COPD and Inhaled Treatment Effects on Mortality in Lung Cancer Patients.

Abstract

Introduction: In lung cancer patients, the impact of COPD diagnosis and subsequent management on mortality remains uncertain, as evidence supporting the efficacy of inhaled therapies in improving clinical outcomes in this population is limited. This study aims to assess whether COPD worsens outcomes in lung cancer patients and to investigate whether inhaled treatments for COPD can improve these outcomes.

Methods: This retrospective cohort study used the Korea Central Cancer Registry (K-CURE) database from 2012 to 2019. Lung cancer patients aged 40 and older with health screening records were included. Patients were classified into COPD and non-COPD groups, and within the COPD group, further classified based on inhaled therapy status. The primary outcome was all-cause mortality, and secondary outcomes included healthcare resource utilization. Subgroup analyses were conducted based on lung cancer stage, histologic subtypes, and treatment modalities.

Results: Among 113,071 lung cancer patients, 38,145 (33.7%) had COPD. COPD was associated with higher all-cause mortality (adjusted HR=1.327, 95% CI=1.305-1.350, P-value<0.001), increased use of steroids, antibiotics, higher rates of hospital admissions, and more frequent emergency room visits. COPD patients receiving inhaled treatment had lower mortality rates at the 3-month landmark (adjusted HR=0.934, 95% CI=0.895-0.975, P-value=0.002). Notably, the dual bronchodilator combination (LABA/LAMA) was associated with a significant mortality reduction, as observed across multiple landmark time points.

Conclusions: COPD is linked to worse clinical outcomes in lung cancer patients. Among the inhaled treatments, the LABA/LAMA dual therapy showed a beneficial effect on mortality, while adding ICS as part of triple therapy did not provide an additional survival benefit. This study suggests the importance of early COPD detection and timely initiation of inhaled therapy in patients with lung cancer.