Chronic obstructive pulmonary disease (COPD), the "chronic killer" of respiratory system

The 2016 annual meeting of the European Respiratory Society (ERS 2016) was held in London, UK from September 3 to 7 As the "first show" of China day, academician Zhong Nanshan released an important report on the early intervention of COPD (chronic obstructive pulmonary disease), introducing the early treatment strategies of COPD for delaying COPD Wang Chen, chairman of ers China, chairman of the respiratory branch of Chinese Medical Association (CTS) and President of China Japan Hospital, introduced the prevalence of COPD in China and how to promote the awareness rate of COPD and deepen the concept of three-level prevention In view of the increasing prevalence of COPD at present, the report of two academicians mentioned the importance of early diagnosis, treatment and intervention of COPD - the advancement of treatment strategy, aiming to arouse the high attention of medical professionals, health decision makers, policy makers and the general public to COPD, improve the awareness of prevention and treatment, and avoid the long-term occurrence of COPD COPD is a pulmonary inflammatory disease characterized by progressive airflow restriction and pulmonary dysfunction Clinically, cough, expectoration and shortness of breath after activity are the main symptoms of the disease However, some patients may have no symptoms in the early and middle stages of the disease and have strong concealment, which is often found only when they develop into severe or extremely severe diseases At present, there are about 210 million people suffering from this disease in the world The World Health Organization (who) predicts that by 2030, COPD will become the third largest cause of death in the world (8.6% of all causes of death) In China, the prevalence of COPD was 14% in the population aged 40 and over, and 8% in the population aged 20 and over Such a high prevalence rate is related to many factors, such as serious air pollution, large number of smokers, aging population, repeated infection of respiratory system in childhood, heredity and so on 1、 Data source of respiratory disease distribution in Shanghai: prescription analysis system (RAS) of China Pharmaceutical Industry Information Center Hospital As shown in Figure 1, the most common causes of respiratory diseases in this city are bronchitis (17.2%), COPD (8.1%), pneumonia (7.3%), cough (7.1%), acute upper respiratory tract infection (5.4%), lung infection (4.7%), lung cancer (3.6%), respiratory tract infection (3.1%) and bronchiectasis (2.9%) The incidence rate of COPD ranks the second in respiratory disease The situation of tracheitis prevention and treatment is severe 2、 Data source of COPD epidemiological survey: Ras database of China Pharmaceutical Industry Information Center hospital prescription analysis system (RAS) in the first half of 2016 (Figure 2, figure 3) shows that the prevalence of COPD in men in this city is significantly higher than that in women, and the proportion of patients is about 2.22:1 The higher prevalence of COPD in men is related to the higher number of smokers and occupational exposure Although only a part of heavy smokers have COPD, but there is conclusive evidence that active smoking is an important factor to induce COPD, the possibility of smoking to develop COPD is 14 times that of non-smoking, and is closely related to the total amount of smoking and smoking age It is worth noting that, although the prevalence of COPD in women is lower than that in men, it has a significant upward trend It is more sensitive to tobacco toxicity, more likely to show dyspnea, and usually associated with more chronic diseases From the perspective of age, COPD is more prevalent in elderly people over 60 years old, and the incidence rate increases with age So COPD is a kind of disease which has a great relationship with gender and age 3、 Common drug analysis of COPD By comparison, three of the 10 COPD treatment drugs (Figure 4, table 1) with the highest frequency in Shanghai sample hospital belong to the first-line drugs recommended by the 2016 updated global initiative for chronic obstructive pulmonary disease (gold): 1 Bronchodilator: tiotropium bromide, as the first long-term anticholinergic agent, has been identified as the first-line drug for long-term and regular use in moderate to very severe patients; 2 Inhalation Corticosteroids (ICS) combined with bronchodilators (especially long-acting β 2 receptor agonists) (Laba): fluticasone + salmeterol, compound, budesonide + formoterol, compound, ICs/ Laba compound is more effective than single drug in reducing the number of acute exacerbations of COPD patients, improving lung function, improving health status, etc., so it is generally not used alone; the other seven are alternative drugs, not recommended for routine use, including leukotriene antagonists, theophylline, antibiotics, expectorants, etc., although these drugs have certain efficacy in improving some symptoms of COPD, but There are often serious adverse reactions, narrow treatment window, or only limited to some patients with indications and other disadvantages, limiting its clinical application Because of the direct effect on the lung and the limitation of the action site, the systemic adverse reactions caused by oral or injection administration are also reduced At present, inhaled aerosols are the first choice for COPD, but systemic drugs are not recommended Data source: China Pharmaceutical Industry Information Center hospital prescription analysis system (RAS) table 1 Main dosage forms and classification of COPD drugs in common use IV marketing and R & D Progress of drugs related to obstructive airway disease According to the latest CPM data (Table 2 and table 3): CFDA has approved 60 domestic drugs related to obstructive airway disease and 19 imported drugs, 7 of which have not been approved domestically There are 91 drugs related to obstructive airway disease to be approved by CDE, 11 of which belong to class a new drugs, mainly long-acting anticholinergic agents or selective β 2-adrenergic receptor agonists Table 2 data sources of imported drugs approved by FDA for treatment of obstructive airway disease that have not been made in China: China new drug research and development monitoring database (CPM) of China Pharmaceutical Industry Information Center Table 3 data sources of new drugs for treatment of obstructive airway disease to be approved by CDE: China new drug research and development monitoring database (CPM) of China Pharmaceutical Industry Information Center current COPD Most of the treatment is symptomatic treatment, which can not completely prevent the progress of the disease, most of them are limited to relieve symptoms At present, the main purpose of COPD treatment is to control symptoms, reduce the deterioration rate and mortality, and improve the quality of life of patients Although new drugs continue to emerge, they can only alleviate symptoms but cannot be completely cured, so it is particularly important to prevent COPD The key is to reduce smoking and control environmental pollution, as two academicians emphasized in ers 2016 report: early detection and early intervention, advanced treatment strategy, and disease control in the embryonic stage