European Community For Coal Research Articles

Assessing the Impact of the Updated 2021 European Respiratory Society/American Thoracic Society Criteria on Bronchodilator Responsiveness in Asthma.

Introduction The European Respiratory Society/American Thoracic Society (ERS/ATS) Task Force released new technical standards on spirometry interpretation in 2021. Our study compares bronchodilator responsiveness (BDR) in asthma, evaluating the impact of the 2005 and 2021 ERS/ATS criteria and the influence of predictive equations. Methods A retrospective cohort study of adult patients with asthma was referred to spirometry with a BDR test at the Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia. The study included adult patients with asthma who underwent BDR testing in the Department of Respiratory Pathophysiology at the institute and had available data on height, gender, age, race, and eosinophil count. Results Among 197 patients, 69 were men (35.0%), the median age was 47 years (interquartile range (IQR) 38-60), and a positive BDR test occurred in 50 (25.38%)according to the 2005 criteria and 42 (21.32%) according to 2021 criteria when using the Global Lung Initiative (GLI) reference equations. Strong agreement was observed between the ERS/ATS 2005 and 2021 criteria (Cohen's kappa index: 0.887, 95%, CI 0.810 to 0.963). Similar results were found with the Third National Health and Nutrition Examination Survey (NHANES III) and the European Community of Coal and Steel (ECCS) predictive equations. Positive BDR tests were common in patients with moderately severe and severe forced expiratory volume in one second (FEV1) impairment and were not associated with eosinophil count or total serum immunoglobulin E (IgE) levels. Conclusion The introduction of the 2021 ERS/ATS criteriadid not significantly alter the classification of BDR in the majority of asthma patients, ensuring diagnostic stability. Whichever criterion was used, positive BDR correlated with the extent of FEV1 impairment, but not asthma biomarkers.

Airway obstruction can be better predicted using Global Lung Function Initiative spirometry reference equations in Marfan syndrome.

Marfan syndrome is a genetic disorder of the connective tissue, including involvement of the lungs.Pulmonary function test was performed in 32 asymptomatic adult Marfan patients using European Community for Coal and Steel (ECCS) and Global Lung Function Initiative (GLI) reference values.Using GLI equations for reference, significantly lower lung function values were noted for forced vital capacity (FVC) (87.0 ± 16.6% vs. 97.1 ± 16.9%; P < 0.01) and forced expiratory volume in the first second (FEV1) (79.6 ± 18.9% vs. 88.0 ± 19.1%; P < 0.01) predicted compared to ECCS. Obstructive ventilatory pattern was present in 25% of the cases when calculating with GLI lower limit of normal (LLN), and it was significantly more common in men as compared to women (n = 6, 50% vs. n = 2, 10%; P = 0.03).GLI is more suitable to detect early ventilatory changes including airway obstruction in young patients with special anatomic features, and should be used as a standard way of evaluation in asymptomatic Marfan population.

Substantial variation exists in spirometry interpretation practices for airflow obstruction in accredited lung function laboratories across Australia and New Zealand

Spirometry forms the foundation investigation for the diagnosis and monitoring of common pulmonary conditions. However, potential variation in spirometry interpretation for airflow obstruction may impact subsequent clinical management. To audit spirometry interpretation practices for airflow obstruction in Thoracic Society of Australia and New Zealand accredited laboratories. Thirty-nine accredited complex lung function laboratories were invited to participate in an online survey. The survey enquired about demographics, definition of lower limit of normal range for spirometry parameters, spirometric parameters used for identifying airflow obstruction, spirometric definition of airflow obstruction, definition of significant bronchodilator response and chosen spirometry reference equations. Thirty-six laboratories provided complete responses (response rate, 92%). To define the lower limit of normal, 26 of 36 used the 5th percentile, 7 of 36 used a fixed cut-off and 3 used other. Twenty-nine laboratories utilised forced expiratory volume in 1 s/forced vital capacity (FEV1 /FVC) as the sole parameter to identify airflow obstruction, 3 of 36 used FEV1 /FVC and FEF25-75% , and 4 used other. To define airflow obstruction, 25 of 36 laboratories used FEV1 /FVC < 5th percentile, 9 of 36 used a fixed cut-off (FEV1 /FVC < 0.7, 6/36; FEV1 /FVC < 0.8, 2/36; FEV1 /FVC < 0.75, 1/36) and 2 of 36 used other. Twenty-six laboratories defined a significant bronchodilator response as an increase of at least 200 mL and 12% in FEV1 and/or FVC, 9 of 36 used ≥200 mL and ≥ 12% increase in FEV1 only, and 1 used other criteria. Reference equations utilised for interpretation of spirometry data included: Quanjer 2012 Global Lung Initiative (16/36), the third National Health and Nutritional Examination Survey (8/36), European Community of Coal and Steel (8/36) and other (4/36). Significant heterogeneity in spirometry interpretation for airflow obstruction exists across Australian and New Zealand accredited lung function laboratories. Lack of standardisation may translate into clinically appreciable differences for the diagnosis and management of common respiratory conditions. Ongoing discussion regarding formal standardisation is required.

