Published ahead of print on December 21, 2006, doi:10.1164/rccm.200608-1125OC
Am. J. Respir. Crit. Care Med., Volume 175, Number 7, April 2007, 712-719
A more recent version of this article appeared on April 1, 2007
Submitted on August 9, 2006
Accepted on December 21, 2006
Inhaled Corticosteroids and Risk of Lung Cancer among Patients with COPD
Tanyalak Parimon1, Jason W Chien2, Chris L Bryson3, Mary B McDonell4, Edmunds M Udris4, and David H Au3*
1 Department of Medicine, University of Washington, Seattle, WA, USA,
2 Department of Medicine, University of Washington, Seattle, WA, USA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA,
3 Department of Medicine, University of Washington, Seattle, WA, USA; Department of Health Services Research and Development, VA Puget Sound Health Care System, Seattle, WA, USA,
4 Department of Health Services Research and Development, VA Puget Sound Health Care System, Seattle, WA, USA
* To whom correspondence should be addressed. E-mail: dau{at}u.washington.edu.
Rationale and Objectives: Lung cancer is a frequent cause of death among patients with chronic obstructive pulmonary disease. We examined whether the use of inhaled corticosteroids among patients with chronic obstructive pulmonary disease was associated with a decreased risk of lung cancer.
Methods: We performed a cohort study of US veterans enrolled in primary care clinics between December 1996 and May 2001. Participants had received treatment for, had an International Classification of Disease, Ninth edition diagnosis of, or a self-reported diagnosis of chronic obstructive pulmonary disease. Patients with a history of lung cancer were excluded. To be exposed, patients must have been at least 80% adherent to inhaled corticosteroids. We used Cox regression models to estimate the risk of cancer and adjust for potential confounding factors.
Findings: We identified 10,474 patients with a median follow-up of 3.8 years. In comparison to non-users of inhaled corticosteroids, adjusting for age, smoking status, smoking intensity, previous history of non-lung cancer malignancy, co-existing illnesses, and bronchodilator use, there was a dose-dependent decreased risk of lung cancer associated with inhaled corticosteroids. (Adjusted: <1,200 mcg/day, 1.13 (95% Confidence Interval [CI], 0.67-1.90), 1,200 mcg/day, 0.39 (95% CI, 0.16-0.96)). Changes in cohort definitions had minimal effects on the estimated risk. Analyses examining confounding by indication suggest biases in the opposite direction of the described effects.
Interpretation: Results suggest that inhaled corticosteroids may have a potential role in lung cancer prevention among patients with chronic obstructive pulmonary disease. These initial findings require confirmation in separate and larger cohorts.
Key words: Chronic Obstructive Pulmonary Disease, pharmacoepidemiology, lung cancer, adherence
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