Lung Cancer Risk in COPD, Regardless of Asthma History

Patients with chronic obstructive pulmonary disease (COPD) have an increased risk of lung cancer with or without childhood asthma, according to the results of a recent study published in the Annals of the American Thoracic Society.

Researchers retrospectively analyzed baseline spirometry and clinical history of smokers from the National Lung Cancer Screening Trial to compare unadjusted and adjusted lung cancer risk after categorizing participants into 5 airway disease subgroups. The primary objective was to determine whether patients with asthma-COPD overlap had a higher risk of lung cancer compared with COPD alone and other conditions related to airway obstruction.

Among the 13,939 smokers in the dataset, there were 208 participants with asthma-COPD overlap, 4428 participants with COPD, 281 participants who were asthmatic smokers, 2547 participants who were considered Global Initiative for COPD (GOLD)-Unclassified, and 6447 participants who were smokers with normal spirometry. The incidence rate of lung cancer per 1000 person-years was: 13.2 among patients with asthma COPD overlap, 11.7 in patients with COPD, 1.8 in asthmatic smokers, 7.7 among patients considered GOLD-Unclassified, and 4.1 among smokers with normal spirometry.

In unadjusted analyses, patients with asthma-COPD overlap had a significantly higher risk of lung cancer vs asthmatic smokers (incidence rate ratio [IRR], 7.58; 95% CI, 2.21-26.02), patients considered GOLD-Unclassified (IRR, 17.2), and smokers with normal spirometry (IRR, 3.23; 95% CI, 1.93-5.40). In adjusted analyses, patients with asthma-COPD overlap continued to have a significantly increased risk of lung cancer compared with patients with asthma and smokers with normal spirometry (adjusted IRR, 2.68; 95% CI-1.52-4.74). However, incidence in lung cancer among patients with asthma-COPD overlap and COPD was not different (adjusted IRR, 1.21; 95% CI, 0.69-2.21), nor was the incidence different between patients with asthma-COPD overlap and patients with asthma, or between patients with asthma-COPD overlap and patients considered GOLD-Unclassified.

“Risk of lung cancer among patients with [asthma-COPD overlap] is similar to those with COPD and higher than other groups of smokers,” the study authors wrote. “These results provide further evidence that COPD, with or without a history of childhood asthma, is an independent risk factor for lung cancer.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Reference

Charokopos A, Braman SS, Brown SAW, et al. Lung cancer risk among patients with asthma-chronic obstructive pulmonary disease overlap. Ann Am Thorac Soc. May 21, 2021. doi:10.1513/AnnalsATS.202010-1280OC