What does Beijing's air pollution do to your lungs?

by Michael Woodhead
Breathing the polluted air in Beijing has the same effect on the lungs as being a heavy smoker, a study carried out before and after the 2008 Olympic Games has shown.
Researchers from Peking University have shown that residents of Beijing have impaired lung function – but that their lungs can revert to normal during clean air periods such as during the Olympic Games, when air pollution was artificially curbed for a few weeks.
The findings come from a novel series of lung function tests done on 200 Beijing residents before, during and after the 2008 Olympics.
Dr Lina Mu of School of Public Health at the University at Buffalo, New York, carried out the research in conjunction with colleagues at the School of Public Health, Peking University,
They found that ordinarily in Beijing, the mean PM2.5 (83 µg/m3) is more than three times higher than the WHO׳s safe limit of 25 µg/m3. At the same time, lung function of Beijing residents (as measured by peak expiratory flow or PEF) was well below the normal range for healthy lungs.  Lung function was impaired by 16-40% for men (PEF of 418 vs a healthy range of 500-700 L/min) and by 23-42% (PEF of 292 vs a norm of 380–500 L/min) for women.
During the Olympic Games the closure of factories and curbs on use of vehicles resulted in air pollution levels falling and particulate matter levels were reduced up to 60%. During this brief ‘clean air’ window lung function was observed to increase by 17% in females and 13% in males, “suggesting an improved airway status after 40 days of lowered exposure to air pollution.” The researchers said.
Interestingly, lung function improved more in non-smokers than smokers and in younger, female residents compared to male and older Beijing residents.
The clean air period in Beijing also saw a reduction in the number of Beijingers with rapid breathing (more than 20 breaths per minute) – a typical response to pollution and impaired lung function.
Lung function deteriorated back to unhealthy levels after the Olympics when factories were re-opened and pollution levels returned to their usual levels.
The researchers said their findings confirmed the adverse effect of particulate matter in the atmosphere on lung function.
“Deposition of particulate matter induces increased oxidative stress that not only results in DNA, lipid and protein damage, but also leads to the inflammatory responses,” they noted.
They said the pollution curbs implemented by the Chinese government during the 2008 Olympics had created conditions for a natural experiment that showed the impact of air pollution on Beijingers’ lung health.
They said the findings confirmed the adverse effects on lung health but showed that these cold be reversed – at least in some sections of the population. However, they also noted that long term exposure to air pollution in Beijing was likely to have more severe ongoing effects on lung health.
The study is published in Environmental Research.

Coal burning and tuberculosis make COPD a common condition for non-smokers in China

In western countries chronic obstructive pulmonary disease is seen as predominantly a disease of smokers - and the only way to halt its progression is to stop smoking. 
In China however, thousands of non-smokers shows signs of non-reversible airways obstruction - and the reasons seem to be the country's ubiquitous use of dirty coal for cooking and heating. A study of 300,000 Chinese adults who have never smoked has found that one in twenty (5%) have COPD, with the condition more common in women than in men.
The main factors associated with COPD were low income, lack of education, living in a rural area and a prior history of tuberculosis.   However, another major factor was cooking with coal.
The study researchers, from the Chinese Academy of Medical Sciences, Beijing, and Oxford university, said the link between low income and lung disease might be due to higher exposure to infections and to air pollution.
The findings are published in the European Respiratory Journal.

Beijing stent success | COPD prevented | Private hospital investor reluctance | Generic companies head for the door

Coronary stent success in Beijing
Chinese cardiologists have come up with a novel answer to the perennial problem of late stent thrombosis with coronary stenting. To avoid  thrombus formation after the use of bare metal or drug eluting stents, Chinese researchers from the Department of Cardiology, Beijing Chaoyang Hospital, have tested stents coated with biodegradable polymers. In a three-year clinical trial whose results are published in the Archives of Medical Sciences they have shown that the stents were just as effective as durable polymer coated stents in reducing major  cardiac events and have the same rate of thrombotic event rates. Biodegradable stents may have the advantage of needing less antiplatelet drug use to prevent thrombus formation they write.

Chinese trial finds new compound to prevent COPD
Another groups of Chinese researchers have come up with a solution to the difficult problem of preventing exacerbations of COPD. In a one year clinical trial carried out at 34 Chinese hospitals they tested the effects of the anti-inflammatory compound N-acetylcysteine compared to placebo in over 1000 patients with COPD.  They found there1·16 COPD exacerbations per patient-year in the treatment group and 1·49 exacerbations per patient-year in the control group. Thus N-acetylcysteine reduced exacerbations by 22%. The treatment was generally well tolerated, according to the study results published in Lancet Respiratory Medicine.

