China News Network, May 5 (Reporter Zhang Ni) "Around 31, there were many hospitalized patients with COPD and asthma, accounting for about half, but now, most of the patients in the ward have been turned into lung cancer patients. We think it's all about smoking. ”

As a doctor in the Department of Respiratory and Critical Care Medicine at a large tertiary hospital in Beijing, Tan Xingyu has witnessed the changes taking place in the ward over the years. She makes weekly visits to the hospital's smoking cessation clinic, where teenage middle school students have begun to be sent by their parents to quit.

Tan Xingyu at work Photo by reporter Zhang Ni

"I've seen 18-year-old patients"

The smoking cessation clinic of Peking University People's Hospital was established in 2008 and has gone through more than ten years.

As the deputy chief physician of the Department of Respiratory and Critical Care Medicine, Tan Xingyu has been on weekly visits since the establishment of the outpatient clinic. Over the years, she has come into contact with thousands of patients.

Different from other outpatient examinations, patients who come to the smoking cessation clinic must first fill out a scale to judge the degree of nicotine dependence, including the number of cigarettes smoked per day, whether they want to smoke when they wake up in the morning, etc., once it is judged to be moderate to severe, then smoking cessation needs to be assisted by drugs.

"If the degree of dependence is usually high, if other interventions are not taken, there is only about a 5% success rate for smoking cessation."

Over the years, what has touched Tan Xingyu the most is that the age composition of patients who come to consult is changing.

"After the implementation of the Beijing Smoking Control Regulations, our outpatient volume has increased significantly more than before. In the past, people in their sixties and seventies quit smoking because of diseases such as coronary heart disease, but now many young people in outpatients take the initiative to quit smoking when they do not have symptoms. ”

On the one hand, patients' awareness of the dangers of tobacco is deepening, and on the other hand, the emergence of some adolescent patients also worries doctors.

"Two or three years ago, I saw an 18-year-old patient who was still in high school, and his parents brought him to the smoking cessation clinic, and this child has been smoking since almost junior high school, but fortunately his nicotine dependence was not severe at that time, and he quit without medication."

Such cases are also a microcosm of adolescents.

The "China Smoking Health Hazards Report 2020" released by the National Health Commission pointed out that the number of smokers in China exceeded 3 million, and in 2018, the smoking rate of people over 15 years old in China was 26.6%. The "2021 China College Students Tobacco Epidemic Survey" previously released by the Chinese Center for Disease Control and Prevention showed that the smoking rate of college students in China was 7.8%, the smoking rate of male students (15.0%) was higher than that of female students (1.1%), and the smoking rate of higher vocational/college students reached 11.6%.

In the eyes of doctors, reducing the smoking rate among teenagers as much as possible is a key means to prevent more "old bongs" in the future.

Photo by reporter Zhang Ni of the Smoking Cessation Clinic of Peking University People's Hospital

In the ward, there are more and more lung cancer patients

"Smoking is harmful to health", this is the warning sign printed on every cigarette box, and its concept has long been widely promoted.

At the national level, tobacco control is also regarded as an important task in the construction of a healthy China. The Healthy China Initiative (2019-2030) states that by 2022 and 2030, the smoking rate of people over 15 years old will be less than 24.5% and 20% respectively.

At the practical level, the promotion of tobacco control work is urgent, because for clinicians, the irreversible harm caused by tobacco to people's health is rapidly emerging.

In the respiratory and critical care medical ward where Tan Xingyu works, the patient's disease spectrum is undergoing obvious changes in the past 20 years.

"Around 2000, there were many hospitalized patients with COPD and asthma, accounting for about half, and we also set up a special chronic clinic, but now, most of the patients in our ward have turned into lung cancer patients. In addition, the number of pneumonia and asthma patients has also increased significantly than before, which we believe is closely related to smoking. ”

Tan Xingyu said that in the past, the progress from COPD to pulmonary heart disease was relatively slow, it may take thirty or forty years, and now, some young patients only need ten or twenty years to develop, and some are diagnosed with lung cancer, these changes are strongly related to smoking.

This change is also demonstrated by the data. According to media reports, according to data from the National Cancer Center, there were about 2021,97 lung cancer cases in China in 8, making it the largest cancer in China. In addition, the proportion of new lung cancer patients in China in the global lung cancer patients increased from 2016.42% in 5 to 2021.43% in 1, showing a continuous upward trend.

In November 2021, researchers published a research paper in the journal Tobacco Control to analyze that the peak of smoking epidemic in China was around the 11s and <>s of the twentieth century, and from the experience of other countries in the early days, the peak of smoking-related deaths usually occurred decades later, so the peak of lung cancer deaths in China has not yet arrived.

The study also projects that smoking-related cancer deaths will rise by 2020 percent in men and 2040 percent in women from 44 to 53.

Photo by Zhang Hengwei, reporter of China News Agency

Access to medicines remains an issue

As early as 1998, the World Health Organization listed tobacco dependence as an international disease as a chronic addictive disease.

With the development of evidence-based medicine in clinical medicine, there is sufficient evidence that smoking cessation is the first treatment for controlling chronic diseases, but smoking cessation is a very difficult process, and drug-assisted smoking cessation is widely used in smoking cessation clinics.

At present, China's clinical smoking cessation guidelines recommend 3 types of smoking cessation treatment drugs, including nicotine replacement therapy drugs, bupropion hydrochloride sustained-release tablets and varenicline tartrate, the treatment cycle of a drug is 3 months, and standardized treatment can increase the success rate of smoking cessation by 1 to 2 times.

However, these drugs are not yet covered by medical insurance, and patients need to buy them at their own expense.

"At present, our outpatient clinics recommend that patients take the drug for at least one month, preferably for twelve weeks, to help patients completely withdraw, and the cost of three months is about 1000,<> yuan."

Tan Xingyu said that although the price of the above drugs is not high, there are still some patients who understand that the drugs will choose not to use drugs to help quit smoking after they pay for themselves.

At the same time, under the current policy, because medical institutions have control over the proportion of self-paid drugs, this also leads to some hospital pharmacies will not purchase too many self-paid drugs, and many smoking cessation clinics are also facing the embarrassing situation of no drugs available. In the smoking cessation clinic where Tan Xingyu is located, there is currently only one medication that patients can choose.

In fact, calls for "including smoking cessation drugs in health insurance" have been going on in recent years. Previously, the Beijing Smoking Control Association also suggested that smoking cessation drugs should be included in designated retail pharmacies, support the settlement and dispensing of external prescriptions in designated retail pharmacies, and give full play to the convenient and accessible role of designated retail pharmacies; Explore smoking cessation services as a qualified "Internet+" medical service coverage coverage, etc.

In Tan Xingyu's view, if policies can help improve access to drugs, it will undoubtedly benefit patients.

Over the years, Tan Xingyu has paid close attention to the dynamics of patients after leaving the smoking cessation clinic, she has set up a special WeChat group, and now more than 200 patients have been pulled into the group, and she will often share smoking cessation related knowledge with patients in the group to understand the patient's situation.

In recent years, Tan Xingyu's department has also had male doctors who have successfully quit smoking with the help of smoking cessation clinics, and her own family has achieved "zero smokers".

However, compared to the huge number of 3 million smokers, China's tobacco control work still has a long way to go. On the road to the construction of a "smoke-free China", how to quickly and successfully replicate the "withdrawal experience" may be a key task. This requires not only more medical workers like Tan Xingyu to participate in it, but also the joint efforts of the government and all sectors of society. (End)