and master’s degree levels? Well this is something really difficult for a scientific society to solve. First of all, what we realised when we developed the curriculum for physiotherapists, but it is the same for other health professional curriculums, is that there is a diverse education track across Europe. Furthermore, lung physiotherapy is a specialisation of the curriculum in some countries and it even does not exist in others. So, I think the main merit of this syllabus for physiotherapists is that we have identified what experts, from around the globe, think that somebody working as a physiotherapist in the respiratory field should know. We have divided it into modules; adult and paediatric patients, critical care, etc. so that what is in this module is what you should know to work properly and successfully. This allows us to organise an educational track for those who have some parts of the knowledge in their basic curriculum but need, for example, to go further to build up the total skills of a specific module. I think it is not for ERS to harmonise the education curriculums, that is for institutes in the different countries. We did provide them with a beacon of expectations for respiratory physiotherapists.

Finally, how do you see the future of pulmonary rehabilitation in 10 years?

Well, I am an optimist, so the future is bright! But I think there is still a lot of work to come from the shadows. What I hope that we will have achieved in ten years are basically two things. First, a better access to rehabilitation programmes, and also a more diverse offer of rehabilitation programmes, as for example, virtual rehabilitation and programmes in primary care. Secondly, I hope that we improve the individualisation of rehabilitation programmes for the patients in several ways; the lengths of the programmes, the content, etc. And of course, we will need early career members to achieve it, so we have great expectations!

Thank you very much Professor Troosters for your time and your enthusiasm to work in the development of the respiratory field. We hope to see you at the next ERS Congress in Barcelona.