Chest tightness, shortness of breath—especially when climbing stairs. Barely a few steps in, and she’d be gasping like a bellows. As soon as the weather turned cool, the coughing wouldn’t stop, accompanied by copious phlegm. Grandma Li sighed, "Ah, old age really takes its toll. My strength just keeps fading day by day." But during a recent cold, a thoughtful doctor told her the truth was quite different.
"You have COPD. It requires long-term medication..."
"What? COPD?" The unfamiliar diagnosis, coupled with the words "long-term medication," left Grandma Li flustered before the doctor could finish.
"Don't worry. As long as you follow medical advice and take your medication properly, your symptoms will improve quickly," the doctor explained.
Chronic respiratory diseases—represented by chronic obstructive pulmonary disease (COPD), bronchial asthma, and lung cancer—are characterized by high incidence, high disability rates, high mortality, prolonged course, and high treatment costs. Among these, COPD is the most prevalent chronic respiratory disease, ranking as the fourth leading cause of death among Chinese residents.
Over the past three decades, deaths and disabilities caused by chronic respiratory diseases have risen globally, particularly among those aged 70 and above, making these conditions a worldwide public health challenge. The ongoing impact of the COVID-19 pandemic has further elevated respiratory disease prevention and lung health as critical priorities.November 17 marks the 20th World COPD Day, with this year's theme being "Healthy Breathing, Unmatched."What are the challenges and key points in preventing and treating chronic respiratory diseases? How should grassroots efforts be strengthened to safeguard public respiratory health?
Preventing and Controlling Respiratory Diseases
Multi-Sector Collaboration and Comprehensive Measures
With accelerating industrialization, urbanization, population aging, and shifts in ecological environments and lifestyles, preventing and controlling chronic respiratory diseases has garnered national-level attention.
In recent years, China has implemented numerous robust measures to combat chronic respiratory diseases.
First, policy guidance has been strengthened. Since 2012, China's "Chronic Disease Prevention and Control Plan (2012–2015)" has incorporated COPD prevention and control into assessment targets, actively advancing comprehensive chronic disease prevention strategies and continuously improving health-supportive environments.In 2014, the Chinese Center for Disease Control and Prevention's Chronic Disease and Nutrition Surveillance program first included COPD in its monitoring scope, initiating a three-year dynamic surveillance cycle to assess the disease's baseline status, development trends, and prevention outcomes in China.Both the Outline of the 13th Five-Year Plan for National Economic and Social Development and the Outline of the Healthy China 2030 Plan call for "implementing a comprehensive chronic disease prevention and control strategy." They set the development goal of "reducing premature mortality from major chronic diseases," with chronic respiratory diseases as one of the key indicators. This aims to increase public awareness of COPD, strengthen early screening, emphasize prevention of acute exacerbations, and enhance grassroots COPD prevention and control capabilities.
The Medium- and Long-Term Plan for Chronic Disease Prevention and Control in China (2017–2025) proposes incorporating pulmonary function testing into routine physical examinations for individuals aged 40 and above. By 2025, the rate of pulmonary function testing among this age group should reach 25%. This initiative will effectively increase the early diagnosis rate of COPD and advance the timing of treatment initiation.In 2017, China's mortality rate for chronic respiratory diseases stood at 11.96 per 100,000 population. The plan targets a 15% reduction in mortality rates for chronic respiratory diseases among individuals under 70 years old by 2025.
The "Outline of the 14th Five-Year Plan for National Economic and Social Development and the Long-Range Objectives Through the Year 2035," released in March 2021, continues to emphasize strengthening the prevention, early screening, and comprehensive intervention of chronic diseases, including chronic respiratory diseases.
Second, enhance project guidance. The "China Adult Lung Health Study," led by institutions including the China-Japan Friendship Hospital, the National Clinical Research Center for Respiratory Diseases, and the Department of Respiratory Medicine at Capital Medical University, has revealed the current state of COPD and asthma diagnosis and treatment, providing guidance for China's prevention and control efforts.
