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Bang Henriksen M, Hansen TF, Jensen LH, Brasen CL, Borg M, Hilberg O, Løkke A. Lung cancer among outpatients with COPD: a 7-year cohort study. ERJ Open Res 2024; 10:00064-2024. [PMID: 39040576 PMCID: PMC11261374 DOI: 10.1183/23120541.00064-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 03/04/2024] [Indexed: 07/24/2024] Open
Abstract
Introduction Lung cancer (LC) is the most common cause of cancer-related deaths worldwide, and its prognosis upon metastasis remains poor. Patients with COPD face a significantly elevated LC risk, up to six times greater than those with normal lung function. We aimed to investigate LC prevalence and stage distribution among COPD outpatients. Furthermore, we aimed to outline the COPD-related variables associated with referral for LC examination. Methods We conducted a retrospective analysis encompassing the period from 1 January 2012 to 31 December 2018 on all outpatients with COPD and LC and individuals referred for LC examinations. Results Among all COPD outpatients, 2231 patients (18%) were referred for LC examinations and 565 (4.6%) were diagnosed with LC. LC patients with COPD were more likely to be stage I-II, in contrast to the non-COPD LC population (46% versus 26%, p<0.001 for all). Patients referred for LC examinations exhibited higher use of COPD-related medications, reported more severe dyspnoea (69% versus 66% with Medical Research Council dyspnoea score >2) and experienced a greater frequency of exacerbations (30% versus 24% with two or more exacerbations). Conclusion Our study revealed a notably high LC incidence among COPD outpatients. LC patients with COPD were diagnosed at earlier stages, and outpatients with more pronounced COPD symptoms were more inclined to undergo LC diagnostics. The overrepresentation of LC cases among COPD outpatients emphasises the importance of tailoring specific screening initiatives for this demographic.
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Affiliation(s)
- Margrethe Bang Henriksen
- Department of Oncology, Vejle University Hospital, Vejle, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Torben Frøstrup Hansen
- Department of Oncology, Vejle University Hospital, Vejle, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | - Claus Lohman Brasen
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Biochemistry and Immunology, Vejle University Hospital, Vejle, Denmark
| | - Morten Borg
- Department of Internal Medicine, Vejle University Hospital, Vejle, Denmark
| | - Ole Hilberg
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Internal Medicine, Vejle University Hospital, Vejle, Denmark
| | - Anders Løkke
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Internal Medicine, Vejle University Hospital, Vejle, Denmark
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Pitre T, Kiflen M, Ho T, Seijo LM, Zeraatkar D, de Torres JP. Inhaled corticosteroids, COPD, and the incidence of lung cancer: a systematic review and dose response meta-analysis. BMC Pulm Med 2022; 22:275. [PMID: 35843928 PMCID: PMC9290283 DOI: 10.1186/s12890-022-02072-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 07/06/2022] [Indexed: 11/16/2022] Open
Abstract
Background There has been debate on whether inhaled corticosteroids (ICS) reduce the incidence of lung cancer amongst patients with Chronic Obstructive Lung Disease (COPD). We aimed to perform a systematic review and dose–response meta-analysis on available observational data. Methods We performed both a dose response and high versus low random effects meta-analysis on observational studies measuring whether lung cancer incidence was lower in patients using ICS with COPD. We report relative risk (RR) with 95% confidence intervals (CI), as well as risk difference. We use the GRADE framework to report our results. Results Our dose–response suggested a reduction in the incidence of lung cancer for every 500 ug/day of fluticasone equivalent ICS (RR 0.82 [95% 0.68–0.95]). Using a baseline risk of 7.2%, we calculated risk difference of 14 fewer cases per 1000 ([95% CI 24.7–3.8 fewer]). Similarly, our results suggested that for every 1000 ug/day of fluticasone equivalent ICS, there was a larger reduction in incidence of lung cancer (RR 0.68 [0.44–0.93]), with a risk difference of 24.7 fewer cases per 1000 ([95% CI 43.2–5.4 fewer]). The certainty of the evidence was low to very low, due to risk of bias and inconsistency. Conclusion There may be a reduction in the incidence for lung cancer in COPD patients who use ICS. However, the quality of the evidence is low to very low, therefore, we are limited in making strong claims about the true effect of ICS on lung cancer incidence.
Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-02072-1.
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Zhao G, Li X, Lei S, Zhao H, Zhang H, Li J. Prevalence of lung cancer in chronic obstructive pulmonary disease: A systematic review and meta-analysis. Front Oncol 2022; 12:947981. [PMID: 36185264 PMCID: PMC9523743 DOI: 10.3389/fonc.2022.947981] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 08/11/2022] [Indexed: 11/20/2022] Open
Abstract
Background There is growing evidence that chronic obstructive pulmonary disease (COPD) can increase the risk of lung cancer, which poses a serious threat to treatment and management. Therefore, we performed a meta-analysis of lung cancer prevalence in patients with COPD with the aim of providing better prevention and management strategies. Methods We systematically searched PubMed, EMBASE, Web of Science, and Cochrane Library databases from their inception to 20 March 2022 to collect studies on the prevalence of lung cancer in patients with COPD. We evaluated the methodological quality of the included studies using the tool for assessing the risk of bias in prevalence studies. Meta-analysis was used to determine the prevalence and risk factors for lung cancer in COPD. Subgroup and sensitivity analyses were conducted to explore the data heterogeneity. Funnel plots combined with Egger’s test were used to detect the publication biases. Results Thirty-one studies, covering 829,490 individuals, were included to investigate the prevalence of lung cancer in patients with COPD. Pooled analysis demonstrated that the prevalence of lung cancer in patients with COPD was 5.08% (95% confidence interval [CI]: 4.17–6.00%). Subgroup analysis showed that the prevalence was 5.09% (95% CI: 3.48–6.70%) in male and 2.52% (95% CI: 1.57–4.05%) in female. The prevalence of lung cancer in patients with COPD who were current and former smokers was as high as 8.98% (95% CI: 4.61–13.35%) and 3.42% (95% CI: 1.51–5.32%); the incidence rates in patients with moderate and severe COPD were 6.67% (95% CI: 3.20–10.14%) and 5.57% (95% CI: 1.89–16.39%), respectively, which were higher than the 3.89% (95% CI: 2.14–7.06%) estimated in patients with mild COPD. Among the types of lung cancer, adenocarcinoma and squamous cell carcinoma were the most common, with incidence rates of 1.59% (95% CI: 0.23–2.94%) and 1.35% (95% CI: 0.57–3.23%), respectively. There were also differences in regional distribution, with the highest prevalence in the Western Pacific region at 7.78% (95% CI: 5.06–10.5%), followed by the Americas at 3.25% (95% CI: 0.88–5.61%) and Europe at 3.21% (95% CI: 2.36–4.06%). Conclusions This meta-analysis shows that patients with COPD have a higher risk of developing lung cancer than those without COPD. More attention should be given to this result in order to reduce the risk of lung cancer in these patients with appropriate management and prevention. Systematic review registration International prospective register of systematic reviews, identifier CRD42022331872.
