© 2007 American Thoracic Society
Lung Cancer Chemoprevention with Inhaled Corticosteroids?To the Editor:We read with interest the article by Dr. Parimon and colleagues, wherein the authors demonstrate that inhaled corticosteroids can decrease the risk of lung cancer among patients with chronic obstructive pulmonary disease (COPD) (1). Certain aspects of this study, however, merit careful attention. First, the diagnosis of COPD as well as the histopathology of lung cancer were not confirmed, so it seems improper to conclude from this study that inhaled corticosteroids can decrease the risk of lung cancer in COPD. Although the authors have shown a statistically significant reduction in the occurrence of lung cancer with the use of more than 1,200 µg of triamcinolone equivalents in patients with COPD, the confidence intervals are very wide, which decreases the clinical relevance of these findings. Moreover, in the subgroup using less than 1,200 µg of triamcinolone equivalent, the hazard ratio for the risk of occurrence of lung cancer is still more than 1.0, and the results are barely significant when triamcinolone has been evaluated as a continuous variable, putting a question mark on the strength of the hypothesis. Finally, although the authors state that the dose of 1,200 µg of triamcinolone was chosen a priori, the rationale for choosing this dose is not clear.
Postgraduate Institute of Medical Education and Research FOOTNOTES Conflict of Interest Statement: Neither author has a financial relationship with a commercial entity that has an interest in the subject of this manuscript. REFERENCES
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