A new study finds that lung scans of COPD patients can also are more likely to die from heart disease than from lung cancer. They measured coronary artery calcium in each scan and found a direct relationship between the level to link to, quote, excerpt or reprint from these stories in any medium as. A better delineation of the relationships between lung cancer, COPD, and emphysema may lead to significant improvements in the. Both COPD and lung cancer are major worldwide health concerns owing to cigarette smoking, and represent a huge, worldwide, preventable disease burden .
Lung cancer The lifetime risk of developing lung cancer is Lung cancer is caused by mutations in oncogenes leading to the proliferation of the mutated cells and the formation of a tumor. Additional mutations can further transform the benign tumor to an invasive cancer, a process marked by metastatis spreadinvasiveness and anaplasia loss of cell type specific features .
The other cancers are termed small cell lung carcinomas SCLCwhich are composed of smaller than normal, undifferentiated cells . COPD was the third most common cause of death worldwide in  and ranked fifth worldwide in terms of burden of disease . Damage to the lungs in COPD is caused by oxidative stress both exogenous from smoking and endogenousinflammatory cytokine release, protease activity due to the protease: These in turn can lead to airway destruction, air trapping and lung hyperinflation.
COPD and lung cancer are linked diseases COPD and lung cancer are caused by cigarette smoking and there is increasing evidence linking the two diseases beyond a common etiology.
COPD is an independent risk factor for lung carcinoma, particularly for squamous cell carcinoma  and lung cancer is up to five times more likely to occur in smokers with airflow obstruction than those with normal lung function .
Even excluding factors such as over diagnosis COPD patients still have twice the risk of lung cancer development . The high prevalence of lung cancer in COPD suggests that there may be common mechanisms, such as premature aging in the lungs, genetic predispositions to either disease or common pathogenic factors, such as growth factors, activation of intracellular pathways or epigenetics.
Lung cancer and COPD: Diseases of the aging lung The probability of developing cancer increases with age  and the median age of onset for lung cancer is 66 years old .
COPD principally affects smokers aged over 40 and is 2. The normal decline in lung function with ageing is accelerated in patients with COPD leading to premature loss of lung function . Aging is principally driven by failure of organs to repair DNA damage by oxidative stress non-programmed aging and from telomere shortening as a result of repeated cell division programmed aging.
These defects are both present in COPD . Some participants felt that the cigarette was comforting and suppressed worries. Other participants felt that the stress associated with the illness or death of a relative justified that they could not stop smoking, and so the occasion to quit was postponed. The participants had often thought about giving up smoking but always as something to be done in the future; now is not the right time.
They considered their being addicted to the cigarette as a scourge, which led to their plans to stop smoking never becoming realized. The participants realized that it was necessary to have the motivation to quit smoking, but such motivation was missing, and their plans to quit did not lead to any results. Half of the participants had decreased their smoking but had not been able to stop completely. It was important to remove distractions, to be in control, and to have peace and quiet.
Furthermore, while there were positive factors that contributed to a smoking cessation plan, such as if nobody was smoking in their environment, if cigarettes were not available, various activities, travel, and exercise, plans to quit entirely were never accomplished. Being aware and enlightened and having a need for autonomy This theme describes an awareness of the risks of smoking and the consequences of COPD.
It was difficult to deal with the surrounding demands of smoking cessation since the decisions had to be taken independently in order to keep their autonomy. Support should be given after the individual has made his or her own decision. Being aware of the consequences of continued smoking The participants were aware of the consequences of continued smoking and had knowledge of COPD.
They knew that people with the disease never regained their health but that the progression of the disease halted after smoking cessation. The annual lung function test performed within their participation in the OLIN studies showed the extent of the disease.
For some participants, it was a good help to start thinking about quitting, while others felt that it was not important. For a number of participants, the lung function test showed beyond all doubt that they needed to make the decision to quit smoking. Other participants said that support was needed after setbacks. It was easier to be open and talk to their loved ones because of the close relation.
Several of the participants felt that it would be easier to quit smoking if their smoking relatives also thought about quitting. The participants experienced demands about smoking cessation, in some cases daily, from spouses, family, friends, employers, and physicians.
Nagging from people in their environment could lead to continued smoking or get them started again after smoking cessation. Some of the participants experienced having people in their environment who were ignorant of their situation.
The relationship between COPD and lung cancer
Telling someone about their situation could result in experiencing pressure to quit, so the participants had not informed anyone about quitting smoking. In fact, smoking can be considered as a weakness, and being a smoker can be regarded as bad as being an alcoholic. Smoking was considered shameful since the act is prohibited in public places in Sweden.