Favorable association of polyphenol-rich diets with lung function: Cross-sectional findings from the Moli-sani study.

The association of the polyphenol content of human diet with pulmonary function is not yet fully understood. This study aims at evaluating the association of polyphenol consumption with lung function in a novel holistic approach. A cross-sectional analysis of 4551 women and 5108 men (age ≥35 years) from the Moli-sani study was performed. Participants were randomly recruited from the general population. The EPIC-FFQ was used for the dietary assessment. Polyphenol intakes were calculated using Eurofir-eBASIS, and a polyphenol antioxidant content (PAC) score was constructed to assess the total content of the diet in these nutrients. Pulmonary function maneuvers were performed, and the forced vital capacity (FVC) and forced expiratory volume in the first second (FEV1) were measured; FVC% predicted and FEV1% predicted were computed using the European Community of Coal and Steel prediction equations that included height and age. In both genders, in age, height, and energy intake adjusted models, the majority of classes of polyphenols (mg/day) showed a positive association with FEV1, FVC, FEV1% predicted, and FVC% predicted (β-coef >0, P < .05). Associations remained significant after adjustment for confounding factors in most cases (β-coef >0, P < .05). The PAC score was associated in both genders with an increase in pulmonary function parameters (β-coef >0, P < .05). The inclusion of white blood cell (WBC) counts in the multivariate model reduced the association in men but not in women. . A higher overall polyphenol content of human diet was associated with better pulmonary function in a general population. The association might be partially mediated by WBC in men.

Ideas, Challenges and the Future of the EU

Ideas for a united Europe dating back too early and were of different nature, but the main purpose was seen mainly as the outcome of conflicts between peoples living in Europe. These ideas emerged particularly from prominent philosophers and intellectuals of the preceding ideas that were later to be implemented after the Second World War. Seeing the tremendous destruction of the First and Second World war, intellectuals, philosophers and rulers of this time all the ideas advocated were intended outcome of conflicts once and for all on the continent of Europe. As their only option to avoid a future conflict between France and Germany was the cooperation in economy which will create a dependency between these two states. The first agreement was signed in 1951, known as the European Community for Coal and Steel, and the European Union considered that has originates from this agreement. After this, in the following years and decades, followed other agreements and ongoing European Union has gone right unification, expansion, and continued strengthening of its institutions.

Reparto de competencias medioambientales entre la Unión Europea y los Estados miembros

Cuando se firmaron los Tratados de Roma de la Comunidad Económica Europea (CEE) en marzo de 1957, en la CEE no existía una preocupación apremiante por la cuestión medioambiental, por ello, los tratados originales no contenían provisión concreta relativa a la protección del medio ambiente, y tampoco se había atribuido una competencia en esta materia a las instituciones comunitarias. No obstante, el Tratado Constitutivo de la Comunidad Económica del Carbón y del Acero (TCECA) de 1952, ya había tomado en consideración la investigación de ciertos aspectos de la contaminación causada por las industrias del carbón y del acero. Y posteriormente, el Tratado Constitutivo de la Comunidad Europea de la Energía Atómica (TCEEA o EURATOM) de 1957 introdujo, por primera vez, algunas normas básicas de índices de radiación ionizante. Afortunadamente la Comunidad Europea CE fue evolucionando rápidamente y en los años 70 la CE comenzó a desarrollar su primera legislación en este área, principalmente en forma de «directivas », iniciando así un camino imparable. De hecho, poseemos el cuerpo normativo ambiental más extenso del mundo y los Estados miembros (EEMM) basan más del 80% de sus normativas nacionales medioambientales en la legislación comunitaria. El presente artículo hace un recorrido por «las competencias» que tienen atribuidas las instituciones de la Unión Europea (UE) por sus EEMM para conseguir los fines medioambientales que tienen en común, asimismo, se compara el grado de atribución de la competencia medioambiental a través de las reformas de los Tratados comunitarios.When the Treaties of Rome of the European Economic Community (EEC) were signed in Rome in March 1957, it did not exist an imminent concern towards the environmental issue, for that reason, the original Treaties did not contain either a specific provision relative to environmental protection, or a recognized competence of this matter attributed to the communitarian institutions. However, the Treaty establishing the European Community of Coal and Steal (TECSC), in 1952, had already taken into account the investigation of some aspects of the contamination caused by the industries of coal and steel. And after, the Treaty establishing the European Atomic Energy Community (TEAEC or EURATOM) in 1957, included, for the very first time, some basic standards of ionizing radiation. Fortunately, the European Community (EC) was progressing quickly on environmental contents. In 70’s decade, the EC began to develop its first legislation in this area, mainly in form of «directives », hence undertaking an unstoppable way. In fact, we possess the most extensive environmental normative body of the world and more of 80% of the environmental national norms of the Member States (MS) are based on the communitarian legislation. The present article mainly makes a route through «the competences », which have been conferred upon the European Union (EU) by its MS in order to attain environmental objectives they have in common. In addition, it is compared the degree of attribution of the environmental competence through the renovation of communitarian Treaties.

