‘Older male COPD patients with interstitial lung disease are highly likely to have lung cancer’

Chronic obstructive pulmonary disease (COPD) has long been linked to the development of lung cancer. A new study found that patients with interstitial lung disease, frequent hospitalizations, older age, and male gender are highly likely to have lung cancer.

COPD is ranked as the third leading cause of death worldwide, and the prevalence of COPD in Korea is high at 13.4 percent among people aged 40 and older.

A research team led by Professor Park Joo-hun of the Department of Respiratory Medicine at Ajou University Medical Center has found that COPD patients who were prescribed a five-day inhaler were more likely to develop lung cancer if they had interstitial lung disease, a high comorbidity index, a history of two or more frequent hospitalizations, and were older and male.

Park’s research team comprised Professor Park Ji-eun of the same university hospital, Professor Lee Eun-young of the University of Texas McGovern Medical School, Professor Kim Eun-kyung of CHA University Bundang Medical Center and Professor Dave Singh of the University of Manchester, U.K.

Given that chronic inflammation of lung tissue and ongoing damage to lung cells in COPD has been reported to increase cancer cell expression, there has been interest in identifying risk factors for lung cancer and whether inhaler therapy is associated with a reduced incidence of lung cancer.

The researchers analyzed factors associated with lung cancer in 63,442 COPD patients 40 and older who received their first inhaler prescription during the five years from 2015 to 2020 from the Health Insurance Review and Assessment Service (HIRA) cohort data.

Those prescribed with inhaler prescriptions included 39,588 (62.4 percent) long-acting muscarinic antagonist-long-acting beta2-agonist combination prescriptions, 22,718 (35.8 percent) inhaled steroid-long-acting beta2-agonist combination prescriptions, and 1,136 (1.8 percent) long-acting beta2-agonist prescriptions.

In multivariate analysis, there was no significant difference between inhaler prescriptions and lung cancer incidence.

“The significance of this study is that it identified risk factors associated with lung cancer by examining only COPD patients who were newly prescribed inhalers and had not been diagnosed with any cancer in the past to overcome errors related to time-related bias,” Professor Park Joo-hun said.

He added that COPD patients need to maintain a healthy lifestyle, including not smoking and managing their comorbidities, and they should be aware of the risk of acute exacerbations during the cold winter months when respiratory tract infections occur.

The study was recently published in the international journal Respiratory Research, with the title "The effect of inhaler prescription on the development of lung cancer in COPD: a nationwide population-based study.”