China has almost 100 million people living with chronic obstructive pulmonary disease (COPD) and accounts for almost 25% of all COPD cases globally. Notably, COPD was the third leading cause of death in China and accounted for more than 0.9 million deaths in 2013. A nationwide intervention with integrated strategies and measures targeting COPD care in primary health care has been implemented with key initiatives, including screening for people at high risk of COPD and a national programme for improving use of lung function tests. Through efforts by the Chinese Government, the capacity of screening and management of COPD in primary health care has been greatly improved.
his work is part of China’s Medium-to-long term plan of China for the prevention and treatment of chronic diseases (2017–2025), which aligns with the objectives of the WHO Global action plan for the prevention and control of noncommunicable diseases.
Improve the accessibility of early diagnosis and treatment of COPD
China has made strategic investments to improve the accessibility of COPD care service in primary health care institutes. This initiative encompasses an in-depth understanding of the COPD country profile, identification the gap in the accessibility and affordability of essential technique and medicines and the formulation of effective solutions to overcome challenges. The China Pulmonary Health Study, conducted from 2012 to 2015, revealed that 8.6% of the general Chinese adult population (or 99.9 million Chinese adults) aged 20 years or older in 2015 had spirometry-defined COPD, with only 10% ever having received a pulmonary function test. Recognizing this gap, the central Government of China launched a national project which allocated funds to equip primary health care institutes with portable spirometers and provided professional training to provide primary care workers.
“China recognizes the urgency of tackling COPD, a disease affecting millions of our citizens. Through strategic investments and targeted interventions, we have significantly improved the accessibility and quality of COPD care in our primary health care settings.” Said Professor Chen Wang, the Director of the WHO Collaborating Centre (WHO CC) in China, “by integrating WHO guidelines and collaborating closely, we aim to further enhance our COPD care capabilities and contribute to global efforts in combating noncommunicable diseases.”
The project’s goal was to improve their capabilities in the early detection and proficient management of COPD. As a result of the work, 30 000 portable spirometry equipment units have been distributed, covering nearly half of the primary care settings nationwide. Between 2020–2023, over 140 000 primary health care workers have received comprehensive training on pulmonary function tests, fortifying their skills in the early diagnosis of COPD. In October 2021 China initiated national COPD screening, and the WHO Collaborating Centre (WHO CC) China-Japan Friendship Hospital played a leadership role in steering this endeavour.
Through a combination of questionnaires and portable spirometers, health care workers successfully screened nearly 1.5 million individuals within 2 years. This effort led to a substantial increase in the diagnosis of COPD patients. Those who have positive scores in COPD-SQ questionnaires but in normal FEV1/FVC ratio were identified as high-risk of COPD. They received early intervention education, including smoking cessation, and underwent repeat spirometry 1 year later.
Improving access to the essential medicines for COPD patients is another crucial aspect of COPD care in primary health care services. In line with WHO Model Lists of Essential Medicine (WHO EML), the National Health Commission developed the National Essential Medicines List. Six essential inhaled bronchodilators were included in the catalogue of essential medicines covered by the national medical insurance system. This strategic inclusion ensures an ample range of treatment options within primary care settings.
A trained health worker conducts COPD screening in a high-risk population
Photo credit: China-Japan Friendship Hospital
Enhancing COPD management through extensive network
“The collaboration between China and the WHO in advancing COPD care represents a transformative model for global health. China’s commitment to improving accessibility, early diagnosis, and treatment aligns with the WHO’s Global Action Plan for the Prevention and Control of Noncommunicable Diseases.” Said Dr Bente Mikkelsen, Director of WHO’s Department for Noncommunicable Diseases, “this partnership demonstrates the collective commitment to achieving the goals set forth in the WHO NCD Action Plan, paving the way for a healthier future”.
To address the poor quality of COPD care service, the WHO CC initiated the Enjoying Breathing Programme in 2017. It aims to establish a new comprehensive COPD patients’ management model engaging all tiers of hospitals and disease prevention and control institutions. The programme spans the entire life course of COPD, including prevention, early detection, treatment, as well as regular follow up based on the triage of COPD patients. Most notably, the programme established a well-structured training framework including training the trainers, medical professionals in hospitals and primary care institutes, COPD patients training and self-management.
To strengthen the quality of primary care services for COPD patients, health care providers undertook specialized training. The training focused on identifying the early conditions, chandelling with exacerbation situation and lifestyle prescription to enhance the medicine compliance. Simultaneously, the COPD patients’ education program was implemented to bridge the awareness gap, rectify poor self-management practices in preventing exacerbation and empower patients to make wise decisions during emergencies. During 2017–2023 the Enjoying Breathing Programme has proven impactful, benefiting over 60 000 COPD patients. Experts from the National Centre for Respiratory Medicine have offered online and on-site education to nearly 100 000 primary health care workers. This comprehensive COPD management network has been successfully implemented in 51 cities across China.
The collaboration between China and WHO in advancing COPD care not only contributes to the well-being of 1.4 billion Chinese people but also serves as a model for global health initiatives. The achievements in reducing COPD-related morbidity and mortality in China have the potential to align with the goals of the WHO NCD Action Plan.
Source : WHO