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Affiliation(s)
- Guixiang Zhao
- Co-Construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan and Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, China
| | - Xuanlin Li
- Co-Construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan and Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, China
| | - Siyuan Lei
- Co-Construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan and Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, China
| | - Hulei Zhao
- Co-Construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan and Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, China
- Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Hailong Zhang
- Co-Construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan and Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, China
- Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Jiansheng Li
- Co-Construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan and Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, China
- Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
- *Correspondence: Jiansheng Li,
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Tareke AA, Debebe W, Alem A, Bayileyegn NS, Zerfu TA, Ayana AM. Inhaled Corticosteroids and the Risk of Lung Cancer in Chronic Obstructive Pulmonary Disease Patients: A Systematic Review and Meta-Analysis. Pulm Med 2022; 2022:9799858. [PMID: 36046848 PMCID: PMC9420625 DOI: 10.1155/2022/9799858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/26/2022] [Accepted: 08/06/2022] [Indexed: 11/18/2022] Open
Abstract
Background The global prevalence of chronic obstructive pulmonary disease (COPD) is increasing, and the risk of lung cancer in these patients is high. The use of inhaled corticosteroids (ICSs) in COPD patients could help to decrease potential lung cancer risk. We planned to conduct this systematic review and meta-analysis to determine the role of ICS in the risk of lung cancer among COPD patients. Methods A comprehensive search of PubMed, Science Direct, Google Scholar, and Cochrane library and a manual search of the list of references were conducted. Studies with cohort, case-control, and randomized clinical trial designs for any ICS use reporting the incidence/hazard ratio (HR) of lung cancer were included. The random-effects model was used to pool hazard ratios. Subgroup analysis and metaregression analysis were employed. Funnel plot and Egger regression test were used to assess publication bias. Results Combining the results of 14 observations, the pooled HR for cancer risk reduction was 0.69 (95% CI 0.59-0.79), p value ≤ 0.001. The use of ICS in COPD patients showed a 31% reduction in the risk of lung cancer. Subgroup meta-analysis showed a significant reduction in the risk of lung cancer as well. Conclusion The use of ICS in COPD patients reduces the risk of lung cancer. The risk reduction was independent of smoking status and latency period. Future studies should focus on the optimum dose and controlling confounders like asthma.
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Affiliation(s)
- Amare Abera Tareke
- Department of Biomedical Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Wondwosen Debebe
- Department of Biomedical Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Addis Alem
- Department of Biomedical Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | | | - Taddese Alemu Zerfu
- College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
- Global Academy of Agriculture & Food Security (GAAFS), University of Edinburg, UK
| | - Andualem Mossie Ayana
- Department of Biomedical Sciences, Faculty of Medicine, Jimma University, Jimma, Ethiopia
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Criner GJ, Agusti A, Borghaei H, Friedberg J, Martinez FJ, Miyamoto C, Vogelmeier CF, Celli BR. Chronic Obstructive Pulmonary Disease and Lung Cancer: A Review for Clinicians. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2022; 9:454-476. [PMID: 35790131 PMCID: PMC9448004 DOI: 10.15326/jcopdf.2022.0296] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/24/2022] [Indexed: 06/15/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) and lung cancer are common global causes of morbidity and mortality. Because both diseases share several predisposing risks, the 2 diseases may occur concurrently in susceptible individuals. The diagnosis of COPD has important implications for the diagnostic approach and treatment options if lesions concerning for lung cancer are identified during screening. Importantly, the presence of COPD has significant implications on prognosis and management of patients with lung cancer. In this monograph, we review the mechanistic linkage between lung cancer and COPD, the impact of lung cancer screening on patients at risk, and the implications of the presence of COPD on the approach to the diagnosis and treatment of lung cancer. This manuscript succinctly reviews the epidemiology and common pathogenetic factors for the concurrence of COPD and lung cancer. Importantly for the clinician, it summarizes the indications, benefits, and complications of lung cancer screening in patients with COPD, and the assessment of risk factors for patients with COPD undergoing consideration of various treatment options for lung cancer.
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Affiliation(s)
- Gerard J. Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
| | - Alvar Agusti
- Cátedra Salud Respiratoria, University of Barcelona; Respiratory Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigacion Biomedica en Red Enfermedades Respiratorias, Barcelona, Spain
| | - Hossein Borghaei
- Department of Medical Oncology, Fox Chase Cancer Center at Temple University, Philadelphia, Pennsylvania, United States
| | - Joseph Friedberg
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
| | | | - Curtis Miyamoto
- Department of Radiation Oncology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
| | - Claus F. Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Centre Giessen and Marburg, Philipps-University Marburg, German Centre for Lung Research, Marburg, Germany
| | - Bartolome R. Celli
- Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States
- Harvard Medical School, Boston, Massachusetts, United States
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Risk of Malignancy in Patients with Asthma-COPD Overlap Compared to Patients with COPD without Asthma. Biomedicines 2022; 10:biomedicines10071463. [PMID: 35884768 PMCID: PMC9313308 DOI: 10.3390/biomedicines10071463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/13/2022] [Accepted: 06/20/2022] [Indexed: 12/25/2022] Open
Abstract
Chronic inflammation such as asthma may lead to higher risks of malignancy, which may be inhibited by anti-inflammatory medicine such as inhaled corticosteroids (ICS). The aim of this study was to evaluate if patients with asthma-Chronic Obstructive Pulmonary Disease (COPD) overlap have a higher risk of malignancy than patients with COPD without asthma, and, secondarily, if inhaled corticosteroids modify such a risk in a nationwide multi-center retrospective cohort study of Danish COPD-outpatients with or without asthma. Patients with asthma-COPD overlap were propensity score matched (PSM) 1:2 to patients with COPD without asthma. The endpoint was cancer diagnosis within 2 years. Patients were stratified depending on prior malignancy within 5 years. ICS was explored as a possible risk modifier. We included 50,897 outpatients with COPD; 88% without prior malignancy and 20% with asthma. In the PSM cohorts, 26,003 patients without prior malignancy and 3331 patients with prior malignancy were analyzed. There was no association between asthma-COPD overlap and cancer with hazard ratio (HR) = 0.92, CI = 0.78–1.08, p = 0.31 (no prior malignancy) and HR = 1.04, CI = 0.85–1.26, and p = 0.74 (prior malignancy) as compared to patients with COPD without asthma. ICS did not seem to modify the risk of cancer. In conclusion, in our study, asthma-COPD overlap was not associated with an increased risk of cancer events.
