On June 8th, the "Small Airway Forum for Multidisciplinary Collaboration to Promote Optimal Treatment of Respiratory Diseases (CROTC) in China" was successfully held online. Professor Zhou Xin from the First People's Hospital affiliated to Shanghai Jiaotong University and Professor Lai Guoxiang from the 900th Hospital of the Joint Logistics Support Force of the People's Liberation Army of China were invited as the chairmen. Professor Zhang Yunfeng of Liqun Hospital in Putuo District shared the interpretation of China's Guidelines for Prevention and Treatment of Bronchial Asthma (2020 Edition), and Professor Ren Xinling of Shenzhen University General Hospital shared "Optimizing Asthma Management with Small Airway". And Professor Ma Zhiyi from the First Hospital of Longyan shared the interpretation of the Guide to Diagnosis and Treatment of Chronic Obstructive Pulmonary Disease (Revised Edition 202 1), and invited many scholars in this field to have academic exchanges and discussions around the latest progress of small airway dysfunction. This academic report is brilliant and unique, attracting thousands of doctors to watch it online. Now I will sort out the wonderful contents of the meeting for readers.
Promote standardized diagnosis and treatment of respiratory diseases
Chairman: Professor Zhou Xin.
Chairman: Professor Lai Guoxiang
At the beginning of the meeting, Professor Zhou Xin, President of the conference, said that the series of online seminars of "CROTC Small Airway Forum" attracted colleagues from many fields to focus on chronic respiratory diseases and discuss the key issues and latest progress in the field of small airways. Professor Lai Guoxiang, chairman of the conference, said that chronic respiratory diseases have different degrees of small airway inflammation, but at present, frontline clinicians lack understanding of this. With the strong support of China Medical Tribune and Bayer Company, we hope to discuss and communicate with colleagues in this field through the series of seminars of "CROTC Small Airway Forum" to understand the relationship between small airway inflammation and respiratory tract infection and refractory infection, so as to improve the diagnosis and treatment level of respiratory tract inflammation and respiratory tract infection.
Interpretation of China Guidelines for Prevention and Treatment of Bronchial Asthma (2020 Edition)
Speaker: Professor Zhang Yunfeng.
According to statistics, in 20 17 years, the control level of outpatients with bronchial asthma in 30 cities in China was only 28.5%. The prevalence of bronchial asthma is high and the burden is heavy, but the control rate is low. According to the patients' clinical manifestations, China Guidelines for the Prevention and Treatment of Bronchial Asthma (2020 Edition) updated the stages of asthma, and clearly defined and distinguished the chronic duration and clinical control period. The new guideline adds two evaluation methods: allergen detection, serum total IgE detection and allergen-specific IgE detection. In addition, the new guidelines mentioned the relationship between small airways and asthma for the first time, indicating that nearly half of patients with cough variant asthma (CVA) have small airways dysfunction. Professor Zhang Yunfeng made an in-depth interpretation of China Asthma Prevention and Treatment Guide (2020 Edition), focusing on the differential diagnosis of asthma, the treatment of chronic duration of asthma, the definition, classification and evaluation of severe asthma, etc. For severe asthma patients with small airway dysfunction, inhalation of ICS/LABA ultrafine particles can make more therapeutic drugs deposited in small airways, better improve small airway function and control asthma.
Professor Zhang Yunfeng concluded that the long-term goal of asthma management is to enable patients to achieve good symptom control and maintain normal activity level, and to minimize the risk of future acute attacks, limited fixed airflow and adverse drug reactions. Professor Zhang emphasized that establishing a good doctor-patient cooperative relationship is the primary measure to achieve effective asthma control, and it is incumbent on patients to educate doctors. The application of Internet technology and artificial intelligence can help doctors to follow up and educate patients.
The "goal" is to hold a small airway and optimize asthma management.
Speaker: Professor Ren Xinling
There are at least 300 million asthma patients in the world. According to the national cross-sectional China lung health (CPH) research data in 20 19, the total asthma prevalence rate in China is 4.2%, and the global asthma prevalence rate has been increasing year by year in recent years. In 2025, the affected population may increase by 1 100 million. Professor Ren Xinling said that no matter the severity of asthma, more than 60% of asthma patients will have small airway dysfunction, and it is a common reason that asthma is not controlled because it is difficult for therapeutic drugs to reach all airways. For adult or adolescent patients who have never received asthma control drugs before, conventional low-dose ICS/LABA as initial maintenance control drugs can relieve asthma symptoms and improve lung function compared with low-dose ICS alone. Compared with ordinary granular ICS/LABA, ultrafine granular beclomethasone/formoterol can be evenly distributed in the whole bronchus, with higher lung deposition rate. At the same time, it can treat small airway dysfunction, increase small airway capacity, significantly reduce daytime symptoms and the use of emergency drugs, which is helpful to improve asthma control rate and play more clinical benefits.
Professor Ren Xinling concluded that asthma is an airway inflammatory disease with large and small airways, and the incidence of small airway dysfunction is high, which affects asthma control. Aerosol is suitable for patients with poor lung function, and the "ultra-fine constant fog" Modulite aerosol device further alleviates the coordination problem of aerosol pressing and inhalation, which is convenient for patients to use.
Interpretation of "Guidelines for Diagnosis and Treatment of Chronic Obstructive Pulmonary Disease (Revised Edition 202 1)"
Speaker: Professor Ma Zhiyi.