Percentiles of Inspiratory Capacity in Healthy Nonsmokers: A Pilot Study

Background: Over the past decade inspiratory capacity (IC) has received increasing attention, especially in studies on chronic obstructive pulmonary disease. Though a few recent studies provide reference values for IC, still little is known on the distribution of its values in healthy subjects. Objective: To estimate percentiles of IC in a sample of healthy nonsmokers by applying quantile regression. Methods: We applied quantile regression to estimate seven percentiles of IC from 5 to 95% for a given age, height and body mass index, separately in males and females, in a sample of 411 healthy nonsmokers, aged 8–73 years, drawn from the general population in Northern Italy. Results: The magnitude and statistical significance of the effect of age, height and body mass on IC varied across percentiles and between genders. When the 50th percentile of IC was compared with the predicted values of several studies, including those published by the European Community for Coal and Steel, the differences were as large as 0.86 liters in males and 0.90 liters in females. The possible advantage of the 5th percentile predicted from quantile regression over the ‘traditional 5th percentile’ as lower limit of normal was also illustrated. Conclusions: Inference on percentiles, rather than just the mean, of IC and other lung function measures may help in the future to better understand the effect of various risk factors, model growth curves and derive more accurate reference values.

J11 A pilot study on respiratory function in people with huntington's disease

BackgroundHuntington's disease (HD) is a neurodegenerative condition resulting in motor, cognitive and behavioural dysfunction. Physiotherapists are involved in the management of respiratory problems during the later stages of the disease1...

Lungenfunktion im Alter: Brauchen wir neue Referenzwerte?

The structure of our aging population has significantly changed in the last three decades as have also the anthropometric data. Therefore, the question arises as to whether or not the largely accepted reference values for ventilatory lung function, which were suggested by the European Community for Coal and Steel (EGKS), may still be used today, since these values were obtained in the 1960s from subjects in a limited age range. For the elderly, the measured values are deduced by extrapolation beyond the range of reference equations which had been obtained in a different population. Therefore decisions concerning elderly and smaller subjects concerning remuneration due to impaired lung function after industrial exposure on the basis of EGKS values are questionable. We have examined lung function using pneumotachography for recording static lung volumes and flow-volume curves in 176 asymptomatic non-smoking males, aged 20 to 90 years, and correlated the results to the reference values of the EGKS, SAPALDIA and LuftiBus. The age dependence of respiratory parameters (VC, FVC, FEV (1), FEV (1) %FVC, PEF, MEF (75,50,25)) for the healthy subjects can be described with a linear function (y = - m x age + n). The forced expiratory volume in one second, FEV (1), is calculated by FEV (1) = - 0.046 x age + 6.11; r = 0.88. Mean FEV1 for younger subjects was found to be 108 +/- 9.9 % of the EGKS reference values, 105 +/- 13.7 % in the middle-aged group and 97.3 +/- 12.4 % in the older subjects. All measured parameters concerning lung function can be described as linear functions of age which are steeper than those described by the EGKS reference values. The steeper slope in age dependency was also seen in other investigated parameters. The correlation of lung function parameters to height largely follows the EGKS predictions. Measured lung function values of healthy younger and elderly subjects showed a close correlation to the extrapolated reference values of the EGKS. Our results relating to normal lung function justify an extrapolation of the reference equations beyond the common ranges of age while applying the same limitations as described for subjects in the middle-age range. Our results permit an extrapolation of EGKS values beyond the range of the reference values and can be used for the classification of impaired lung function in older subjects. The alternatively discussed reference equations of the SALPADIA Study, of NHANES and partially of the LuftiBus Study are higher, but do not cover all the necessary parameters and/or age ranges. A multicentric study for contemporary reference values should be performed in order to solve the problems concerning valid reference values.