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Patel B, Priefer R. Impact of chronic obstructive pulmonary disease, lung infection, and/or inhaled corticosteroids use on potential risk of lung cancer. Life Sci 2022; 294:120374. [DOI: 10.1016/j.lfs.2022.120374] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/29/2022] [Accepted: 01/30/2022] [Indexed: 11/24/2022]
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Ge H, Liu X, Gu W, Feng X, Zhang F, Han F, Qian Y, Jin X, Gao B, Yu L, Bao H, Zhou M, Li S, Jie Z, Wang J, Chen Z, Hang J, Zhang J, Zhu H. Distribution of COPD Comorbidities and Creation of Acute Exacerbation Risk Score: Results from SCICP. J Inflamm Res 2021; 14:3335-3348. [PMID: 34290518 PMCID: PMC8289369 DOI: 10.2147/jir.s315600] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/17/2021] [Indexed: 12/13/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) often coexists with multiple comorbidities which may have a significant impact on acute exacerbations of patients. At present, what kind of comorbidities affects acute exacerbations and how comorbidities lead to poor prognosis are still controversial. The purpose of our study is to determine the impact of comorbidities on COPD exacerbation and establish an acute exacerbation risk assessment system related to comorbidities. Methods A total of 742 COPD patients participated in the Shanghai COPD Investigation on Comorbidity Program (SCICP, ChiCTR2000030911). Finally, the baseline information of 415 participants and one-year follow-up data were involved in the analysis. We collected hemogram indices, pulmonary function tests and acute exacerbation of COPD with regular medical follow-up. Q-type cluster analysis was used to determine the clusters of participants. Receiver operating characteristic (ROC) analysis was constructed to assess the ability of indicators in predicting acute exacerbations. Results Almost 65% of the population we investigated had at least one comorbidity. The distribution and incidence of comorbidities differed between exacerbation group and non-exacerbation group. Three comorbidity clusters were identified: (1) respiratory, metabolic, immune and psychologic disease (non-severe cases); (2) cardiovascular and neoplastic disease (severe cases); (3) less comorbidity. Different sub-phenotypes of COPD patients showed significant distinction in health status. Anxiety (OR=5.936, P=0.001), angina (OR=10.155, P=0.025) and hypertension (OR=3.142, P=0.001) were found to be independent risk factors of exacerbation in a year. The novel risk score containing BODEx and four diseases showed great prognostic value of COPD exacerbation in developing sample. Conclusion Our study detailed the major interaction between comorbidities and exacerbation in COPD. Noteworthily, a novel risk score using comprehensive index – BODEx – and comorbidity parameters can identify patients at high risk of acute exacerbation.
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Affiliation(s)
- Haiyan Ge
- Department of Respiratory and Critical Care Medicine, Huadong Hospital, Fudan University, Shanghai, People's Republic of China
| | - Xuanqi Liu
- Department of Respiratory and Critical Care Medicine, Huadong Hospital, Fudan University, Shanghai, People's Republic of China
| | - Wenchao Gu
- Department of Respiratory Medicine, Pudong New District People's Hospital, Shanghai, People's Republic of China
| | - Xiumin Feng
- Department of Respiratory and Critical Care Medicine, Changhai Hospital Affiliated to Navy Military Medical University, Shanghai, People's Republic of China.,Department of Respiratory and Critical Care Medicine, Changji Branch of First Affiliated Hospital of Xinjiang Medical University, Xinjiang, People's Republic of China
| | - Fengying Zhang
- Department of Respiratory Medicine, Putuo District People's Hospital, Shanghai, People's Republic of China
| | - Fengfeng Han
- Department of Respiratory Medicine, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Yechang Qian
- Baoshan District Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, People's Republic of China
| | - Xiaoyan Jin
- Department of Respiratory Medicine, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Beilan Gao
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, Shanghai, People's Republic of China
| | - Li Yu
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Hong Bao
- Department of Respiratory Medicine Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, People's Republic of China
| | - Min Zhou
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Shengqing Li
- Department of Respiratory and Critical Care Medicine, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Zhijun Jie
- Department of Respiratory Medicine, Shanghai Fifth's Hospital, Fudan University, Shanghai, People's Republic of China
| | - Jian Wang
- Department of Respiratory Medicine, Shanghai Ninth's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Zhihong Chen
- Department of Respiratory and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Jingqing Hang
- Department of Respiratory Medicine, Putuo District People's Hospital, Shanghai, People's Republic of China
| | - Jingxi Zhang
- Department of Respiratory and Critical Care Medicine, Changhai Hospital Affiliated to Navy Military Medical University, Shanghai, People's Republic of China
| | - Huili Zhu
- Department of Respiratory and Critical Care Medicine, Huadong Hospital, Fudan University, Shanghai, People's Republic of China
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Machida H, Inoue S, Shibata Y, Kimura T, Ota T, Ishibashi Y, Murano H, Furuyama K, Yang S, Nakano H, Sato K, Sato M, Nemoto T, Nishiwaki M, Yamauchi K, Igarashi A, Watanabe M. The Incidence and Risk Analysis of Lung Cancer Development in Patients with Chronic Obstructive Pulmonary Disease: Possible Effectiveness of Annual CT-Screening. Int J Chron Obstruct Pulmon Dis 2021; 16:739-749. [PMID: 33790550 PMCID: PMC8006963 DOI: 10.2147/copd.s287492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 02/25/2021] [Indexed: 01/18/2023] Open
Abstract
Purpose Lung cancer is a serious complication in patients with chronic obstructive pulmonary disease (COPD) and accounts for approximately 15% of deaths in patients with COPD. However, with the exception of emphysema, few reports to date have been published on the factors that predict lung cancer development in COPD patients. It has been reported that patients with COPD develop lung cancer at a rate of 0.8% - 1.7%/year, but the incidence may be higher in the Japanese population. Therefore, we investigated the incidence of lung cancer and the lung cancer mortality rate in Japanese COPD patients, as well as factors that are associated with the development of lung cancer in COPD patients. Patients and Methods We followed up 224 patients with stable COPD and performed CT examinations at least once per year. The incidence of lung cancer was recorded and data at enrollment were compared with data of the group that did not develop lung cancer. Results Over a median follow-up period of 4.58 years, lung cancer was newly diagnosed in 19 patients; the incidence of lung cancer in this population was 1.85%/year. Patients who developed lung cancer had more severe emphysema assessed by CT and GOLD classification and were more likely to be current smokers than those who did not develop lung cancer. No other significant differences were observed between these two groups. Mortality was significantly increased in patients who developed lung cancer compared with those who did not. Conclusion In COPD patients, the incidence of lung cancer is higher and the development of lung cancer worsens the prognosis; however, lung cancer development is unpredictable and attention should be paid to all patients. Annual CT screening is important for early detection of lung cancer.
