© 2007 American Thoracic Society
A Major Cause of Death in COPD and Risk Factors for Lung Cancer—a Dilemma or a Mistake?From the Authors:We appreciate the comments from Dr. Gowani and colleagues on our article (1). There is a robust literature that clearly describes an association between chronic obstructive pulmonary disease (COPD) and an increased risk of lung cancer that is independent of age and tobacco smoke (2, 3), and recent perspectives suggest a potential genetic linkage between these two commonly occurring diseases (4). What needs further elucidation is why the lung injury that results in COPD augments the risk of lung cancer. In addition, based on the current literature, a patient's cause of death is dependent on the severity of lung disease (5). There is little debate that in patients with severe COPD, respiratory failure is a common cause of death. Of the possible 24 million Americans with COPD, however, most will have mild to moderate airflow limitation (6), and the Lung Health Study demonstrated that among these individuals, lung cancer was the most common cause of death (7). Furthermore, the editorial by Miller and Keith (8) recognized the inclusion of adherence in our article as an advantage, allowing better exposure assessment, rather than a shortcoming. Finally, we appreciate Dr. Gowani and colleagues' attention to the fallibility of the peer-review process, for both pointing out an important typographical error and allowing us to highlight that the cohort was followed for a median of 3.8 years.
Veterans Administration Puget Sound Health Care System, Seattle, Washington and University of Washington, Seattle, Washington
Fred Hutchinson Cancer Research Center, Seattle, Washington and University of Washington, Seattle, Washington
Veterans Administration Puget Sound Health Care System, Seattle, Washington and University of Washington, Seattle, Washington FOOTNOTES Conflict of Interest Statement: D.H.A. received $1,500 for participating in a GlaxoSmithKline-sponsored advisory round table. J.W.C. has no financial relationship with a commercial entity that has an interest in the subject of this manuscript. C.L.B. has no financial relationship with a commercial entity that has an interest in the subject of this manuscript. REFERENCES
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