Using the lower limit of normal for the FEV1/FVC ratio reduces the misclassification of airway obstruction

Aim:The prevalence of airway obstruction varies widely with the definition used.Objectives:To study differences in the prevalence of airway obstruction when applying four international guidelines to three population samples using four...

FEV 1/FVC and FEV 1 for the assessment of chronic airflow obstruction in prevalence studies: Do prediction equations need revision?

Little is known on the long-term validity of reference equations used in the calculation of FEV(1) and FEV(1)/FVC predicted values. This survey assessed the prevalence of chronic airflow obstruction in a population-based sample and how it is influenced by: (i) the definition of airflow obstruction; and (ii) equations used to calculate predicted values. Subjects aged 45 or more were recruited in health prevention centers, performed spirometry and fulfilled a standardized ECRHS-derived questionnaire. Previously diagnosed cases and risk factors were identified. Prevalence of airflow obstruction was calculated using: (i) ATS-GOLD definition (FEV(1)/FVC<0.70); and (ii) ERS definition (FEV(1)/FVC<lower limit of normal) with European Community for Coal and Steel (ECCS) reference equations and with predicted values derived from the presumably normal fraction of the studied population. A total of 5008 subjects (4764 adequate datasets) were studied. Prevalence of airflow obstruction was 8.71% with ATS-GOLD definition and 6.40% with ERS definition and ECCS predicted values. The ERS definition with predicted values derived from the studied population provided a 7.96% prevalence. Severity distribution of airflow obstruction was also influenced by the equation used to calculate predicted values of FEV(1). Prevalence and severity of chronic airflow obstruction are influenced not only by the definition used but also by equations used to calculate predicted FEV(1)/FVC and FEV(1) values. These equations likely need to be periodically revised.

Reference equations for lung function screening of healthy never-smoking adults aged 18-80 years

The need for updated spirometric reference values to be used on European populations is widely acknowledged, especially for subjects aged >70 yrs. Their reference values are generally based on extrapolations. The aim of the present study was to calculate reference values for lung function screening of healthy, never-smoking adults aged 18-80 yrs and to compare them with the most widely used reference equations. Results of screening spirometry of 8,684 healthy, never-smoking adults were used to calculate mean values and fifth percentiles of lung function variables. The European Community of Coal and Steel (ECCS) reference equations underestimate forced expiratory volume in one second (FEV(1)) and forced vital capacity (FVC). For example, in 50-yr-old males (height 175 cm), lower limits of normal for FEV(1) are underestimated by 198 mL, and for FVC by 210 mL. In 50-yr-old females (height 165 cm), lower limits of normal for FEV(1) are underestimated by 191 mL, and for FVC by 270 mL. The decline of FVC in elderly subjects is steeper than predicted by the ECCS. Reference equations derived from spirometry data locally collected in a practical setting by well-trained personnel might be more appropriate for everyday use than generally used equations based on data from scientific studies in the distant past.

Nutritional status and long-term mortality in hospitalised patients with chronic obstructive pulmonary disease (COPD)

Patients with chronic obstructive pulmonary disease (COPD) often have difficulties with keeping their weight. The aim of this investigation was to study nutritional status in hospitalised Nordic COPD patients and to investigate the association between nutritional status and long-term mortality in this patient group. In a multicentre study conducted at four university hospitals (Reykjavik, Uppsala, Tampere and Copenhagen) hospitalised patients with COPD were investigated. Patient height, weight and lung function was recorded. Health status was assessed with St. George's Hospital Respiratory Questionnaire. After 2 years, mortality data was obtained from the national registers in each country. Of the 261 patients in the study 19% where underweight (BMI <20), 41% were of normal weight (BMI 20-25), 26% were overweight (BMI 25-30) and 14% were obese. FEV(1) was lowest in the underweight and highest in the overweight group (p=0.001) whereas the prevalence of diabetes and cardio-vascular co-morbidity went the opposite direction. Of the 261 patients 49 (19%) had died within 2 years. The lowest mortality was found among the overweight patients, whereas underweight was related to increased overall mortality. The association between underweight in COPD-patients, and mortality remained significant after adjusting for possible confounders such as FEV(1) (hazard risk ratio (95% CI) 2.6 (1.3-5.2)). We conclude that COPD patients that are underweight at admission to hospital have a higher risk of dying within the next 2 years. Further studies are needed in order to show whether identifying and treating weight loss and depletion of fat-free mass (FFM) is a way forward in improving the prognosis for hospitalised COPD patients.