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Affiliation(s)
- Hiroyoshi Machida
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Sumito Inoue
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Yoko Shibata
- Department of Pulmonary Medicine, Fukushima Medical University, Fukushima, Japan
| | - Tomomi Kimura
- Respiratory Medicine, Yamagata Saisei Hospital, Yamagata, Japan
| | - Takahito Ota
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Yu Ishibashi
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Hiroaki Murano
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Kodai Furuyama
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Sujeong Yang
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Hiroshi Nakano
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Kento Sato
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Masamichi Sato
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Takako Nemoto
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Michiko Nishiwaki
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Keiko Yamauchi
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Akira Igarashi
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Masafumi Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan
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10
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Ge F, Feng Y, Huo Z, Li C, Wang R, Wen Y, Gao S, Peng H, Wu X, Liang H, Cheng B, Zhong R, He J, Liang W. Inhaled corticosteroids and risk of lung cancer among chronic obstructive pulmonary disease patients: a comprehensive analysis of nine prospective cohorts. Transl Lung Cancer Res 2021; 10:1266-1276. [PMID: 33889508 PMCID: PMC8044471 DOI: 10.21037/tlcr-20-1126] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND It remains uncertain whether there is a protective effect of inhaled corticosteroids (ICs) against lung cancer in chronic obstructive pulmonary disease (COPD) patients. METHODS Databases including PubMed, Web of Science, EMBASE, and Medline were comprehensively searched. Random-effects model meta-analysis was conducted to calculate the hazard ratios (HRs) for lung cancer incidence among ICs users versus non-ICs users in patients with COPD. Stratified analysis was performed based on region and age of each study. This review was registered on PROSPERO (registration number CRD42020159082). RESULTS Based on data from 181,859 COPD patients with a total follow-up duration of 1,109,339.9 person-years, we identified that the use of ICs in COPD patients was associated with a decreased risk of lung cancer [HR: 0.73, 95% confidence interval (CI): 0.62-0.86; P<0.001]. The region-specific HRs for lung cancer incidence were 0.62 (95% CI: 0.62-0.86; P=0.004), 0.77 (95% CI: 0.60-0.97; P=0.028) and 0.81 (95% CI: 0.61-1.08; P=0.155) among European, Asian and North American COPD patients, respectively. Additionally, we found the consistent outcome among age groups (≥70 years old: HR: 0.73, 95% CI: 0.65-0.99, P=0.043; <70 years old: HR: 0.74, 95% CI: 0.56-0.99, P=0.040). CONCLUSIONS This study demonstrates that ICs have a protective effect against lung cancer in COPD patients. It could provide guidance for clinicians in the prevention of lung cancer among patients with COPD.
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Affiliation(s)
- Fan Ge
- Department of Thoracic Surgery and Oncology, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China;,First Clinical School, Guangzhou Medical University, Guangzhou, China
| | - Yi Feng
- Department of Thoracic Surgery and Oncology, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China;,Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Zhenyu Huo
- Department of Thoracic Surgery and Oncology, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China;,Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Caichen Li
- Department of Thoracic Surgery and Oncology, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Runchen Wang
- Department of Thoracic Surgery and Oncology, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China;,Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Yaokai Wen
- Department of Thoracic Surgery and Oncology, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China;,Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Sirui Gao
- Department of Thoracic Surgery and Oncology, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China;,Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Haoxin Peng
- Department of Thoracic Surgery and Oncology, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China;,Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Xiangrong Wu
- Department of Thoracic Surgery and Oncology, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China;,Nanshan School, Guangzhou Medical University, Guangzhou, China
| | - Hengrui Liang
- Department of Thoracic Surgery and Oncology, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Bo Cheng
- Department of Thoracic Surgery and Oncology, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ran Zhong
- Department of Thoracic Surgery and Oncology, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jianxing He
- Department of Thoracic Surgery and Oncology, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wenhua Liang
- Department of Thoracic Surgery and Oncology, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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11
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Lin P, Fu S, Li W, Hu Y, Liang Z. Inhaled corticosteroids and risk of lung cancer: A systematic review and meta-analysis. Eur J Clin Invest 2021; 51:e13434. [PMID: 33053199 DOI: 10.1111/eci.13434] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/09/2020] [Accepted: 09/21/2020] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Current studies investigating the association between inhaled corticosteroid (ICS) use and risk of lung cancer have yielded inconsistent findings. The aim of this systematic review and meta-analysis was to pool all currently available data to estimate this association. METHODS We systematically searched MEDLINE (1946 to July 2020), EMBASE (1974 to July 2020) and the Cochrane Library (June 2020) via Ovid to identify relevant articles investigating the association between the ICS use and the risk of lung cancer. Random-effects analysis was used to calculate pooled relative risks (RRs) with 95% confidence intervals (CIs). RESULTS Ten articles including 234 920 patients were analysed. ICS use was identified to have a decreased risk of lung cancer in chronic obstructive pulmonary disease (8 studies, 1806 patients; RR = 0.73, 95% CI: 0.61-0.87, P < .01; I2 = 60.0 %), asthma (1 study, 41 438 patients; RR = 0.44, 95% CI: 0.34-0.57, P < .01) and mixed (1 study, 46 225 patients; RR = 0.79, 95% CI: 0.69-0.90, P < .01) patients. The findings of reduced risk of lung cancer were consistent in all subgroup analyses except for the short-term follow-up (≤5 years) (RR = 0.94, 95% CI: 0.81-1.07, P = .34) and free of immortal time bias (RR = 0.94, 95% CI: 0.82-1.08, P = .38) subgroups. CONCLUSIONS The present study suggested that ICS use was associated with decreased risk of lung cancer. However, our findings should be interpreted with caution because most original studies were judged to be at high risk of immortal time bias.
