Inhaled steroids reduce lung cancer risk in COPD patients

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The use of inhaled steroids reduces the risk of developing lung cancer in people with chronic obstructive pulmonary disease (COPD), a study suggests. Inhaled steroids can be prescribed to treat COPD, particularly in more severe cases in which first-line treatments like beta agonists aren’t enough. Beta agonists work by relaxing muscles in the lungs to widen the airways. Meanwhile, steroids work by decreasing the number of a type of inflammatory cell, called eosinophil, in the lungs.

The relationship between the use of steroids and the risk of lung cancer development – a major cause of death among people with COPD – has not, until now, been assessed.

To learn more, a team led by researchers at the University of British Columbia, in Canada, analysed data from 1997 through 2007 for 39,676 people in British Columbia with COPD. All patients were over 50 years old (mean age of 70.7 years), and all had received at least three COPD-related prescriptions.

Of the 39,676 COPD patients analysed, 994 (2.5%) developed lung cancer. Using this information, along with the prescription data, researchers determined that patients who used inhaled steroids to manage their COPD were much less likely to develop lung cancer – an association that remained constant even when different statistical methods were used.

“Results showed that if you had COPD and consistently used a steroid inhaler, your chances of getting lung cancer were between 25% and 30% lower, compared to people who took other treatments,” Dr Larry Lynd, a professor at the University of British Columbia and co-author of the study, said.

The study, however, has some limitations, the researchers pointed out. For one thing, it is only showing an association, and not a direct cause-and-effect relationship in which the use of steroids would “prevent” the development of cancer. Additionally, the analysis relied on administrative data and prescription records. While allowing for a larger sample size, this type of data is, predictably, imperfect.

“More work is clearly needed to understand the exact nature of the relationship between lung cancer risks and steroid use,” Lynd said, adding that the team plans to further study the interplay between steroids and lung cancer, as well as to determine which patients might particularly benefit from such treatment.

“Over the next few months, we will find out which COPD patients would benefit the most from inhaled steroids,” Lynd concluded.

For many people with chronic obstructive pulmonary disease or COPD, a steroid inhaler is a daily necessity to keep their airways open and help them to breathe. Now, a new UBC analysis shows that these medicated devices may also reduce patients’ risk of lung cancer by as much as 30%.

The researchers evaluated 10 years’ worth of medical and pharmacy data for 39,676 adults in British Columbia who were diagnosed with COPD, including 994 people who were later diagnosed with lung cancer. They compared outcomes for people who took inhaled steroids versus those who used beta agonists, another class of drugs used to treat COPD.

Beta agonists, which work by relaxing muscles in the lungs to widen the airways, are the first choice of treatment for COPD. But doctors will often prescribe steroids, which reduce the number of inflammatory cells called eosinophils in the lungs, for more severe cases.

“Results showed that if you had COPD and consistently used a steroid inhaler, your chances of getting lung cancer were between 25% and 30% lower compared to people who took other treatments,” said study author Larry Lynd, a professor who leads the Collaboration for Outcomes Research and Evaluation project at UBC’s faculty of pharmaceutical sciences and an associate member of the faculty of medicine.

COPD is a group of diseases, including emphysema and chronic bronchitis, that hamper airflow to the lungs and cause serious long-term disability and early death. Although there is no cure, treatments can help manage the disease.

“In Canada alone, more than 700,000 people have been diagnosed with COPD,” said study co-author Don Sin, a professor of medicine at UBC and the Canada Research chair in COPD. “These results highlight the importance of identifying which of those patients may be at the highest risk for lung cancer and may benefit from therapy with inhaled steroids.”

The study is limited by its reliance on administrative data, which limits the scope of data available for analysis, and the fact that COPD diagnosis was based solely on prescription records. For the next stage in this research, the researchers plan to do studies to understand how steroids reduce lung cancer risk in COPD patients.

“More work is clearly needed to understand the exact nature of the relationship between lung cancer risks and steroid use,” said Lynd. “Over the next few months, we will find out which COPD patients would benefit the most from inhaled steroids.”

Abstract
Inhaled corticosteroids (ICSs) are often prescribed in patients with chronic obstructive pulmonary disease (COPD). Their impact on the risk of lung cancer, a leading cause of mortality in COPD patients, remains uncertain.
Population-based linked administrative data between the years 1997 and 2007 from the province of British Columbia, Canada, were used to evaluate the association between lung cancer risk and ICS use in COPD patients. COPD was defined on the basis of receipt of three COPD-related prescriptions in subjects ≥50 years of age. Exposure to ICS was incorporated into multivariable Cox regression models using several time-dependent methods (“ever” exposure, cumulative duration of use, cumulative dose, weighted cumulative duration of use and weighted cumulative dose).
There were 39 676 patients who met the inclusion criteria. The mean±SD age of the cohort was 70.7±11.1 years and 53% were female. There were 994 (2.5%) cases of lung cancer during follow-up. In the reference case analysis (time-dependent “ever” exposure), ICS exposure was associated with a 30% reduced risk of lung cancer (HR 0.70 (95% CI 0.61–0.80)). ICS exposure was associated with a decrease in the risk of lung cancer diagnosis over all five methods of quantifying exposure.
This population-based study suggests that ICS use reduces the risk of lung cancer in COPD patients.

Authors
Adam JN Raymakers, Mohsen Sadatsafavi, Don D Sin, J Mark FitzGerald, Carlo A Marra, Larry D Lynd

University of British Columbia material
European Respiratory Journal abstract


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