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Special article

Chinese children's respiratory diseases in 60 years

QIN, Qiang; SHEN, Kun-ling

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doi: 10.3760/cma.j.issn.0366-6999.2009.19.009
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This year marks the 60th anniversary of the founding of the People's Republic of China. On this occasion, it is worthy to recall the past and look towards the future in order to do a better job in research and control of children's respiratory diseases.

Before the founding of the People's Republic of China in 1949, Chinese children used to suffer from infectious diseases, pneumonia and diarrhea. According to the report Present Status of People's Health1 published in January 1942, the annual number of infant death was 3.6 millions, a mortality as high as 200/1000. After 1949, the Chinese government put the restoration of national economy on the agenda while emphazing the priority of people's health. The principle of “prevention first” has been the center of the medical care system. Since 1953, hygiene and epidemic prevention centers have been set up at all levels throughout the country. At the first 10 years after the founding of new China, the infantile mortality was lowered to 70/1000, and child morbidity rate was also reduced.2

In the first decade after 1949, the task of pediatricians concentrated on the control of respiratory infectious diseases, lowering the child morbidity and mortality. With the emphasis of “prevention first” in health service and the decline of child morbidity and mortality, pediatrians could make efforts in studying the pathogenesis and treatment of respiratory diseases as illustrated by more seminars or meetings on multiple organs damage in severe pneumonia, and their enhanced understanding of the diseases. In the 1960s, an attenuated measles vaccine developed by ZHU Fu-tang and YU Ding-xin strikingly declined the morbidity and mortality of measles as well as measles related pneumonia in Chinese children.3 Lower respiratory tract infection is one of the most common diseases in children in China. In 2001, the Guideline for judicious use of antimicrobial agents for pediatric lower respiratory tract infections4 and in 2007, the Guideline for children community acquired pneumonia5,6 were issued by Chinese Pediatric Respiratory Group which played important role for the management of pneumonia. According to widely use of new antibiotics, the morbidity of bacterial pneumonia decreased sharply, but drug-resistance became a big problem to Chinese pediatricians. Several studies carried out by YANG Yong-hong and his groups focused on antimicrobial resistance in pediatric pneumonia found that penicillin nonsusceptibility rates, although variable, demonstrated an increase over time in China. The prevalence of resistance to erythromycin, trimethoprim-sulfamethoxazole or tetra-cycline was reported to be over 80% and exceeded those reported from other developed countries.7

With the development of cell and molecular biology in the 1980s and 1990s, pediatrians found that pneumonia is not a single disease, but induces systemic inflammatory reactions (SIRS). This led to a great leap forward in the treatment of the disease.8 In this period, more than 20 respiratory virus laboratories were established in different institutions throughout the country. In 2003, an outbreak of severe acute respiratory syndromes (SARS) took place in Beijing and Guangzhou, also involving children. Fortunately, SARS was controlled in a short period.

Before the invention of pulmonary surfactant (PS), adult respiratory distress syndrome (ARDS) and respiratory distress syndrome (RDS) were big challenges to human life, and most of the patients died helplessly. In the 1980s, DONG Sheng-huan and his colleagues did a lot in purifying the PS extracted from swine.9 Their work decreased the antigenicity of the PS for its wide application in clinics, saving the life of infants from RDS.

Prevention and treatment of child asthma is a hard job for pediatrians. The morbidity and mortality of asthma are increasing in the modern society. In the period of 1988-1990, an epidemic investigation was carried out among 900 000 children by the Chinese Pediatric Respiratory Group, and the data of Chinese children with asthma (average morbidity 0.9%, 0-14 years old) were gathered for the first time.10 From June to October 2000, a second nationwide randomized survey, covering 43 cities in 31 provinces, on the prevalence of childhood asthma was carried out including a population of 437 873 children aged 0-14 years. There has been a significantly increasing trend of asthma prevalence (average 1.97%) during the ten years, especially in the older age group.11 Many hypotheses have been suggested in recent years, including “hygiene hypothesis”. More attention has been paid to prevention and cure of asthma in children with deep understanding of GINA. In this field, Zhou and Li et al12,13 pioneered in research into the pathogenesis of child asthma. In 1993, 1998, 2003 and 2008 the Guidelines for Diagnosis and Treatment of Child Asthma in China were revised by the Chinese Pediatric Respiratory Group. In the treatment of this disease, traditional Chinese medicine has shown good therapeutic results in some children with resistant asthma.

In the 1990s, a network of international organizations was formed on the internet in the USA and Europe, which developed quickly in the year 2000 as a form for information exchange among different institutions.

Increasing multicenter studies have focused on clinical evidence as a tool to evaluate the therapeutic efficacy of diseases including acute lung injury (ALI) in NICU.

In 2001, Sun et al14 from the Children's Hospital Affiliated to Fudan University conducted a multicenter network research in China for the first time. In 2006, a network including 40 institutions dealing with neonatal respiratory diseases, especially ALI, was established by researchers to serve as a platform for pediatrians in the developing countries to access update medical knowledge and techniques.

Sleep-related breathing disorder (SRBD) is a kind of respiratory disorder including sleep apnea syndrome (SAS), hypoventilation syndrome, upper airway resistance syndrome (UARS) and chronic lung diseases, neuro-mucular diseases, etc. In recent 10 years, research has been increasingly concentrated on SRBD in Chinese children in many institutions. The first report on SRBD has been published in 1995.15 The method of study includes questionnaire investigation, clinical study and laboratory research which involves transcutaneous oxygen saturation, blood gas analysis and polysomnography. The data of these studies revealed that SRBD in Chinese children is caused by UARS and OSAS; thus adenoid and tonsil resection would be beneficial to such patients.16 Recently, a study of obstructive sleep apnea-hypopnea syndrome in obese and non-obese Chinese children was carried out by XU Zhi-fei, which found out that obesity is a risk factor for (obstructive sleep apnea-hypopnea syndrome) OSAHS, and the degree of obesity is positively correlated with the severity of OSAHS.17

New apparatus and techniques which have been widely used clinically assure the diagnosis and treatment of some complicated diseases like chronic cough.11 For example high resolution computerized tomography (HRCT), bronchofibroscope reverse transcription-polymerase chain reaction (RT-PCR), immunofluorescence, etiological detection of resistant organism are now available in some clinics. And many achievements have been made in nitric oxide (NO) inhalation and mechanism ventilation in Neonatal Intensive Care Unit (NICU) and Pediatric Intensive Care Unit (PICU).

Although China has made marked progress in child health care, respiratory disease is still hazardous to children. Control of infectious diseases remains to be the priority in the future in this country.

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    Keywords:

    respiratory tract infection; respiratory distress syndrome; asthma; sleep-related breathing disorder

    © 2009 Chinese Medical Association