China Dramatic increase in lung diseases

China is experiencing a massive increase in chronic lung disease

27.09.2012

In China, the health authorities have been observing a massive increase in lung disease for years. Causes are above all the high tobacco consumption, the increased concentration of the air pollutants and the inhalation „Impure air while working in factories, on large-scale operations or while cooking at stoves“, so the statement in a review article of the science magazine „Nature“.

The growing problem of lung disease in China is aggravated by outdated diagnosis and treatment options, writes author Virginia Hughes in the current article. In total, experts expect an increase in the deaths caused by lung disease in the next twenty years in China to three million a year. Every year, around two million people in the world's most populous country die from such a disease.

300 million smokers in China
More and more Chinese people are suffering from chronic obstructive pulmonary disease (COPD), also known as smoker's cough. The disease is usually caused by regularly high pollution levels of the respiratory tract. For example, COPD can be caused by smoking or high concentrations of air pollutants at work. In China, several unfavorably complementary factors play a role in the marked increase in lung disease. For example, nearly half of adult Chinese men smoke (about 300 million). Tobacco use is widespread, cigarettes are cheap and smoking bans did not exist until 2011. In addition, the smoking bans in public places and restaurants are still ignored by many Chinese.

Also in medical practices is smoked
„In rural areas, cigarette smoke permeates buses, shops and even doctors' offices“, reports the trade magazine „Nature“. Critical voices are relatively rare. It is hardly surprising that a study from 2007 in six major Chinese cities revealed that even among physicians, 41 percent smoke - 15 percent even smoked in front of their patients. According to the experts in China, 1,700 billion cigarettes are smoked every year. „Since the late 1970s, disposable income in China has increased significantly and so has the Chinese tobacco industry, production and advertising ramped up“, writes the author. While more than half of the men smoke, this only applies to one in every 50 Chinese women, according to Don Sin, specialist in respiratory medicine at the University of British Columbia, Vancouver, in the latest article. Yet, Chinese women also often suffer from COPD. This is due on the one hand to the passive smoking, on the other hand to increased pollution with air pollutants.

Secondhand smoke as a cause of COPD?
The author of the „Nature“-The article reports on two studies that have explored possible associations between women's passive smoking and chronic obstructive pulmonary disease. „The first of these studies, published in 2007, was based on the Guangzhou Biobank Cohort Study, a collection of blood samples and comprehensive medical data from more than 20,000 people over the age of 50 from the southern Chinese city of Guangzhou. The longer the subjects were passively exposed to tobacco smoke, the higher the results of the study were the likelihood of chronic obstructive pulmonary disease. The second long-term study of only 910 study participants, all of whom did not smoke, found that the probability of COPD with regular passive smoking was more than twice as high. However, the results of the two studies are still highly controversial. Especially as other studies have found no link between passive smoking and COPD.

Contaminants during cooking cause chronic lung diseases
„There is no question that secondhand smoke is bad, but how much COPD this causes in China is not yet known“, said David Christiani of the Harvard School of Public Health in the journal „Nature“. According to the expert, other risk factors also play a role in the relatively high number of Chinese women. Here, for example, air pollution in interiors should be mentioned. More than 70 percent of Chinese households and 90 percent of rural households use ovens for cooking and heating that are powered by wood, crop residues, coal or manure. According to the experts, the resulting particulate matter and the smoke enriched with carbon monoxide, formaldehyde and free radicals lead to a significant increase in the COPD risk. Women, who mostly cook for families, are increasingly exposed to these pollutants, which may also cause the high proportion of chronic obstructive pulmonary diseases among non-smokers, said Don Sin.

Air pollutants due to industrial production
Another major factor in the increase in lung disease in China is the economic boom and the associated increased release of pollutants by industrial production. This also affects the stress in the workplace, the experts report in the journal „Nature“. Currently, particularly high levels of stress are given, for example, in the cotton industry, silk production, grain processing and construction. Here workers would be regularly exposed to high pollutant concentrations, despite the limits that have now been introduced. In addition to the damage to the lungs due to inadequate protective measures at work, the smog in the cities as well as the high number of tuberculosis diseases (1.5 million Chinese people suffering from tuberculosis), the spread of pneumonia in children and malnutrition play a major role Don Sin testifies to the increase in chronic obstructive pulmonary disease.

Inadequate diagnosis and treatment of COPD in China
According to the experts, the consequences of increased lung disease in China may be less dramatic if adequate diagnosis and treatment were to be provided. Far too often, however, the symptoms such as coughing, shortness of breath and fatigue are confused with other medical conditions such as asthma by Chinese doctors. The late diagnosis of COPD usually complicates treatment, especially as irreversible damage to the lungs is often present at a later stage of the disease. In addition, the therapy offers in China are not state-of-the-art medical standards. All of China needs a wake-up call, according to David Christiani, „to realize the considerable human and economic burdens caused by COPD.“ As soon as China realizes this is the problem „can be addressed, there may be some significant progress“ give, so the hope of the expert. However, it was already too late for millions of older Chinese, and their hope of avoiding COPD went up in smoke. (Fp)

Picture: Rainer Sturm