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. 2024 May 31;25(1):229.
doi: 10.1186/s12931-024-02838-7.

The effect of inhaler prescription on the development of lung cancer in COPD: a nationwide population-based study

Ji Eun Park #  1 , Eunyoung Lee #  2 , Dave Singh #  3 , Eun Kyung Kim #  4 , Bumhee Park  5   6 , Joo Hun Park  7
Affiliations

The effect of inhaler prescription on the development of lung cancer in COPD: a nationwide population-based study

Ji Eun Park et al. Respir Res. .

Abstract

Background: COPD is associated with the development of lung cancer. A protective effect of inhaled corticosteroids (ICS) on lung cancer is still controversial. Hence, this study investigated the development of lung cancer according to inhaler prescription and comorbidties in COPD.

Methods: A retrospective cohort study was conducted based on the Korean Health Insurance Review and Assessment Service database. The development of lung cancer was investigated from the index date to December 31, 2020. This cohort included COPD patients (≥ 40 years) with new prescription of inhalers. Patients with a previous history of any cancer during screening period or a switch of inhaler after the index date were excluded.

Results: Of the 63,442 eligible patients, 39,588 patients (62.4%) were in the long-acting muscarinic antagonist (LAMA) and long-acting β2-agonist (LABA) group, 22,718 (35.8%) in the ICS/LABA group, and 1,136 (1.8%) in the LABA group. Multivariate analysis showed no significant difference in the development of lung cancer according to inhaler prescription. Multivariate analysis, adjusted for age, sex, and significant factors in the univariate analysis, demonstrated that diffuse interstitial lung disease (DILD) (HR = 2.68; 95%CI = 1.86-3.85), a higher Charlson Comorbidity Index score (HR = 1.05; 95%CI = 1.01-1.08), and two or more hospitalizations during screening period (HR = 1.19; 95%CI = 1.01-1.39), along with older age and male sex, were independently associated with the development of lung cancer.

Conclusion: Our data suggest that the development of lung cancer is not independently associated with inhaler prescription, but with coexisting DILD, a higher Charlson Comorbidity Index score, and frequent hospitalization.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of study population. Abbreviations: CCI = Charlson Comorbidity Index score; COPD = chronic obstructive pulmonary disease; HIRA = Health Insurance Review and Assessment Service; ICS = inhaled corticosteroid; LABA = long-acting beta-agonist; LAMA = long-acting muscarinic antagonist
Fig. 2
Fig. 2
Study design. Medications received during the latency period between medication exposure and lung cancer diagnosis were not counted as exposures
See this image and copyright information in PMC

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