Smoking, COPD, Infection, and Lung Cancer: How are They Interconnected?


  • Benjamin J. Tanuwihardja RS Borromeous/Tan Clinic, Bandung


Kata Kunci:

smoking, copd, infection, lung cancer


A case of an elderly ex-smoker chronic obstructive pulmonary disease (COPD) patient with controlled type 2 diabetes mellitus (T2DM) as comorbid was followed-up for 10 years. His stable COPD in the course of time slowly declined to multiple acute exacerbation (AE)-COPD and multiple hospital admissions. High-dose systemic corticosteroids given during AE-COPD with prolonged oral steroids continuation led to depressed immunity that ended with severe immunosuppression, causing sepsis and chronic heart failure (CHF) with non-ST elevated myocardial infarction (NSTEMI) and worsening of COPD in his ninth year follow-up. This immunosuppression also triggered the emergence of lung cancer by allowing malignant cell to evade immune surveillance. Fortunately patient is survived and recovered to stable COPD.


Shiels, MS et al. Cigarettes smoking and variation in systemic immune and inflammation markers. J Natl Cancer Inst. 2014;106(11) DOI:10.1093/jnci/dju294 DOI:

WHO Factsheet 2018 Indonesia.;

GOLD 2019, Pocket Guide to COPD diagnosis, management and prevention.

Sandelin, M et al. Factors associated with lung cancer in COPD patients. Int J Chron Obstruct Pulmon Dis. 2018; 13: 1833–1839. DOI:

Sekine ,Y. et al. Early detection of COPD is important for lung cancer surveillance. Eur Respir J 2012; 39: 1230–1240 DOI:

Lee, J. et al. Cigarettes smoking and inflammation. J Dent Res 2012;90(2):142-149 DOI:

Mosenifar, Z. What is the pathogenesis of COPD?

Sabroe, I. et al. The yin and the yang of immunosuppression with inhaled corticosteroids. Thorax 2013;68(12):1085-7 DOI:

Yousef, J. et al. Infection Risk and Safety of Corticosteroid Use. Rheum Dis Clin North Am. 2016; 42(1):157–176 DOI:

Detterbeck, FC. et al. Turning Gray: The Natural History of Lung Cancer Over Time. J Thorac Oncol. 2008;3:781–792 DOI:

Kadara, H. et al. Early Events in the Molecular Pathogenesis of Lung Cancer. Cancer Prev Res. 2016;9(7):781-792 DOI:

Wang, FT. et al. Cancer associated fibroblast regulation of tumor neo angiogenesis. Oncol. Letters 2019;17:3055-3065

Stanta, G., Bonin, S. Overview of clinical relevance of intra tumor heterogeneity. Frontiers in Medicine. 2018;5:1-10 DOI:




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Cara Mengutip

Smoking, COPD, Infection, and Lung Cancer: How are They Interconnected?. MEDICINUS 2020;33:17-2.