Forced spirometry reference values for Norwegian adults: the Bronchial Obstruction in Nord-Trøndelag Study.

The purpose of this study was to develop new prediction equations for flow/volume spirometry parameters in asymptomatic, never-smoking adults in Norway, and to assess any differences of these parameters when applying the new and most commonly used equation sets. Flow/volume spirometry was measured according to the American Thoracic Society criteria in 2,792 subjects aged > or = 20 yrs, randomly selected from participants in the Nord-Trøndelag Health Study. Ever-smokers and subjects with respiratory symptoms and/or diseases reported in this questionnaire were excluded. A total of 546 females and 362 males met the inclusion criteria and were included in the analyses. Most lung function variables were nonlinear by age and had to be transformed. After a plateau in younger adults, the variables declined by age. The reference values for forced expiratory volume in one second and forced vital capacity from the present study, were higher than those given by prediction equations from the European Community for Coal and Steel, but in closer agreement with later studies from Europe, Australia and the USA. Healthcare providers should be encouraged to reconsider their choice of prediction equations of spirometry in order to improve management of obstructive lung diseases.

Lung function prediction equations derived from healthy South African gold miners

OBJECTIVESTo estimate lung function prediction equations and to identify appropriate normal reference values for the population of about 250 000 of South African gold miners.METHODSData from a lung function screening...

Pulmonary function in Sardinian fire fighters.

Our study examined the respiratory function of 92 firemen whose main activity is fire fighting in forests and open country. Such fire fighting activities are to be considered a risk to the respiratory tract, taking into account studies already in the literature that have evaluated the nature and quantity of inhalable toxins present in activities of this kind. The control group was composed of 51 Carabinieri (policemen), who were asked to fill in a questionnaire about their work activities. Forced expiratory volume and flow, total lung capacity, respiratory volume, and the permeability of the alveolar-capillary barrier were measured. Firemen and Carabinieri (policemen) showed FVC rates higher than the European Community for Coal and Steel standards. The firemen showed a significant reduction in forced expiratory volume in 1 second (FEV1)[3.90 (0.50) vs. 4.04 (0.44); p < 0.05] and forced expiratory flow at 75% of forced vital capacity (FVC) (FEF75) [8.37 (4.11) vs. 8.38 (1.67) p < 0.05] and more markedly in the FEV 1/FVC relationship [80.07 (5.89) vs. 83.89 (1.67) p < 0.001] and in FEF50 [4.73 (1.34) vs. 5.54 (1.44) p < 0.01] and FEF25[1.58 (.47) vs. 1.99 (.69) p < 0.001]. There were no marked differences in air-blood exchanges. No correlation was found between respiratory function data and years of service or the number of fires extinguished during work experience.

Pulmonary function in Sardinian fire fighters

Our study examined the respiratory function of 92 firemen whose main activity is fire fighting in forests and open country. Such fire fighting activities are to be considered a risk to the respiratory tract, taking into account studies already in the literature that have evaluated the nature and quantity of inhalable toxins present in activities of this kind. The control group was composed of 51 Carabinieri (policemen), who were asked to fill in a questionnaire about their work activities. Forced expiratory volume and flow, total lung capacity, respiratory volume, and the permeability of the alveolar-capillary barrier were measured. Firemen and Carabinieri (policemen) showed FVC rates higher than the European Community for Coal and Steel standards. The firemen showed a significant reduction in forced expiratory volume in 1 second (FEV1) [3.90 (0.50) vs. 4.04 (0.44); p < 0.05] and forced expiratory flow at 75% of forced vital capacity (FVC) (FEF75) [8.37 (4.11) vs. 8.38 (1.67) p < 0.05] and more markedly in the FEV1/FVC relationship [80.07 (5.89) vs. 83.89 (1.67) p < 0.001] and in FEF50 [4.73 (1.34) vs. 5.54 (1.44) p < 0.01] and FEF25 [1.58 (.47) vs. 1.99 (.69) p < 0.001]. There were no marked differences in air-blood exchanges. No correlation was found between respiratory function data and years of service or the number of fires extinguished during work experience. © 1996 Wiley-Liss, Inc.