Professor Ma Zhiyi said that chronic obstructive pulmonary disease is characterized by persistent airflow limitation and corresponding respiratory symptoms, and the pathological changes are mainly airway and/or alveolar abnormalities. In the diagnosis of COPD, in order to reduce missed diagnosis, medical history should be collected comprehensively, including symptoms, exposure history of risk factors, past history and complications. Pulmonary function examination is still the "gold standard" for the diagnosis of chronic obstructive pulmonary disease. In the case that primary hospitals do not have the conditions for lung function examination, high-risk individuals with chronic obstructive pulmonary disease can be found through screening questionnaires. The management goal of COPD in stable period is to relieve current symptoms and reduce future risks. Bronchodilators are the basic first-line treatment drugs for COPD, and the guidelines suggest that inhaled corticosteroids should be combined with long-acting bronchodilators. It was found that the clinical symptoms and pulmonary function indexes of COPD patients were significantly improved after continuous application of beclomethasone/formoterol ultrafine particles. Compared with fluticasone/salmeterol, beclomethasone/formoterol has a better effect on improving pulmonary function in COPD patients. Compared with systemic application of glucocorticoid, inhaled corticosteroid has fewer adverse reactions and can replace or partially replace systemic application of glucocorticoid.
Professor Ma Zhiyi concluded that the prevalence of chronic obstructive pulmonary disease (COPD) in China is rising, and there are still many problems in the COPD guidelines, but it also provides a direction for the follow-up research. The guideline has absorbed the latest research progress at home and abroad in recent years, combined with the clinical practice in China, which is very consistent with the clinical situation in China and worth learning and learning from in our daily work.
Big coffee talks, * * * words are stingy.
Discussion guest: Professor Du Chunling
Professor Du Chunling, Qingpu Branch of Zhongshan Hospital affiliated to Fudan University: Standardized and individualized treatment should be emphasized for asthma. "Guidelines for Prevention and Treatment of Bronchial Asthma in China (2020 Edition)" describes in detail the patient evaluation, severity classification and treatment degree classification, but the clinical treatment is not very standardized at present. For asthma, individualized treatment should be carried out according to the standard basis of the guidelines in our clinical work.
Discussion guest: Professor Zhang.
Professor Zhang from pulmonary hospital, Fuzhou, Fujian: Compared with the 20 16 guideline, the China Guidelines for the Prevention and Treatment of Bronchial Asthma (2020 Edition) is more complete, clinical, understandable and practical. For the treatment of asthma, after years of repeated education and popularization of drugs, patients with mild and moderate asthma see fewer doctors in 3A hospitals, and relatively severe asthma accounts for a large part, which is relatively difficult to treat. The guide gives many treatment plans and provides reference for the treatment of severe asthma.
Discussion guest: Professor Ge Dehai
Professor Ge Dehai from Nanjing Meishan Hospital: There are several difficulties to be paid attention to in asthma treatment. The first is poor patient compliance. In addition to the limitations of economic conditions, many patients are unwilling to use hormone therapy for a long time because of the side effects of drugs. The second is that therapeutic drugs cannot reach all airways. If two-thirds of inhaled drugs reach the large airway and 1/3 reach the small airway, the dosage of hormones can be reduced and the side effects can be alleviated. The third is the convenience of operation of the inhalation device. For most elderly patients, a simple inhalation device can avoid poor therapeutic effect caused by improper operation.
Discussion guest: Professor Feng
Professor Feng from the Hospital of Integrated Traditional Chinese and Western Medicine of Southern Medical University: Drug particles larger than 3 microns are deposited in the large airway, but the amount in the small airway is very small, so now we need to find drugs with ultrafine particles to solve the problem of small airway dysfunction and fundamentally relieve asthma symptoms. The drug with the diameter of 1.4 micron to 1.5 micron accumulates in the lung as high as 3 1%, which realizes the uniform distribution of large and small airways, reduces the dosage of hormones, and can effectively control asthma.
Discussion guest: Professor Qing Xue.
Professor Qing Xue from Ningde Hospital affiliated to ningde normal university: The revised edition of 20021Guidelines for the Diagnosis and Treatment of Chronic Obstructive Pulmonary Disease was included in the screening questionnaire for chronic obstructive pulmonary disease for the first time, which not only quoted CAT and MMIC scores, but also emphasized the importance of moderate and severe acute exacerbation in judging disease risk. In addition, the new guide also adds suggestions on when to enable ICS. The new guideline is closer to the actual situation of clinical diagnosis and treatment in China, especially for the management and prevention of patients with chronic obstructive pulmonary disease at the grassroots level, and it is a very good guiding document.
Discussion guest: Professor Li Lin
Professor Li Lin from Jiangxi Cancer Hospital: With the improvement of medical level, cancer patients live longer and longer, and pay more and more attention to the improvement of quality of life. Treat airway inflammation, obstructive pneumonia, bacterial infection, viral infection, mycoplasma infection, chemical injury, etc. It is becoming more and more important for chest oncologists in the treatment process. Clinical use of related new airway dilators has a good effect on relieving symptoms. Through this study, I deeply feel the importance of knowledge about respiratory diseases related to small airways, and hope to have more learning opportunities in the future.
Professor Lai Guoxiang, chairman of the conference, said in the summary of the meeting that we learned a lot through the discussion at this meeting, expounded the relationship between small airway dysfunction and asthma and chronic obstructive pulmonary disease, deeply understood the pathophysiological mechanism of small airway dysfunction, the mechanism of therapeutic drugs and the clinical application of related devices, and further realized that the treatment of small airway diseases requires higher inhalation devices, inhalation flow rate and drug particle size. The diameter of beclomethasone/formoterol ultrafine particles reaches 1.4 μ m ~ 1.5 μ m. After inhalation, beclomethasone/formoterol ultrafine particles move close to Brownian motion in the respiratory tract, and it is easier to enter the distal bronchioles and small airways and reach the inflammatory target of small airways. Through this exchange and study, I deeply understand the main points of diagnosis and treatment of respiratory diseases related to small airway dysfunction, and hope to have more exchange platforms in the future.