Inhaled Corticosteroids and Lung Cancer in COPD

[New therapeutic advances in patients with lung cancer immunosuppressed with chronic lung diseases in the period 2014-2022 from the review of the literature.]

Lung cancer is a malignant neoplasm with a high prevalence and mortality, more so in patients with respiratory comorbidities, whose cells have a massive proliferation capacity in the lung tissue, managing to invade other organs, which deteriorates the patient's physical and emotional state, decreasing their quality of life and defense system; therefore, treatment today is not sufficient for patient survival and there has been evidence of a certain evolution in the treatment of the disease or early detection to prevent it. This article aimed to analyze the new therapeutic advances in patients with lung cancer associated with chronic lung diseases in the period 2014-2022 based on a review of the literature. Several parameters were used to limit the search, extrapolating the articles of interest, validating fifty three articles, six doctoral theses and two books, which were in Spanish and English.The various search strategies used were keywords, subject and author follow-up. The sections developed in this review are the concept of Lung Cancer (LC), clinical manifestations, risk factors, relationship between LC and chronic lung diseases, diagnosis, treatment, prevention and new therapeutic advances. All the filtered information of the selected articles shows us the importance that the use of various biomarkers is taking for its early detection; however, the transfer of antitumor T cells in patients with underlying lung disease had an efficiency of 48.

Integrating Comorbidities and Phenotype-Based Medicine in Patient-Centered Medicine in COPD

Despite recent notable innovations in the management of chronic obstructive pulmonary disease (COPD), no major advances in patient-centered medicine have been achieved. Current guidelines base their proposals on the average results from clinical trials, leading to what could be termed ‘means-based’ medical practice. However, the therapeutic response is variable at the patient level. Additionally, the variability of the clinical presentation interacts with comorbidities to form a complex clinical scenario for clinicians to deal with. Consequently, no consensus has been reached over a practical approach for combining comorbidities and disease presentation markers in the therapeutic algorithm. In this context, from the patients’ first visit, the clinician faces four major dilemmas: (1) establishing the correct diagnosis of COPD as opposed to other airway diseases, such as bronchial asthma; (2) deciding on the initial therapeutic approach based on the clinical characteristics of each case; (3) setting up a study strategy for non-responding patients; (4) pursuing a follow-up strategy with two well-defined periods according to whether close or long-term follow-up is required. Here, we will address these major dilemmas in the search for a patient-centered approach to COPD management and suggest how to combine them all in a single easy-to-use strategy.

Ten Research Questions for Improving COPD Care in the Next Decade

With the 60th anniversary of the CIBA symposium, it is worth evaluating research questions that should be prioritized in the future. Coming research initiatives can be summarized in 10 main areas. (1) From epidemiology the impact of new forms of electronic cigarettes on prevalence and mortality of COPD will be sought. (2) The study of the disease endotypes and its relationship phenotypes will have to be unraveled in the next decade. (3) Diagnosis of COPD faces several challenges opening the possibility of a change in the definition of the disease itself. (4) Patients' classification and risk stratification will need to be clarified and reassessed. (5) The asthma-COPD overlap dilemma will have to be clarified and define whether both conditions represent one only chronic airway disease again. (6) Integrating comorbidities in COPD care will be key in a progressively ageing population to improve clinical care in a chronic care model. (7) Nonpharmacological management have areas for research including pulmonary rehabilitation and vaccines. (8) Improving physical activity should focus research because of the clear prognostic impact. (9). Pharmacological therapies present several challenges including efficacy and safety issues with current medications and the development of biological therapy. (10) The definition, identification, categorization and specific therapy of exacerbations will also be an area of research development. During the next decade, we have a window of opportunity to address these research questions that will put us on the path for precision medicine.