No rush to invest in private hospitals
In the SCMP, Zhuang Pinghui writes that investment in private hospitals on the mainland is set to rise following the relaxation of regulations,  but don't expect a gold rush- there are still many obstacles. The article says the government wants to see more private investment but private hosptals have problems claiming health insurance rebates and getting permission to buy major items of equipment such as  scanners. This means private healthcare might become just a niche product for the China's rich.

China not attractive to foreign generic companies
In Forbes, Benjamin Shorbert looks at what made one the world's biggest generic manufacturers, Actavis, quit China's $82 billion drug market. He suggests it was due to the increasing pressure on drug prices and the Chinese government's favouritism for local companies and penchant for targeting foreign pharma companies for unpleasant attention. I know things have been tough for Actavis but I think it must be a typo when he says the company only made $7 profit in China last year.

COPD patients at high risk due to poor treatment: study

About one in three men with COPD continue to smoke

by Michael Woodhead 
Patients with chronic obstructive pulmonary disease in China are highly vulnerable to exacerbations because many continue to smoke and few take medications appropriately, a Jiangsu study shows.
Dr Lou Peian and other researchers from the Xuzhou Center for Disease Control and Prevention in Jiangsu Province, Xuzhou, China interviewed 2825 male and 2825 female patients with COPD living in rural areas.
They found that 30% of  men were still smoking and 11% of women were current smokers, despite smoking being a major risk factor for poor disease control. In addition, 32% of men and 75% of women were using fuel such as coal in the house, despite this being know to exacerbate their COPD.
In terms of COPD medication, 26% of male patients and 16% of the female patients did not take theophylline regularly when their disease was stable. During acute exacerbations, 66% of the male patients and 40% of the female patients took theophylline or similar drugs.
The researchers estimated that COPD would reduce life expectancy by 1.76 years for men and 1.18 years for women. The disease also imposed an indirect economic burden was 11,158 yuan for men and 7481 yuan for women. The quality of life was worse in female patients than in male patients.
"We found that patients with COPD were vulnerable and that factors determining vulnerability were different for men than for women. Therefore, we recommend adopting different measures for men and women when attempting to prevent, control, and treat COPD, rehabilitate these patients, and improve their quality of life," they conclude.
Source: International Journal of Chronic Obstructive Pulmonary Disease.

Chinese screening tool is an accurate alternative to spirometry for COPD

Nine-point questionnaire as accurate as spirometry

by Michael Woodhead
Guangzhou respiratory specialists have developed a simple and inexpensive alternative to spirometry for diagnosing COPD in Chinese primary care settings.
Writing in the Journal of Thoracic Disease, Dr Cui Jiangyu and colleagues at the Guangzhou Institute of Respiratory Diseases, The First Affiliated Hospital, Guangzhou Medical University, say that although spirometry is the “gold standard” for COPD detection, it is underused in primary care settings, particularly in China because it is expensive, requires skill to operate and is unfit for some patients. They have previously shown that in China, only 6.5% of patients with COPD had ever been tested by spirometry.
"Thus, it is of great value to develop a simple and economical method which can be used as an alternative option for spirometry to screen COPD and to predict the COPD stage in primary care settings.
They therefore developed a nine-point screening tool based on data from 243 COPD patients and 112 non-COPD subjects from a COPD survey in urban and rural communities and local primary care settings in Guangdong Province, China. The nine factors used to test for COPD included age, gender, smoking, body mass index, occupational exposure, living environment, wheezing, cough and dyspnoea.
In testing the model they found that the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, accuracy and error rate of the function model to discriminate COPD were 89%, 82%, 4.94, 0.13, 87% and 13%, respectively.
They conclude that "Our study tentatively developed a discriminant function model consisting of nine variables which can be applied to screen COPD as an alternative option in areas where spirometry is unavailable. To our knowledge, no previous study used a discriminant function model to screen for COPD, though the same way has been used in the diagnosis of other diseases."
The researchers say that compared with spirometry, the short screening questionnaire of nine variables is much simpler, easier and economical. It also seems to be a more sensitive method to screen COPD than the scoring system of the COPD diagnostic questionnaires
"In addition, our discriminant function model can also be used to predict the stage of COPD, with an accuracy of about 70%," they add.
"In conclusion, the discriminant function model reported here is a first attempt of its kind to develop an alternative method for the COPD screening in Chinese settings. We believe that it may help diagnosis early enough a great number of COPD patients who may not be diagnosed otherwise and the early diagnosis can allow them to have a timely medical treatment."
Source: Journal of Thoracic Disease