Abstract
Whether the use of inhaled corticosteroids (ICS) protects patients with chronic obstructive pulmonary disease (COPD) from lung cancer remains undetermined. In this retrospective nationwide population-based cohort study, we extracted data of 13,686 female COPD patients (ICS users, n = 1,290, ICS non-users, n = 12,396) diagnosed between 1997 and 2009 from the Taiwan's National Health Insurance database. These patients were followed-up until 2011, and lung cancer incidence was determined. Cox regression analysis was used to estimate hazard ratios (HRs) for lung cancer incidence. The time to lung cancer diagnosis was significantly different between ICS users and non-users (10.75 vs. 9.68 years, P < 0.001). Per 100,000 person-years, the lung cancer incidence rate was 235.92 for non-users and 158.67 for users [HR = 0.70 (95% confidence interval {CI}: 0.46–1.09)]. After adjusting for patients' age, income, and comorbidities, a cumulative ICS dose > 39.48 mg was significantly associated with a lower risk of lung cancer [ICS users > 39.48 mg, HR = 0.45 (95% CI: 0.21–0.96)]. Age ≥ 60 years, pneumonia, diabetes mellitus, and hypertension decreased lung cancer risk, whereas pulmonary tuberculosis increased the risk. Our results suggest that ICS have a potential role in lung cancer prevention among female COPD patients.
Highlights
Chronic obstructive pulmonary disease (COPD) is characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and lungs to noxious particles or gases [1]
Studies have shown that patients with mild or moderate/severe obstructive pulmonary disease have a significantly higher incidence of lung cancer than non-chronic obstructive pulmonary disease (COPD) patients after adjusting for factors related to smoking [4], and similar results have been reported in other studies after matching or adjusting for age, sex, and smoking status [5, 6]
Our study demonstrated that inhaled corticosteroids (ICS) have a dosedependent negative association with lung cancer risk, and that an ICS cumulative dose > 39.48 mg is significantly associated with a lower risk for lung cancer after adjusting for age, income, and comorbidities
Summary
Chronic obstructive pulmonary disease (COPD) is characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and lungs to noxious particles or gases [1]. COPD patients have a high incidence of smoking and higher incidence to develop lung cancer than non-COPD smokers [2, 3]. Studies have shown that patients with mild or moderate/severe obstructive pulmonary disease have a significantly higher incidence of lung cancer than non-COPD patients after adjusting for factors related to smoking [4], and similar results have been reported in other studies after matching or adjusting for age, sex, and smoking status [5, 6]. There is a positive relationship between COPD severity and the development of lung cancer [7]
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