Inhaled Corticosteroids and Lung Cancer Chemoprevention in Chronic Obstructive Pulmonary Disease Patients: What Should We Make of What We Observe?

Review Article


A Victor Kiri

Affiliation: Department of Peri Approval Clinical Excellence, PAREXEL International, Uxbridge, UK


ABSTRACT

Chronic obstructive pulmonary disease (COPD) is a major cause of mortality and morbidity worldwide with an estimated 2.75 million deaths in 2000 (fourth leading cause of death). The lung is a major site of cancer in the world today, representing about 13% of all new cancers. Epidemiological data indicate that COPD patients are at increased risk of cancer, especially lung cancer, and COPD is recognized as a major risk factor for lung cancer independent of the effect of smoking. Both diseases incur significant healthcare and societal costs, and smoking cessation remains the most effective control for reducing the risk of developing either disease. Although no randomized controlled trial has demonstrated an effective therapy against COPD mortality, many trials have reported positive results for inhaled corticosteroids (ICS) and long‐acting bronchodilators (LABA) on lung function improvement, reduction in exacerbation, and reduction in health‐related costs. Indeed, observational studies have suggested some COPD survival benefits from the combined use of both ICS and LABA and, more notably, a few others have also found evidence of reduction in lung cancer risk among COPD patients exposed to ICS. The possibility that ICS may possess such chemopreventive effects in COPD deserves better attention.

Keywords: chronic obstructive pulmonary disease (COPD), lung cancer, chemoprevention, inhaled corticosteroids, peripheral adenocarcinoma, squamous cell carcinoma
Correspondence: Victor A Kiri, Department of Peri Approval Clinical Excellence, PAREXEL International, Uxbridge, Middlesex UB8 1LZ, UK. Tel: (44)‐1895–614760; Fax: (44)‐1895–614277; e‐mail: Victor.Kiri@PAREXEL.com