First Affiliated Hospital of Guangzhou Medical University, China
Nanshan Zhong is an Academician of Chinese Academy of Engineering, Medical Professor of Guangzhou Medical College, and a PhD tutor of respiratory medicine. Over the past decades, Prof Nanshan Zhong has been a leading scientist in promoting China’s respiratory medicine towards the forefront of international advances. In a systemic review of aetiology of chronic cough in China, he elucidated the neuroinflammatory mechanisms to gastroesophageal reflux-induced cough. For the first time, his methods for diaphragm function assessment during exercise demonstrated protein-energy malnutrition in even 60% of patients with early to middle stage COPD, which generated a correction equation of basic energy intake in this cohort. A national epidemiological study steered by him showed the unprecedented prevalence of COPD in China. His famous research found that hydro sulfuryl-containing expectorants (carbocysteine) can be effective in preventing or reducing acute exacerbation of COPD.
Prevalence of COPD increased by 67% from 2004 to 2015 in China (13.7% in >40 years population). [1, 2] Among patients population >92% were characterized as stage I & II, which are always neglected by physicians and patients.
By using Endobronchial Optical Coherence Tomography and exercise test, those patients present with apparent small air way remodeling and less exercise tolerance.  The earlier the staging, the faster the annual declining of FEV1.  Patients may not present with dyspnea (even exercise dyspnea) until their FEV1 dropped to ≤50% predicted. Early intervention may ameliorate disease progression. Community based integrated intervention (medical education, smoking cessation, improved air pollution and short cause SAMA) significantly reduced the incidence of COPD and annual decline of FEV1. In a two-years “Tie-COPD” study, we have firstly demonstrated that regular use of inhaled Tiotropium (18 µg qd two yrs )significantly improved trough FEV1 (127-169ml), FVC (116-164ml), annual post bronchodilator FEV1 decline rate, CAT score, CCQ score and exacerbation rate in stage I to II patients, even in the subgroup with CAT <10 , suggesting an active intervention of stage I to II COPD may greatly improve lung function and reverse (or partly reverse) disease progression.
We suppose that the strategy of the management of COPD may move to the upstream of the disease, which may alleviate the progression of COPD ,similar to the management of early stage of hypertension or diabetes .