"About 2000, there are many patients with slow lungs and asthma patients in hospitalization, which can account for about half. However, most of the patients who have income in the ward have become lung cancer patients. We think this is close to smoking.Related. "
As a doctors in the Department of Breathing and Critical Medicine in a large three -level hospital in Beijing, Tan Xingyu has witnessed the changes in the ward over the years.She was diagnosed at the hospital quit clinic at the hospital every week. Here, a teenage middle school student has begun to quit smoking by parents.
"I have been diagnosed with 18 -year -old patient"
The smoking quit clinic at Peking University People’s Hospital was established in 2008 and has gone through more than ten years.
Tan Xingyu, the deputy chief physician of the Department of Discerity and Critical Critical Medicine, has been published every week since the establishment of the clinic.Over the years, thousands of patients have been in contact with.
Different from other outpatient examinations, patients who come to smoking quit outpatient clinic must first fill out the scale to judge the degree of dependence of nicotine, including the number of smoking daily, whether to wake up early in the morning and want to smoke, etc., once it is judged as a medium weightThen, the smoking quit needs to be used to help.
"If the degree of dependencies is generally high, if other intervention methods are not adopted, there are only about 5%of the success of smoking cessation."
Over the years, Tan Xingyu’s deepest feeling is that the age composition of patients who came to consult for consultation is changing.
"After the implementation of the" Beijing Regulations on Control of Smoking ", our outpatient clinics are obviously more than before. In the past, elderly people aged 60 or 70 quit smoking because of detecting diseases such as coronary heart disease.Young people take the initiative to quit smoking when there is no condition. "
On the one hand, the patient’s understanding of the harm of tobacco is deepening. On the other hand, the appearance of some adolescent patients also worry about doctors.
"Two or three years ago, I had been diagnosed with a 18 -year -old patient. At that time, he was still in high school. It was his parents brought him a smoking quit clinic. This child has already had a history of smoking since junior high school.At that time, his nicotine dependence was not serious.
Such cases are also a microcosm of teenagers.
The "China Smoking Harm Health Report 2020" issued by the National Health and Health Commission pointed out that the number of smokers in my country exceeds 300 million. In 2018, the smoking rate of people over the age of 15 or over in my country was 26.6%.The "2021 Chinese University Student Tobacco Population Survey" previously released by the China Centers for Disease Control and Prevention shows that the smoking rate of college students in my country is 7.8%, boys smoking rate (15.0%) is higher than girls (1.1%), and higher vocational/college smoking rates reached 11.6 %.
In the eyes of doctors, reducing the smoking rate of adolescents as much as possible is the key means to prevent more "old smoke guns" in the future.
In the ward, there are more and more patients with lung cancer
"Smoking is harmful to health", which is a warning slogan printed on each cigarette case, and its concept has long been widely publicized.
From the perspective of national level, tobacco control is also considered an important task in the construction of healthy China.In the "Healthy China Action (2019-2030)", it is proposed that by 2022 and 2030, the smoking rates of people over the age of 15 are less than 24.5%and 20%, respectively.
At the actual level, the advancement of smoke control is urgent, because for clinicians, the irreversible damage of tobacco to the health of the people is emerging rapidly.
In the medical ward of breathing and critical condition where Tan Xingyu is located, the patient’s disease spectrum has changed significantly in the past 20 years.
"About 2000, there are many patients with slow lungs and asthma patients in hospitalization, which can occupy about half of them. We have also set up a slow branch clinic, but now, most of the patients in our ward have become convertedPatients with lung cancer. In addition, patients with pneumonia and asthma have also increased significantly compared to before. We think this is closely related to smoking. "
Tan Xingyu said that in the past, the progress of the progress of pulmonary heart disease was relatively slow, and it may take 30 or 40 years. Now, some young patients have only taken more than ten or twenty years, and some are diagnosed with lung cancer.These changes are all related to smoking strong.
This change is also demonstrated by data.According to media reports, according to the data of the National Cancer Center, in 2021, there are about 978,000 patients with lung cancer, which is the largest cancer in China.In addition, the proportion of new patients with lung cancer accounted for new patients with global lung cancer rose from 42.5%in 2016 to 43.1%in 2021, showing a tendency to continue to rise.
In November 2021, researchers published a research paper published by the Tobacco Control magazine.Related death peaks usually occur after decades, so the peak of the number of lung cancer deaths in China has not yet arrived.
Studies also predict that from 2020 to 2040, cancer mortality related to smoking will rise by 44%among men and 53%among women.
Drugs are still a problem
As early as 1998, the World Health Organization included tobacco dependence as a chronic addictive disease in international diseases.
With the development of clinical medical evidence -based medicine, there is sufficient evidence that smoking quitting is the preferred treatment method for controlling chronic diseases, but smoking quitting is a very difficult process. Drug assistance smoking quitting is widely used in smoking quit clinics.
At present, my country ’s clinical smoking quit guidelines recommend 3 types of smoking therapy drugs, including nicotine replacement therapy drugs, psyllite hydrochloride, and alcoholic acid sequences. The success rate is increased by 1 to 2 times.
However, these drugs have not yet entered the scope of medical insurance reimbursement, and patients need to buy them at their own expense.
"At present, our outpatient clinics recommend that patients take at least one month of medication. It is best to adhere to the twelve weeks to help patients fully quit. The three months will cost about 1,000 yuan."
Tan Xingyu said that although the prices of the above drugs are not high, some patients still know that the drug will choose not to quit smoking with the help of drugs.
At the same time, under the current policy, because medical institutions have controlled the proportion of self -funded drugs, this has also led to some hospitals in pharmacies in some hospitals that do not purchase too many self -funded medicines, and many smoking quit clinics also face the embarrassing situation without medicine.Tan Xingyu’s smoking quit clinic, currently there are only one medication for patients.
In fact, the call of "incorporating smoking cessation medicine into medical insurance" has been there in recent years.Earlier, the Beijing Municipal Control of the Smoking Association also suggested that the smoking cessation drugs are included in a fixed -point retail pharmacy, supporting the settlement and distribution of external prescriptions at fixed -point retail pharmacies, and giving full play to the role of fixed retail pharmacies.The scope of "Internet+" medical service guarantee, and so on.
In Tan Xingyu’s view, if it can help improve the accessibility of drugs from the policy, it will undoubtedly benefit patients.
Over the years, Tan Xingyu is very concerned about the dynamics of the patient after leaving the cigarette quit clinic. She has built a special WeChat group. Now that more than 200 patients have been pulled into the group, she will often share with patients in the group to share with patients and learn about it.Patient condition.
In recent years, the department where Tan Xingyu is located has also successfully quit smoking with the help of the smoking quit clinic. Her own family has achieved "zero smokers".
However, compared to the huge number of 300 million smokers, China’s tobacco control work is still promoting.On the road of "smoke -free China", how to quickly and successfully copy the "abstinence experience" is perhaps a key task.What this requires is not just more medical workers like Tan Xingyu, but also the joint force of the government and all sectors of society.(Zhang Ni)
Source: China News Network