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Affiliation(s)
- Ping Lin
- Department of Respiratory and Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, Chengdu, China
| | - Siyu Fu
- Center of Infectious Diseases, West China School of Medicine and West China Hospital, Sichuan University, Chengdu, China
| | - Weijing Li
- Department of Respiratory and Critical Care Medicine, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuehong Hu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Zongan Liang
- Department of Respiratory and Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, Chengdu, China
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12
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Gagnat AA, Gjerdevik M, Lie SA, Gulsvik A, Bakke P, Nielsen R. Acute exacerbations of COPD and risk of lung cancer in COPD patients with and without a history of asthma. Eur Clin Respir J 2020; 7:1799540. [PMID: 32944202 PMCID: PMC7480432 DOI: 10.1080/20018525.2020.1799540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Rationale There is limited knowledge on the effect of acute exacerbations in chronic obstructive pulmonary disease (AECOPD) on lung cancer risk in COPD patients with and without a history of asthma. This study aims to examine whether AECOPD is associated with risk of lung cancer, and whether the effect depends on a history of asthma. Methods In the GenKOLS study of 2003–2005, 852 subjects with COPD performed spirometry, and filled out questionnaires on smoking habits, symptoms and disease history. These data were linked to lung cancer data from the Cancer Registry of Norway through 2013. AECOPD, measured at baseline was the main predictor. To quantify differences in lung cancer risk, we performed Cox-proportional hazards regression. We adjusted for sex, age, smoking variables, body mass index, and lung function. Measurements and results During follow-up, 8.8% of the subjects with, and 5.9% of the subjects without exacerbations were diagnosed with lung cancer. Cox regression showed a significant increased risk of lung cancer with one or more exacerbations in COPD patients without a history of asthma, HRR = 2.77 (95% CI 1.39–5.52). We found a significant interaction between a history of asthma and AECOPD on lung cancer. Conclusions AECOPD is associated with an increased risk of lung cancer in COPD patients without a history of asthma.
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Affiliation(s)
- Ane Aamli Gagnat
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Miriam Gjerdevik
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Stein Atle Lie
- Department of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - Amund Gulsvik
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Per Bakke
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Rune Nielsen
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
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13
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Zgodic A, Zahnd WE, Miller DP, Studts JL, Eberth JM. Predictors of Lung Cancer Screening Utilization in a Population-Based Survey. J Am Coll Radiol 2020; 17:1591-1601. [PMID: 32681828 DOI: 10.1016/j.jacr.2020.06.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 06/15/2020] [Accepted: 06/15/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE Annual low-dose CT (LDCT) screening in high-risk individuals has been recommended to detect lung cancer earlier and reduce mortality. The objective of this study was to identify demographic, financial, and health care factors associated with screening uptake in a population-based survey. METHODS Data from the Lung Cancer Screening Module and core modules of the 2017 Behavioral Risk Factor Surveillance System, a population-based survey administered via cell phone and landline, were analyzed to examine demographic, health, and financial factors associated with screening uptake among the 10 states that administered the screening module. Weighted frequencies and confidence intervals (CIs) were produced, and weighted Wald χ2 tests were used to compare differences in screening utilization by patient characteristics. A multivariate logistic mixed-effects model was constructed, in which participant clustering by state was accounted for with a random intercept. RESULTS The uninsured were less likely to undergo LDCT screening (odds ratio [OR], 0.28; 95% CI, 0.12-0.65). LDCT screening uptake was higher for participants with chronic respiratory conditions (OR, 4.14; 95% CI, 2.33-7.35); those who were divorced, separated, widowed, or refused to answer (OR, 1.41; 95% CI, 1.05-1.86); those who had previous cancer diagnoses (OR, 1.90; 95% CI, 1.40-2.56); and those aged 65 to 69 years (OR, 1.23; 95% CI, 1.06-1.44) or 70 to 74 years (OR, 1.17; 95% CI, 1.00-1.37). Utilization also varied significantly across states. CONCLUSIONS Having a related health condition whereby participants were sensitized to the benefits of early screening (ie, another cancer diagnosis, presence of chronic respiratory conditions) and having insurance coverage were associated with higher LDCT screening uptake. Providers should engage LDCT-eligible patients through informed and shared decision making to increase preference-sensitive screening decisions.
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Affiliation(s)
- Anja Zgodic
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina; Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Whitney E Zahnd
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - David P Miller
- Associate Director, Clinical and Translational Science Institute, Wake Forest School of Medicine; Director, KL2 Training Program, Wake Forest School of Medicine; Department of Internal Medicine and Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Jamie L Studts
- Professor, Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine; Scientific Director, Behavioral Oncology, Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado; University of Colorado Cancer Center, Aurora, Colorado
| | - Jan M Eberth
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina; Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina; Director, Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.