Their experiences with treatments were both positive and negative. Several of the participants said they had experienced side effects that made them cancel the treatment.
Several participants had experienced temporary help from drugs. Some had been involved in smoking cessation groups at the medical center, but they did not think that group meetings were helpful because all the participants in the group had not decided to quit smoking.
Furthermore, one participant who had attempted smoking cessation said that it was easier to refrain from smoking as long as he was involved in the weaning group. In earlier attempts to quit, several participants had not used any aids.
Why do smokers diagnosed with COPD not quit smoking? - a qualitative study
Almost all the participants were critical of the information and support they had gotten from health care professionals. Discussion Smoking cessation is the most important intervention to reduce the risk for cardiovascular and respiratory diseases [ 6 ], especially COPD.
While most individuals understand the benefits of smoking cessation and many who are diagnosed with COPD quit smoking, some continue to smoke. In order to understand why individuals diagnosed with COPD continue to smoke, qualitative studies are required. The purpose of the present study was to describe the difficulties of smoking cessation experienced by individuals diagnosed with moderate COPD who had been unable to stop smoking.
We have shown that the participants had a long habit of smoking; they had begun smoking when they were between 12 and 13 years old. The participants described incidents in their lives as reasons for never finding the time to focus on smoking cessation. Motivation and support are needed after the smoker has made the decision to quit.
Those participants who hesitated to make the decision also felt critical of the information and support that were provided. Because nicotine dependence is a strong addiction and smoking is related to a feeling of pleasure, smoking often becomes a lifelong habit.
It has been reported that already at a young age, 14—17 years, smokers experience a strong urge to smoke [ 21 ]. Similar to the experiences described by the participants in the present study, smoking initiation at a young age has been shown to be related to a lifelong dependence on nicotine [ 22 ].
The feeling of pleasure whenever they smoked was described as a positive experience in their lives. This finding is supported by other studies that have shown that smokers often smoked after a meal, when they had coffee, during a break, while drinking alcohol, and when socializing with other people such as co-workers [ 23 ]. Besides the feeling of pleasure, another factor that made the participants want to smoke more was stress and pressure at work, which is in accordance with a study by Kouvonen et al.
The participants in the present study had plans to quit smoking, but these had not been actualized. Other stressful situations in life, such as having ill relatives, occasions of death in the family, or depression, were some of the reasons that led to difficulties in finding the right time to quit smoking. As in other studies [ 25 ], weight gain was another reason to start smoking again after cessation for some of the participants.
This was not a surprising result since most smokers know that nicotine dependence is a strong addiction and that smoking cessation entails substantial behavior modification that requires a huge effort.
Why do smokers diagnosed with COPD not quit smoking? - a qualitative study
Therefore, the decision to quit smoking is postponed. Both the reasons for not quitting, and the reasons leading up to the decision to quit smoking, vary among individuals. It has been shown that persons with COPD are more likely to develop depression and anxiety [ 2728 ].
Several of our participants described that they began to smoke again after smoking cessation because of depression, which is in accordance with other studies [ 2930 ]. The participants were aware of the consequences of continued smoking. Some wished to continually receive information about their decreasing lung function or even get a verdict on whether they would die if they continued to smoke.
While some studies have shown that worries about future health problems motivated smokers to achieve smoking cessation [ 3132 ], another study showed that having unpleasant respiratory symptoms were not enough [ 17 ]. The chart by Fletcher et al. However, some smokers find the available smoking cessation support and information insignificant. One study showed that half of the smokers quit spontaneously without any support or planning [ 33 ].
All the participants in the present study had been informed about the available support from the health care system, but not all had used it. In another study, smokers described that they were not interested in joining support groups because they expected these to be ineffective [ 34 ]. This is in contrast to the finding in the present study that while the participants did not want support before they have made the decision to quit, they wanted support after they have decided to quit.
The participants in the present study described that friends and relatives expressed their wish for them to stop smoking, but this had the opposite result. It is thus important that smokers maintain their autonomy; no one can make the decision to quit smoking for them. The important issue for successful smoking cessation seems to be the understanding of individual differences. Health professionals involved in smoking cessation support should recognize the individual smoker in his or her full life situation and adapt the support thereafter.
The strength of this study design is the possibility to give a further understanding of why individuals with COPD continue to smoke, which would not be possible in a quantitative study.
One limitation of the study could be the sample size as more participants might have yielded a different result. However, there are no rules for sample size in qualitative research, but six to eight participants can be sufficient when the sample are a homogenous group [ 36 ].