Health survey of workers occupationally exposed to cobalt

The results are presented for a health control program using 236 male workers exposed to a cobalt inhalation risk. The study group consisted of grinders, producers of diamond tools, workers in metallurgical and mechanical industries (where Widia tools are processed and sharpened), and finally formerly exposed workers. All subjects received a clinical examination, the European Community for Coal and Steel questionnaire on respiratory complaints, a chest X-ray, pulmonary function test, electrocardiogram and determination of urinary cobalt; in 91 subjects, the metacholine bronchial provocation test was performed. Three cases of interstitial lung disease were identified. There were no cases with a significant alteration of ventilatory function while 20 cases (16 exposed and four formerly exposed workers) showed a reduced carbon monoxide transfer coefficient (T L,CO,sb/Va).

Asthma and Asthma-like Symptoms in Adults Assessed by Questionnaires: A Literature Review

The first widely used questionnaire in respiratory epidemiology was the questionnaire from the Medical Research Council (MRC) of Great Britain. In the first version, from 1960, there were only a few questions about wheezing, but in later editions, more questions about asthma and asthma-like symptoms were added. The MRC questionnaire initiated the development of other questionnaires such as the European Community for Coal and Steel (ECSC) questionnaire of respiratory symptoms and the questionnaire from the American Thoracic Society and the Division of Lung Diseases (ATS-DLD-78). In Tucson, Ariz, a questionnaire was developed in the 1970s that was focused on the subject's own report of asthma. In Great Britain, a questionnaire was developed in the 1980s with the intention of finding the most valid symptom-based items for identifying asthma, "the IUATLD (1984) questionnaire." When judging the validity of a questionnaire, it is essential to understand sensitivity and specificity. Sensitivity is the fraction of the truly diseased subjects found to be diseased using the questionnaire. Specificity is the fraction of the truly healthy subjects found to be healthy using the questionnaire. Regarding questionnaires dealing with asthma, the situation is confusing because of the absence of any gold standard for asthma. The most usual mode of validation has been to test the questionnaire against the results of a clinical physiologic investigation, often a nonspecific bronchial challenge test. Another approach has been to compare the answers from the questionnaire with the clinical diagnoses of asthma. When validated in relation to bronchial challenge tests, the questions about self-reported asthma have a mean sensitivity of 36 percent (range, 7 to 80 percent) and a mean specificity of 94 percent (range, 74 to 100 percent). The questions about "physician-diagnosed asthma" have even higher specificity, 99 percent. When validated in relation to a clinical diagnosis of asthma, the mean sensitivity for the question about self-reported asthma was 68 percent in the reviewed studies (range, 48 to 100 percent). The specificity was 94 percent (range, 78 to 100 percent). One problem in using the presence of bronchial hyperreactivity (BHR) as a gold standard for asthma is that many people with BHR report no respiratory complaints. In other words, the presence of BHR is a measure with high sensitivity but low specificity for asthma. The effect of using a methacholine challenge test as a standard for the disease will thus be an underestimation of the sensitivity of the questionnaire.(ABSTRACT TRUNCATED AT 400 WORDS)

The Democratic Dimension of European Integration

SINCE 1952, THAT IS SINCE THE SETTING UP OF THE FIRST European Community for Coal and Steel, there have been two views of European integration: the first regards and continues to regard European integration as the removal of state powers from the national administrations in specific sectors. This deliberately restrictive approach, with its overriding concern for efficiency, considers it is enough to limit the activities of national bureaucracies at European level. The view is that to a large extent one can do without the control and safeguard mechanisms which are usually built into the exercise of state power in all our member states. One eminent proponent of this view, Professor Ispen, an expert on German cotstitutional and European law, has described this form of integration, and the European Community it has produced, as an ad hoc association.The second view is also based on removing the exercise of state power from the national administrations in certain restricted areas. However it is not satisfied with a technocratic and bureaucratic approach but is concerned to preserve hard-won rights in the area of the control and exercise of sovereignty. I am of course thinking here first of all of the democratic element. Those who belong to this school of thought can cite the text of the Treaties establishing the European Communities in support of their view: the Preamble to the ECSC Treaty refers to ’… the basis for a broader and deeper Community among peoples …’. The Preamble to the EEC Treaty speaks of laying ‘the foundations for an ever-closer union among the peoples of Europe’.