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14
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Peltola L, Pätsi H, Harju T. COPD Comorbidities Predict High Mortality - Asthma-COPD-Overlap Has Better Prognosis. COPD 2020; 17:366-372. [PMID: 32602748 DOI: 10.1080/15412555.2020.1783647] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The purpose of this study was to investigate the characteristics and survival of patients with COPD and asthma-COPD overlap (ACO) and how these patient groups differ from each other. We examined the impact of different comorbidities, multimorbidity, lung function and other factors have on survival in COPD and ACO patients. We also examined the causes of death to determine how many patients die of other than respiratory diseases. This retrospective study includes 214 patients with an exacerbation of COPD requiring hospitalisation during the year of 2005. The patients were followed up until the end of year 2015. The survival of ACO patients was significantly higher than COPD patients (4.7 vs. 1.7 years, p = 0.001). Poor lung function predicted worse survival in both patient groups, but the prognosis was still better in ACO patients with both FEV1 over and under 50% of predicted (median survival 8.4 years vs. 5.8 years, p < 0.001) compared to COPD (4.9 and 3.1 years, respectively). In this study setting, the negative effect of having three or more comorbidities on survival was significant in both groups. We didn't see major differences in the profiles of comorbidity patterns, in the underlying cause of deaths or in the pulmonary functions between ACO and COPD groups at the beginning of follow-up. Patients with a BMI over 25 seemed to have a trend for better survival (p = 0.055), but no differences were found between ACO and COPD groups.
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Affiliation(s)
- Lotta Peltola
- Oulu University Hospital, Department of Medicine, Respiratory Unit and MRC Oulu, Respiratory Research Group, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Heikki Pätsi
- Oulu University Hospital, Department of Medicine, Respiratory Unit and MRC Oulu, Respiratory Research Group, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Terttu Harju
- Oulu University Hospital, Department of Medicine, Respiratory Unit and MRC Oulu, Respiratory Research Group, University of Oulu and Oulu University Hospital, Oulu, Finland
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15
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Abstract
In chronic obstructive pulmonary disease (COPD), treatment with inhaled corticosteroids (ICSs) in combination with long acting beta-2-agonists (LABA) or LABA/long-acting muscarinic antagonists (LAMA) is used in order to reduce exacerbations. Treatment with ICS is, however, associated with side effects such as oropharyngeal candidiasis, skin thinning or easy bruising and pneumonia. The aim of this review was to investigate when to use ICS in COPD and to compare the effectiveness and safety of different ICSs. Studies comparing the effect of ICS/LABA and LABA/LAMA on exacerbations have shown divergent results, whereas most studies comparing ICS/LABA/LAMA (triple therapy) with LABA/LAMA have reported fewer exacerbations with triple therapy. Several investigations have shown that the number of eosinophils in blood predicts whether a patient will benefit from treatment with ICS. There is also data indicating that ICS has a small but significant positive effect on lung function decline and decrease mortality. There are four observational studies showing a better effect on exacerbations with budesonide/formoterol than fluticasone propionate/salmeterol and three observational studies showing less risk of pneumonia with budesonide than fluticasone propionate. Studies comparing the effect and safety of other ICSs such as fluticasone furoate and beclomethasone are too few to draw firm conclusions from. In conclusion, ICS together with LABA or LABA/LAMA reduces the risk of exacerbations in COPD. The indication of using ICS in COPD is stronger if the patient has increased blood eosinophils levels. There are data indicating that the choice of ICS matters, with studies showing a better effect-safety profile with budesonide compared to fluticasone propionate whereas it is not possible to make benefit-risk comparisons between the other licensed ICSs.
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Affiliation(s)
- Christer Janson
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
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16
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Gottlieb M, Mellemgaard A, Marsaa K, Godtfredsen N. Optimizing COPD treatment in patients with lung- or head and neck cancer does not improve quality of life - a randomized, pilot, clinical trial. Eur Clin Respir J 2020; 7:1731277. [PMID: 32194927 PMCID: PMC7067155 DOI: 10.1080/20018525.2020.1731277] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 02/12/2020] [Indexed: 11/29/2022] Open
Abstract
Background: Chronic obstructive pulmonary disease (COPD) is a common comorbidity in patients with lung and head- and neck cancer. Patients with lung cancer who also suffer from COPD have a worse prognosis than patients with lung cancer and no COPD. It has previously been shown that diagnosis and treatment of concomitant COPD in patients with newly diagnosed lung- or head and neck cancer need optimization. In this randomized, controlled trial we aimed to assess if intervention directed at improving treatment for COPD in these patients improved health-related quality of life (QoL). Methods: During 2014, we randomized 114 patients referred for oncological treatment at a large university hospital in the Capital Region of Denmark, to either usual care or intervention regarding concomitant COPD. The intervention consisted of two visits in an out-patient clinic established at the oncological department and staffed with a pulmonary physician. At baseline, week 13 and week 25, all patients filled out the cancer- and COPD-specific QoL questionnaires CAT and EORTC, respectively. The primary outcome was change in CAT-score between control- and intervention group. The secondary outcome was change in EORTC. Results: There was no change in CAT-score by week 13 or 25 between the groups. For the EORTC there was a statistically significant improvement only in the fatigue domain at week 13 (p = 0.03), but not at week 25. There was a trend towards less dyspnea in the intervention group at week 13, measured by EORTC (p = 0.07). Mortality by week 25 was similar in both groups. Conclusion: In this population of severely ill cancer patients, we did not find that this intervention, focusing on inhaled COPD medication, for the management of COPD had any convincing positive impact on the patients’ perceived quality of life compared with usual care. Further studies are needed.