Chinese researchers have successively conducted studies on COPD prevalence and risk factors in China, as well as specific risk factors and prevention strategies. These studies confirm a significant correlation between COPD in rural areas and exposure to biomass fuels, providing substantial support for effective prevention and control of COPD and asthma.
Third, strengthen technical guidance. Current talent pools and system development fall far short of meeting the needs for chronic respiratory disease prevention and control. Primary healthcare workers, who are on the front lines of early screening and management, are key to effective chronic respiratory disease prevention and control. Training programs conducted by tertiary hospitals to enhance primary care providers' capabilities in early screening and intervention for respiratory diseases will help primary care settings improve chronic respiratory disease prevention and control.
Fourth, enhance public health education. As a major tobacco-consuming nation, China benefits from regular smoking cessation campaigns to reduce chronic respiratory disease incidence. Hospitals leading public awareness initiatives on COPD, asthma, and lung cancer can also improve public understanding of these conditions.
Fifth, explore enhanced mechanisms. Continuously investigate and optimize appropriate technologies and management models for screening and intervention tailored to China's realities and population characteristics, driving the establishment of long-term mechanisms for chronic disease screening and intervention.
Preventing Risk Factors
Tailored Comprehensive Treatment
Preventing COPD begins with guarding against all risk factors.
Smoking cessation is the key intervention for all smokers with COPD. Health education on smoking cessation should be strengthened for COPD patients. Healthcare providers should actively encourage smoking cessation during patient consultations and offer multiple cessation pathways to ultimately improve success rates. For patients with occupational exposure, awareness and management of protective measures within their workplaces and for individuals should be enhanced.Effective indoor ventilation, use of clean-burning stoves, and similar interventions can significantly reduce exposure to fuel smoke. Comprehensive COPD management encompasses both pharmacological and non-pharmacological treatments. Non-pharmacological approaches—including pulmonary rehabilitation, ventilatory support, self-management programs, and surgical or bronchoscopic lung volume reduction procedures—all contribute to improving patients' quality of life.Additionally, COPD patients often have comorbidities including cardiovascular and cerebrovascular diseases, lung cancer, hypertension, diabetes, and metabolic syndrome. Management of these comorbidities is essential alongside COPD treatment. Tailoring treatment to individual patients not only promotes safe, effective, and cost-effective medication use but also guides patients in rational drug utilization, enhances therapeutic outcomes, and reduces financial burdens.
Early-stage COPD may present no symptoms or only coughing and phlegm production, making it prone to being overlooked and misdiagnosed.By the time patients experience shortness of breath with minimal exertion, the disease has often progressed to moderate or advanced stages. Therefore, promoting lung function testing—incorporating it into routine physical examinations for individuals aged 40 and above, much like blood pressure checks—and implementing community-based screening for high-risk populations are crucial for early COPD diagnosis.
The 2014–2015 Chinese COPD Surveillance Survey revealed that only 11.7% of COPD patients aged 40 and above received medication, while the proportion utilizing non-pharmacological treatments (including smoking cessation, vaccination, and respiratory rehabilitation) ranged from a mere 0.8% to 25%. Significant progress remains needed to promote standardized diagnosis and treatment of COPD.
Misdiagnosis and missed diagnosis rates exceed two-thirds among China's COPD patients, reaching as high as 80% in some regions. Pulmonary function testing remains underutilized in primary care hospitals nationwide. Therefore, strengthening training and enhancing the skills of primary care physicians is crucial for respiratory disease prevention and treatment.
We must intensify public education on COPD and smoking cessation to raise awareness among the population. Routine early screening for high-risk groups should be implemented in communities. Promoting pulmonary function testing, standardizing COPD diagnosis and treatment by community physicians, establishing communication channels between specialists and primary care providers, and implementing tiered diagnosis and treatment across different hospital levels will elevate the diagnostic and therapeutic capabilities at the primary care level.