COPD in China: the burden and importance of proper management

Abstract

Although, to our knowledge, there has been no exhaustive or credible review of the evidence of the disease burden of COPD in China, COPD has become an increasing public health concern to the Chinese medical community. The purpose of this article is to review the evidence and evaluate and clarify the disease burden of COPD in China with the aim of improving effective management. We reviewed previous studies of COPD in China, which included data on prevalence, mortality, disease burden, risk factors, diagnosis, and management by searching related Web sites, including PubMed, ProQuest, and Thomson Reuters' Web of Knowledge, as well as major Chinese databases and government Web sites. Reported COPD prevalence varied between 5% and 13% in different provinces/cities across China. In 2008, COPD ranked fourth as a leading cause of death in urban areas and third in rural areas. In addition, COPD accounted for 1.6% of all hospital admissions in China in that year. The high prevalence of smoking and biomass fuel use acted as major contributors to the high occurrence of COPD in China. Management of COPD in China should focus on adjusting the distribution of medical resources and on addressing public health policies to facilitate earlier diagnosis in rural areas, aim to reduce smoking prevalence, improve patients' self-management, and keep physicians' knowledge up to date and consistent with current guidelines. COPD is one of the most challenging medical issues facing China because of its influence on both personal and public health and its impact on the economy. Optimal management strategies should be adopted and strengthened immediately.

Figure 1

A, COPD mortality trend in urban and rural areas from 1990 to 2008. Data were collected from the Chinese Ministry of Health. B, Hospitalization rate of COPD for 1998, 2003, and 2008 in China. The decline of hospitalization in 2003 could be attributable to the outbreak of severe acute respiratory syndrome.

Figure 2

The leading chronic diseases that caused disability-adjusted life years (DALYs) lost in China. Data were collected from the Chinese Center for Disease Control. The DALYs lost caused by chronic diseases accounted for 70% of the total DALYs lost. Cerebrovascular disease and COPD ranked as the top two leading causes of DALYs lost in China, responsible for 17.9% and 13.9%, respectively, followed by ischemic heart disease, gastric cancer, liver and lung cancer, and others.

Figure 3

Smoking prevalence in China. A, Overall prevalence of smoking for 1984, 1996, and 2002 by age group in China. B, Smoking rate trend for women and men from 1984 to 2002.