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Affiliation(s)
- Magnus Gottlieb
- Department of Respiratory Medicine, Copenhagen University Amager and Hvidovre Hospital, Denmark
| | | | - Kristoffer Marsaa
- Palliative Unit, Copenhagen University Herlev and Gentofte Hospital, Denmark
| | - Nina Godtfredsen
- Department of Respiratory Medicine, Copenhagen University Amager and Hvidovre Hospital, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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17
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Ellingsen J, Johansson G, Larsson K, Lisspers K, Malinovschi A, Ställberg B, Thuresson M, Janson C. Impact of Comorbidities and Commonly Used Drugs on Mortality in COPD - Real-World Data from a Primary Care Setting. Int J Chron Obstruct Pulmon Dis 2020; 15:235-245. [PMID: 32099348 PMCID: PMC7006848 DOI: 10.2147/copd.s231296] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 01/09/2020] [Indexed: 01/21/2023] Open
Abstract
Background Life expectancy is significantly shorter for patients with chronic obstructive pulmonary disease (COPD) than the general population. Concurrent diseases are known to infer an increased mortality risk in those with COPD, but the effects of pharmacological treatments on survival are less established. This study aimed to examine any associations between commonly used drugs, comorbidities and mortality in Swedish real-world primary care COPD patients. Methods Patients with physician-diagnosed COPD from a large primary care population were observed retrospectively, utilizing primary care records and mandatory Swedish national registers. The time to all-cause death was assessed in a stepwise multiple Cox proportional hazards regression model including demography, socioeconomic factors, exacerbations, comorbidities and medication. Results During the observation period (1999-2009) 5776 (32.5%) of 17,745 included COPD patients died. Heart failure (hazard ratio [HR]: 1.88, 95% confidence interval [CI]: 1.74-2.04), stroke (HR: 1.52, 95% CI: 1.40-1.64) and myocardial infarction (HR: 1.40, 95% CI: 1.24-1.58) were associated with an increased risk of death. Use of inhaled corticosteroids (ICS; HR: 0.79, 95% CI: 0.66-0.94), beta-blockers (HR: 0.86, 95% CI: 0.76-0.97) and acetylsalicylic acid (ASA; HR: 0.87, 95% CI: 0.77-0.98) was dose-dependently associated with a decreased risk of death, whereas use of long-acting muscarinic antagonists (LAMA; HR: 1.33, 95% CI: 1.14-1.55) and N-acetylcysteine (NAC; HR: 1.26, 95% CI: 1.08-1.48) were dose-dependently associated with an increased risk of death in COPD patients. Conclusion This large, retrospective, observational study of Swedish real-world primary care COPD patients indicates that coexisting heart failure, stroke and myocardial infarction were the strongest predictors of death, underscoring the importance of timely recognition and treatment of comorbidities. A decreased risk of death associated with the use of ICS, beta-blockers and ASA, and an increased risk associated with the use of LAMA and NAC, was also found.
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Affiliation(s)
- Jens Ellingsen
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Gunnar Johansson
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | - Kjell Larsson
- Integrative Toxicology, National Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Karin Lisspers
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | - Andrei Malinovschi
- Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden
| | - Björn Ställberg
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | | | - Christer Janson
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
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18
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Lin TH, Chen SI, Su YC, Lin MC, Lin HJ, Huang ST. Conventional Western Treatment Combined With Chinese Herbal Medicine Alleviates the Progressive Risk of Lung Cancer in Patients With Chronic Obstructive Pulmonary Disease: A Nationwide Retrospective Cohort Study. Front Pharmacol 2019; 10:987. [PMID: 31572178 PMCID: PMC6753872 DOI: 10.3389/fphar.2019.00987] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 07/31/2019] [Indexed: 12/24/2022] Open
Abstract
Background and purpose: Lung cancer has high global incidence and mortality rates. Chronic obstructive pulmonary disease (COPD) is strongly associated with lung cancer and is an independent risk factor for lung cancer with or without smoking. Chinese herbal medicines (CHMs) are used to treat COPD. This study sought to determine whether CHM treatment effectively decreases the incidence of lung cancer in COPD patients receiving conventional Western medical treatment. Methods: Records obtained from the National Health Insurance Research Database (NHIRD) were used to identify 81,780 adults aged ≥18 years newly diagnosed with COPD in Taiwan between 2000 and 2010. Among them, 11,180 received CHMs after COPD diagnosis and 23,319 did not (non-CHM). After excluding patients with missing basic demographic information, each group consisted of 2,682 patients. Statistical methods analyzed the baseline characteristics for both groups and we performed a Cox proportional hazard regression analysis to examine the incidence of lung cancer. The cumulative incidence of lung cancer in COPD patients with or without CHM treatment was calculated by the Kaplan-Meier method. The association between herbs and formulas was examined by NodeXL to perform a network analysis of CHM. Results: COPD patients using CHM had a lower risk for lung cancer (adjusted hazards ratio [aHR] = 0.36, 95% confidence interval [CI] = 0.24–0.53, p < 0.001). Older age was associated with a higher risk of lung cancer: patients aged 40–59 years (aHR = 5.32, 95% CI = 2.19–12.94, p < 0.001) and those aged ≥60 years (aHR = 16.75, 95% CI = 7.54–37.23, p < 0.001) were at significantly greater risk compared with patients aged 18–39 years. CHM use was associated with a trend for a lower cumulative incidence of lung cancer compared with non-CHM use (p < 0.001). Among the 10 most commonly used single herbs and formulas used to decrease the risk of lung cancer in COPD patients, Fritillariae thunbergii was the most commonly used single herb and Xiao Qing Long Tang the most commonly used formula. Conclusion: The findings from this nationwide retrospective cohort study indicate that CHM as adjunctive therapy in COPD treatment regimens may reduce the risk of lung cancer in this vulnerable patient population.
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Affiliation(s)
- Tsai-Hui Lin
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Shu-I Chen
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Yuan-Chih Su
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Mei-Chen Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Hung-Jen Lin
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan.,School of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Sheng-Teng Huang
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan.,School of Chinese Medicine, China Medical University, Taichung, Taiwan.,An-Nan Hospital, China Medical University, Tainan, Taiwan.,Chinese Medicine Research Center, China Medical University, Taichung, Taiwan.,Research Center for Chinese Herbal Medicine, China Medical University, Taichung, Taiwan.,Cancer Research Center for Traditional Chinese Medicine, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
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19
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Seijo LM, Soriano JB, Peces-Barba G. New evidence on the chemoprevention of inhaled steroids and the risk of lung cancer in COPD. Eur Respir J 2019; 53:53/6/1900717. [PMID: 31167885 DOI: 10.1183/13993003.00717-2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 04/11/2019] [Indexed: 11/05/2022]
Affiliation(s)
- Luis M Seijo
- Clínica Universidad de Navarra, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, CIBERES, Instituto de Salud Carlos III, Madrid, Spain
| | - Joan B Soriano
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, CIBERES, Instituto de Salud Carlos III, Madrid, Spain.,Hospital Universitario La Princesa, Madrid, Spain
| | - Germán Peces-Barba
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, CIBERES, Instituto de Salud Carlos III, Madrid, Spain.,IIS - Fundación Jiménez Díaz, Madrid, Spain
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20
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Zamarrón E, Prats E, Tejero E, Pardo P, Galera R, Casitas R, Martínez-Cerón E, Romera D, Jaureguizar A, García-Río F. Static lung hyperinflation is an independent risk factor for lung cancer in patients with chronic obstructive pulmonary disease. Lung Cancer 2018; 128:40-46. [PMID: 30642451 DOI: 10.1016/j.lungcan.2018.12.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 12/13/2018] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Static hyperinflation, a hallmark characteristic of some patients with chronic obstructive pulmonary disease, is related to higher mortality and cardiovascular morbidity. However, information about its association with lung cancer is scarce. Our aim was to evaluate whether static hyperinflation is associated with future risk of lung cancer in COPD patients. METHODS A cohort of 848 COPD patients recruited outside the hospital setting was monitored for an average period of 4.3 years, totaling 2858 person-years, regarding diagnosis of cancer of any origin or lung cancer. Static hyperinflation was defined by functional residual capacity measured by plethysmography greater than 120% of the predicted value. RESULTS The incidence rates for cancer of any origin and lung cancer were 16.0 (95%CI, 15.1-17.8) and 8.7 (95%CI, 7.7-9.8) per 1000 patient-years, respectively. Among the patients with lung cancer, non-small cell lung cancer predominated (88%). In a stepwise multivariate Cox regression model, body mass index (BMI), pack-years, Charlson index, and postbronchodilator FEV1/FVC ratio were retained as independent predictors of cancer of any origin. In contrast, features associated with a future risk of lung cancer included older age, low BMI, increased pack-years and presence of static hyperinflation (adjusted hazard ratio: 4.617, 95%CI: 1.007-21.172, p = 0.049). CONCLUSION In a general COPD outpatient population, static hyperinflation is an independent risk factor for the development of lung cancer, which might contribute towards justifying the excess mortality identified in COPD patients with hyperinflation.
