Pulmonary Perspectives® China’s Pulmonary Crisis

The Air We Breathe

Air pollution comprises a second pulmonary insult to China’s health. The International Agency for Research on Cancer designated particulate matter (PM) as a class I carcinogen (Kurt O, et al. Curr Opin Pulm Med. 2016;22[2]:138). PM forms from combustion of bio-mass fuel, as well as from dust storms or construction. Once particulates are smaller than 2.5 microns (PM2.5), they cause substantial harm to the pulmonary microenvironment. Guo and colleagues demonstrated markedly increased lung cancer risks associated with spatial mapping of ozone and PM2.5 concentrations (Guo Y, et al. Environ Res. 2016;144;60). PM2.5 also doubles the odds of contracting COPD in nonsmoking adults, conferring as much as a three-fold risk of contracting the disease in nonsmoking women (Fang, 2011).

Apart from causing pulmonary disease, studies also implicate air pollution as frequently causing exacerbations of existing disease. One study found an incremental increase in ED visits for respiratory illnesses for every 10 µg/m³ above the median PM2.5 level (Xu, et al. PLoS One. 2016;11(4): e0153099). In 2013, 83% of Chinese lived in places where PM2.5 levels exceeded China’s own ambient air standard. In this cohort, elevated PM2.5 levels contributed directly to 300,000 premature deaths from lung cancer and COPD, with PM2.5 causing 1.2 million premature deaths overall (Liu J, et al. Sci Total Environ. 2016;568;1253).

Moving Forward

The Chinese have few illusions about these pulmonary concerns, and they are making progress. The government recently introduced stricter smoking controls in Beijing and Shanghai and continues to explore ways to decrease emissions. President Xi has put forward strong initiatives to improve the health of the Chinese. However, the nation is trying to balance its national priorities in the context of a fluid, and, at times, perilous geopolitical climate. In some ways, their position is not too dissimilar from the US geopolitical and health-care situation of the 1970s. While challenging, the issue of Chinese health care should not overshadow the remarkable resources or the truly remarkable culture of their people. Friendship, cooperation, the reduction of suffering: these are ideals where all clinicians find common ground, regardless of nationality.

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Dr. Mackay is Chief Fellow of Critical Care Medicine, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, New Jersey; Dr. Flenaugh is Associate Professor of Medicine, Division Chief of Pulmonary and Critical Care Medicine, Director of Advance Diagnostic and Interventional Pulmonary, Morehouse School of Medicine, Atlanta, Georgia.

Editor’s Note

This excellent, up-close Pulmonary Perspective details observations of Drs. Mackay and Flenaugh as they have participated in cross-cultural exchanges in

China with realization of the many obstacles to good pulmonary health for the Chinese population, obstacles including tobacco use, COPD, and air pollution. We appreciate their bringing these observations to the forefront.

The American College of Chest Physicians, likewise concerned about pulmonary health in China, has approached the problem on a different front, working closely with partners, such as the Chinese Thoracic Society, the Chinese Association of Chest Physicians, and the Chinese Medical Doctor Association, to implement China’s first ever fellowship program offering standardized training in PCCM for Chinese physicians. Read more at https://www.mdedge.com/chestphysician/article/131179/society-news/pccm-endorsed-pilot-subspecialty-chinese-national-health.

Nitin Puri, MD, FCCP, is the section editor of Pulmonary Perspectives.