China has added chronic lung diseases including bronchitis and emphysema to a key national public health program, which will give millions of patients access to free, regular check-ups for the first time.

Lung diseases are a major public health issue in China. Though the country has reduced air pollution in major cities over the past decade, it still has a high smoking rate, with over 300 million people using tobacco regularly.

That has led to a high incidence of chronic obstructive pulmonary disease (COPD), a basket of conditions associated with restricted lung function that includes bronchitis and emphysema.

There are an estimated 100 million COPD sufferers in China, with as many as one in eight people over 40 affected by the disease. Over one-quarter of the world’s COPD patients are Chinese, according to the World Health Organization.

But the vast majority of these patients receive no regular care for their condition. Nearly 90% of COPD sufferers in China have never received a clear diagnosis, with most only seeking treatment if their symptoms become severe.

To tackle this issue, the government announced on Sept. 13 that it plans to add COPD to the National Basic Public Health Service Program — a scheme that provides subsidized primary care for certain chronic diseases at clinics across China.

The policy will require community clinics to provide free screenings for COPD, as well as follow-up evaluations and routine check-ups to every COPD patient aged 35 and above.

By doing this, authorities not only hope to improve health outcomes for patients but also relieve the pressure on major hospitals, which are severely overstretched due to the lack of a developed primary care system.

The addition of COPD represents a major expansion of China’s public health program, which previously focused on conditions such as hypertension and Type 2 diabetes. Wang Chen, president of the Peking Union Medical College under the Chinese Academy of Medical Sciences, hailed the move as a “historic breakthrough.”

“With COPD being included in the basic public health service program, grassroots medical staff will give it the same level of attention as hypertension and diabetes, ensuring it receives the necessary focus and intervention,” Wang told domestic media.

But providing this extra care will be a challenge for China’s community-level health system, which has long faced a shortage of resources. Authorities have set clear requirements regarding the type of services clinics must provide in an attempt to ensure they comply.

For example, local authorities must provide at least an annual check-up for registered COPD patients and clinics with the necessary equipment should offer one lung function test per year.

Clinics are also required to provide at least four follow-up visits to patients each year to monitor their symptoms and ensure they are taking their medication.

Significant investment will be needed to meet these goals. At present, large lung function testing equipment is typically only available in China’s major hospitals, Cheng Kebin, chief physician of the respiratory and critical care department at Shanghai Pulmonary Hospital, told domestic media.

In western China — a particularly high-risk area for COPD due to high smoking rates and the widespread use of firewood and coal to heat homes — only 40% of basic health care institutions are equipped with lung function testing devices, according to Li Weimin, a doctor at the West China Hospital of Sichuan University.

COPD cannot be completely cured, but it can be detected early through regular lung function tests and controlled via the use of prescribed inhalers. But detecting the disease early is difficult because its initial symptoms, such as chronic coughing, are frequently ignored by smokers.

China has invested ever greater resources in expanding access to COPD treatment in recent years. In 2016, the government incorporated lung function tests into routine health check-ups. Three years later, it issued special action plans for preventing and treating chronic respiratory diseases, including COPD and asthma.

Hu Yang, associate chief physician of the respiratory department at Shanghai Pulmonary Hospital, said that the inclusion of COPD into the public health program will benefit both patients and hospitals.

“Not only will it make early screening and diagnosis more accessible at local community facilities, but managing the disease will no longer require frequent visits to large hospitals,” Hu said. “This will help to alleviate the strain on large hospitals.”

(Header image: VCG)