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Affiliation(s)
- Ester Zamarrón
- Servicio de Neumología, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Eva Prats
- Sección de Neumología, Hospital Universitario de Fuenlabrada, Fuenlabrada, Spain
| | - Elena Tejero
- Servicio de Urgencias, Hospital Universitario de Fuenlabrada, Fuenlabrada, Spain
| | - Paloma Pardo
- Servicio de Urgencias, Hospital Universitario de Fuenlabrada, Fuenlabrada, Spain
| | - Raúl Galera
- Servicio de Neumología, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Raquel Casitas
- Servicio de Neumología, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Elisabet Martínez-Cerón
- Servicio de Neumología, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Delia Romera
- Servicio de Neumología, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Ana Jaureguizar
- Servicio de Neumología, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Francisco García-Río
- Servicio de Neumología, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain.
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Mouronte-Roibás C, Fernández-Villar A, Ruano-Raviña A, Ramos-Hernández C, Tilve-Gómez A, Rodríguez-Fernández P, Díaz ACC, Vázquez-Noguerol MG, Fernández-García S, Leiro-Fernández V. Influence of the type of emphysema in the relationship between COPD and lung cancer. Int J Chron Obstruct Pulmon Dis 2018; 13:3563-3570. [PMID: 30464438 PMCID: PMC6214583 DOI: 10.2147/copd.s178109] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction There are no studies analyzing the relationship between emphysema and lung cancer (LC). With this aim and in order to make some comparisons between different clinical variables, we carried out the present study. Methods This is a case–control study, patients with COPD and LC being the cases and subjects with stable COPD being the controls. Clinical and functional parameters, as well as the existence of radiological emphysema, were evaluated in a qualitative and quantitative way, using a radiological density of −950 Hounsfield units as a cutoff point in the images. The existence of several different types of emphysema (centrilobular, paraseptal, panacinar, or bullae) was analyzed, allowing patients to have more than one simultaneously. The extent to which lobes were involved was evaluated and the extension of emphysema was graduated for each type and location, following a quantitative scale. Differences between cases and controls were compared by using bivariate and multivariate analyzes with results expressed as OR and 95% CI. Results We included 169 cases and 74 controls, 84% men with a FEV1 (%) of 61.7±18.5, with 90.1% non-exacerbators. Most of them (50%) were active smokers and 47.2% were ex-smokers. Emphysema was found in 80.2% of the subjects, the most frequent type being centrilobular (34.4%). The only significantly different factor was the presence of paraseptal emphysema (alone or combined; OR =2.2 [95% CI =1.1–4.3, P = 0.03]), with adenocarcinoma being significantly more frequent in paraseptal emphysema with respect to other types (67.2% vs 32.8%, P =0.03). Conclusion Patients with COPD and paraseptal emphysema could be a risk group for the development of LC, especially adenocarcinoma subtype.
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Affiliation(s)
- Cecilia Mouronte-Roibás
- Pneumology Department, Álvaro Cunqueiro Hospital, Sanitary Area of Vigo, NeumovigoI+i Investigation Group, Health Research Institute Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain,
| | - Alberto Fernández-Villar
- Pneumology Department, Álvaro Cunqueiro Hospital, Sanitary Area of Vigo, NeumovigoI+i Investigation Group, Health Research Institute Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain,
| | - Alberto Ruano-Raviña
- Public Health and Preventive Medicine Department, Medicine School, Santiago de Compostela University, CIBER of Epidemiology and Public Health, Madrid, Spain
| | - Cristina Ramos-Hernández
- Pneumology Department, Álvaro Cunqueiro Hospital, Sanitary Area of Vigo, NeumovigoI+i Investigation Group, Health Research Institute Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain,
| | - Amara Tilve-Gómez
- Radiology Department, Hospital Sanitary Area of Vigo, Health Research Institute Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain
| | - Paula Rodríguez-Fernández
- Radiology Department, Hospital Sanitary Area of Vigo, Health Research Institute Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain
| | - Adriana Carolina Caldera Díaz
- Radiology Department, Hospital Sanitary Area of Vigo, Health Research Institute Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain
| | - Míriam García Vázquez-Noguerol
- Radiology Department, Hospital Sanitary Area of Vigo, Health Research Institute Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain
| | - Sara Fernández-García
- Pneumology Department, Álvaro Cunqueiro Hospital, Sanitary Area of Vigo, NeumovigoI+i Investigation Group, Health Research Institute Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain,
| | - Virginia Leiro-Fernández
- Pneumology Department, Álvaro Cunqueiro Hospital, Sanitary Area of Vigo, NeumovigoI+i Investigation Group, Health Research Institute Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain,
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