TY - JOUR T1 - Mechanisms of dyspnoea relief following radiation treatment in a patient with severe COPD JF - European Respiratory Journal JO - Eur Respir J SP - 728 LP - 730 DO - 10.1183/09031936.00029411 VL - 38 IS - 3 AU - P. O'Meara AU - J.A. Guenette AU - N. Raghavan AU - N. Amornputtisathaporn AU - C.E. deMetz AU - R.L. Nolan AU - D.E. O’Donnell Y1 - 2011/09/01 UR - http://erj.ersjournals.com/content/38/3/728.abstract N2 - To the Editors:Chronic obstructive pulmonary disease (COPD) and lung cancer coexist in many smokers. In those with more advanced COPD in whom surgical resection is contraindicated, palliative or curative radiotherapy may be considered. The effects of radiation treatment on respiratory physiology and functional status in patients with background COPD are highly variable and difficult to predict [1]. Radiation-associated inflammatory injury to airways, lung parenchyma and the pulmonary vasculature can lead to further respiratory impairment, including disruption of pulmonary gas exchange with consequent clinical deterioration. The decision to proceed with radiotherapy must be carefully weighed and based on individualised risk–benefit analysis, especially in those patients with severe COPD. Contrary to expectation, there are anecdotal reports of patients with COPD who experience symptomatic improvement following radiation treatment, but the mechanisms remain unknown [2].Our patient was a 70 yr-old female with a 50-pack-yr smoking history who had documented progressive respiratory deterioration despite maximal medical therapy and pulmonary rehabilitation. Pulmonary function tests (PFTs) prior to treatment indicated very severe airway obstruction (forced expiratory volume in 1 s (FEV1) 34% predicted) and lung hyperinflation (total lung capacity (TLC) 155% pred), and diffuse centrilobular emphysema was evident on computed tomography (CT) scan, although diffusing capacity of the lung for carbon monoxide (DL,CO) was relatively preserved (13.6 mL·min−1·mmHg−1, 73% pred). CT scanning fortuitously identified a suspicious spiculated nodule (10.5×11 mm) in the patient’s right middle lobe, which increased in size by 2 mm over 11 months with no evidence of airway obstruction or atelectasis. Subsequent positron emission tomography demonstrated that she probably had primary lung cancer in stage Ia (T1aN0M0). Tissue diagnosis was not attempted given the location of the nodule, her fragile respiratory status and the high risk of pneumothorax. Our patient had … ER -