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Chronic obstructive pulmonary disease (COPD) is characterized by progressive airflow obstruction that is only partly reversible, and causes a worldwide public health problem [1]. About 90% of deaths caused by COPD occurred in low-income and middle-income countries [2, 3]. In 2016, it was the fifth leading cause of death in China, the largest developing country [4]. However, over the past decade, few studies had examined COPD prevalence based on post-bronchodilator test in China. A reliable survey of spirometry-defined COPD in China was conducted during 2002–2004 among 20,245 adults aged 40 years or older and it observed an overall prevalence of 8.2% [5]. More recently, two nationwide estimations indicated that the prevalence of COPD among people aged 40 years or older increased rapidly to approximately 13.6% during 2014–2015 [6, 7].


A person with COPD is at increased risk of a number of complications, including:

  • Chest infections – a common cold or flu, can easily lead to a severe infection
  • Pneumonia – a lung infection that targets the alveoli and bronchioles
  • Collapsed lung – the lung may develop an air pocket. If the air pocket bursts during a coughing fit, the lung will deflate, similar to Atelectasis.
  • Heart problems – the heart has to work extremely hard to pump blood through the lungs to maintain the carbon dioxide/oxygen balance.
  • Anxiety and depression – breathlessness or the fear of breathlessness can often lead to feelings of anxiety and depression


Research in context [7].


Evidence before this study
We screened papers by reviewing abstracts to identify full-text reports that were relevant to the study aims. The most recent national survey of chronic obstructive pulmonary disease (COPD) in China was done during 2002–04 among 20245 adults aged 40 years or older and reported an overall prevalence of 8·2% (12·4% in men and 5·1% in women). To the best of our knowledge, no national data for COPD prevalence in Chinese adults younger than 40 years are available.


Added value of this study
Our large, national, cross-sectional study was undertaken in a nationally representative sample of 50991 adults from the general Chinese population. A post-bronchodilator pulmonary function test was done in all participants to diagnose COPD. Our findings indicate that, in 2015, the spirometry-defined prevalence of COPD was 8·6%, accounting for 99·9 million Chinese adults aged 20 years or older. The prevalence was 13·7% among people aged 40 years or older. For the first time, the prevalence of COPD was reported among the general population aged 20–39 years in China (2·1%). Additionally, our we showed that most people with COPD were unaware of their condition and few had received a previous pulmonary function test. Finally, cigarette smoking and heavy exposure to particulate matter with a diameter less than 2·5 µm were identified as major preventable risk factors for COPD in the Chinese adult population.


Implications of all the available evidence
Spirometry-defined COPD is highly prevalent and increasing in the Chinese adult population. Furthermore, the proportions of people with COPD who are aware of their condition or who have received pulmonary function tests are very low. Moreover, cigarette smoking and air pollution are major preventable risk factors for COPD. Our study calls for new national policy and programmes for the prevention and early detection of COPD. Specifically, health promotion for smoking cessation, control of ambient air pollution and biomass use, and screening for COPD using spirometry in high-risk individuals should be public health priorities.


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1. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease (2017 report). Accessed 10 Apr 2018.
2. Adeloye D, Chua S, Lee C, Basquill C, Papana A, Theodoratou E, et al. Global and regional estimates of COPD prevalence: systematic review and meta-analysis. J Glob Health. 2015;5:020415.
3. World Health Organization. Global surveillance, prevention and control of chronic respiratory diseases: a comprehensive approach. Accessed 4 Mar 2018.
4. GBD 2016 Causes of Death Collaborators. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390:1151–210.
5. Zhong N, Wang C, Yao W, Chen P, Kang J, Huang S, et al. Prevalence of chronic obstructive pulmonary disease in China: a large, population-based survey. Am J Respir Crit Care Med. 2007;176:753–60.
6. Fang L, Gao P, Bao H, Tang X, Wang B, Feng Y, et al. Chronic obstructive pulmonary disease in China: a nationwide prevalence study. Lancet Respir Med. 2018;6:421–30.
7. Wang C, Xu J, Yang L, Xu Y, Zhang X, Bai C, et al. Prevalence and risk factors of chronic obstructive pulmonary disease in China (the China pulmonary health [CPH] study): a national cross-sectional study. Lancet. 2018;391:1706–17.


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