{"doi":"10.21037/jtd-23-1273","title":"Inhaled medications for chronic obstructive pulmonary disease predict surgical complications and survival in stage I non-small cell lung cancer","abstract":"Background: Lung function is routinely assessed prior to surgical resection for non-small cell lung cancer (NSCLC). Further assessment of chronic obstructive pulmonary disease (COPD) using inhaled COPD medications to determine disease severity, a readily available metric of disease burden, may predict postoperative outcomes and overall survival (OS) in lung cancer patients undergoing surgery. Methods: We retrospectively evaluated clinical stage I NSCLC patients receiving surgical treatment within the Veterans Health Administration from 2006-2016 to determine the relationship between number and type of inhaled COPD medications (short- and long-acting beta2-agonists, muscarinic antagonists, or corticosteroids prescribed within 1 year before surgery) and postoperative outcomes including OS using multivariable models. We also assessed the relationship between inhaled COPD medications, disease severity [measured by forced expiratory volume in 1 second (FEV1)], and diagnosis of COPD. Results: Among 9,741 veterans undergoing surgery for clinical stage I NSCLC, patients with COPD were more likely to be prescribed inhaled medications than those without COPD [odds ratio (OR) =5.367, 95% confidence interval (CI): 4.886-5.896]. Increased severity of COPD was associated with increased number of prescribed inhaled COPD medications (P<0.0001). The number of inhaled COPD medications was associated with prolonged hospital stay [adjusted OR (aOR) =1.119, 95% CI: 1.076-1.165), more major complications (aOR =1.117, 95% CI: 1.074-1.163), increased 90-day mortality (aOR =1.088, 95% CI: 1.013-1.170), and decreased OS [adjusted hazard ratio (aHR) =1.061, 95% CI: 1.042-1.080]. In patients with FEV1 ≥80% predicted, greater number of prescribed inhaled COPD medications was associated with increased 30-day mortality (aOR =1.265, 95% CI: 1.062-1.505), prolonged hospital stay (aOR =1.130, 95% CI: 1.051-1.216), more major complications (aOR =1.147, 95% CI: 1.064-1.235), and decreased OS (aHR =1.058, 95% CI: 1.022-1.095). When adjusting for other drug classes and covariables, short-acting beta2-agonists were associated with increased 90-day mortality (aOR =1.527, 95% CI: 1.120-2.083) and decreased OS (aHR =1.087, 95% CI: 1.005-1.177). Conclusions: In patients with early-stage NSCLC, inhaled COPD medications prescribed prior to surgery were associated with both short- and long-term outcomes, including in patients with FEV1 ≥80% predicted. Routine assessment of COPD medications may be a simple method to quantify operative risk in early-stage NSCLC patients.","journal":"Journal of Thoracic Disease","year":2023,"id":365050,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":7,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.965,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":715286,"name":"Daniel B. Eaton","orcid":"0000-0001-9819-2159","position":1,"is_corresponding":false},{"id":446033,"name":"Brendan T. Heiden","orcid":"0000-0002-0116-7377","position":2,"is_corresponding":false},{"id":63706,"name":"Nikki E. Rossetti","orcid":"0000-0001-5218-0902","position":3,"is_corresponding":false},{"id":729802,"name":"Valerio Rasi","orcid":"0000-0001-5727-6188","position":4,"is_corresponding":false},{"id":401484,"name":"Su‐Hsin Chang","orcid":"0000-0001-5872-9556","position":5,"is_corresponding":false},{"id":715287,"name":"Yan Yan","orcid":"0000-0002-4618-7654","position":6,"is_corresponding":false},{"id":1120566,"name":"Deepika Gopukumar","orcid":"0000-0003-0820-5986","position":7,"is_corresponding":false},{"id":715288,"name":"Mayank R. Patel","orcid":"0000-0002-0210-9750","position":8,"is_corresponding":false},{"id":401482,"name":"Bryan F. Meyers","orcid":"0000-0003-2720-0312","position":9,"is_corresponding":false},{"id":401483,"name":"Benjamin D. Kozower","orcid":"0000-0002-9059-5807","position":10,"is_corresponding":false},{"id":376149,"name":"Varun Puri","orcid":"0000-0001-7761-8421","position":11,"is_corresponding":false},{"id":334404,"name":"Martin W. Schoen","orcid":"0000-0001-6388-5553","position":12,"is_corresponding":false},{"id":1120565,"name":"Steven Tohmasi","orcid":"0000-0002-0904-6692","position":0,"is_corresponding":true}],"reference_count":38,"raw_metadata":null,"created_at":"2026-07-19T01:14:46.760245Z","pmid":"38249867","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}