Can't Stop Coughing at Night? Here's What To Do
Asthma Or COPD: How Symptoms Could Mask Signs Of Lung Cancer
Certain chronic conditions that affect the lungs, such as asthma and chronic obstructive pulmonary disease (COPD), can have symptoms that mimic lung cancer. A recent study found that this could delay a timely lung cancer diagnosis. The study was published in the British Journal of Cancer.
The study focused on people already living with chronic conditions that have symptoms similar to those of lung cancer. The researchers found that people with only 1 chronic condition were diagnosed with lung cancer about a month later than people who did not have a chronic condition. People who had 2 or more chronic conditions were diagnosed more than 2 months later.
For some people, the delay in diagnosis could be explained because they had symptoms of another condition that masked the early signs of lung cancer. This can make it harder for doctors to identify when cancer has developed.
"For people with asthma or COPD, it is critically important that they talk with their doctor about monitoring and screening for potential lung cancers. The sooner a patient is diagnosed, the sooner they can start treatment. And the sooner they start treatment, the more likely they are to have a good outcome," said Charu Aggarwal, MD, MPH, FASCO, an American Society of Clinical Oncology (ASCO) expert and the Leslye M. Heisler Professor for Lung Cancer Excellence at Penn Medicine.
How are asthma, COPD, and lung cancer symptoms different?Asthma, COPD, and lung cancer all start in the respiratory system. They all can cause breathing problems. But how are they different?
For people with asthma, symptoms often appear during an asthma flare-up or attack. A flare-up can be triggered by things like pollen, dust, exercise, or an allergy. Flare-ups can last anywhere from a few minutes to a few days. Symptoms of asthma include wheezing and tightness in the chest.
For people with COPD, symptoms tend to get worse over time. Symptoms of COPD include coughing up mucus and having trouble breathing during physical activity.
For people with lung cancer, symptoms often don't show up in early stages and can get worse over time, too. This makes it hard to tell the difference between COPD and lung cancer symptoms. However, lung cancer has several key signs and symptoms that are different from those of asthma or COPD, including:
"If you experience any new symptoms or a change in symptoms, it's important to let your doctor know right away," said Dr. Aggarwal. "They can help you determine the cause of any new or changing symptoms."
Talking about lung cancer risk with your doctorHaving either asthma or COPD can increase the risk of developing lung cancer. If you have one or both conditions, talk with your doctor about your lung cancer risk. They can tell you what symptoms to watch for that may signal lung cancer. They may also recommend yearly lung cancer screening if you are eligible for it.
Some questions to ask your doctor include:
Dr. Aggarwal is an Associate Editor on ASCO's Patient Information Editorial Board.
Asthma And Your Diet: What To Eat And What To Avoid
While there's no single food or nutrient that relieves asthma symptoms, eating a balanced diet and avoiding processed and other triggering foods may help reduce asthma flare-ups.
If you live with asthma, you may wonder whether certain foods and dietary choices can help you manage your condition.
There's currently no conclusive evidence that a specific diet has an effect on the frequency or severity of asthma attacks. However, eating fresh, nutritious foods and avoiding triggering ones may improve your overall health as well as your asthma symptoms.
In some cases, food allergies can also mimic or result in asthma symptoms. Keep reading to learn more about recommended diets for people with asthma, individual foods to avoid, and foods that may be beneficial to you.
There currently aren't any standard recommendations on a particular diet for those with asthma. Reviews of the current literature recommend further study with more rigorous evaluation methods. Early evidence suggests there's no single food or nutrient that improves asthma symptoms on its own.
Instead, people with asthma may benefit from eating a well-rounded diet high in fresh fruits and vegetables. According to research from 2019, a shift from eating fresh foods, such as fruits and vegetables, to processed foods may be linked to an increase in asthma cases in recent decades.
A 2022 review that analyzed the science behind the many elements of Mediterranean-type diets found the effects of short-term diets on asthma symptoms to be inconclusive. However, the researchers hypothesize that a long-term commitment to a more nutritious diet is more likely to have a positive effect on asthma and overall health.
There's no specific diet recommended for asthma, but some foods and nutrients have anti-inflammatory and anti-allergic effects, which can help support your lung function and immune system.
If you have asthma or severe asthma, consider adding the following foods and nutrients to your diet:
Foods rich in vitamins
Scientists have extensively investigated vitamin C, vitamin E, and vitamin A/beta carotene for their effects on asthma.
Beside supplementation and sunlight exposure, you can obtain vitamin D through foods like:
If you know you have allergies to milk or eggs, you may want to avoid them as a source of vitamin D. Sometimes allergy symptoms from a food source can manifest as asthma.
Foods rich in minerals
As oxidative stress significantly contributes to asthma, and as selenium is a powerful antioxidant, increasing selenium intake in your diet can help reduce oxidative stress and thus reduce asthma.
A 2022 study involving 206 patients (103 with asthma and 103 without asthma) concluded that selenium deficiency led to an impaired immune response. This finding suggests that adding selenium to your diet may help reduce oxidative stress in the lungs.
A 2022 review of research on the anti-inflammatory properties of magnesium found that magnesium had a positive effect on lung function and reduced asthma symptoms.
New to meal planning?Don't get overwhelmed by all the options out there. Meal planning isn't as hard as it looks. If you need a quick guide to get you started, you can check out these other Healthline resources on nutrition:
Some foods may trigger asthma symptoms or cause severe asthma to get worse. You may wish to avoid these. However, it's best to consult your doctor before you start eliminating certain foods from your diet.
Sulfites
Sulfites are a type of preservative that may worsen asthma for some people. They're found in:
Foods that cause gas
Salicylates
Although it's rare, some people with asthma may be sensitive to salicylates found in coffee, tea, and some herbs and spices.
Salicylates are naturally occurring chemical compounds, and they're sometimes also found in foods.
Artificial ingredients
Chemical preservatives, flavorings, and colorings are often found in processed and fast food. Some people with asthma may be sensitive or allergic to these artificial ingredients.
Common allergens
Asthma Drug Did Not Reduce Symptom Duration In Mild To Moderate COVID
Among patients with mild to moderate COVID-19, the asthma drug montelukast (Singulair) did not reduce duration of symptoms, results of the randomized controlled ACTIV-6 trial showed.
After receiving montelukast or placebo for 14 days, no differences in time to sustained recovery were observed between groups (adjusted HR 1.02, 95% credible interval 0.92-1.12, P=0.63), and the unadjusted median time to sustained recovery was 10 days for both groups, reported Susanna Naggie, MD, MHS, of the Duke University School of Medicine in Durham, North Carolina, and colleagues in JAMA Network Open.
"In this case, across the entire population of the study, we did not see a clear benefit," Naggie told MedPage Today. "So I think there are a lot of people who were interested in montelukast as a potential active drug, and I think this says that at least in the overall population, that's not true, but that maybe there are some populations where further study would be justifiable."
She noted that "there was maybe a hint" that getting the drug earlier in the disease course may have been beneficial, but "that has not been true of most of the other drugs that we've studied," and further studies should investigate this question specifically.
Naggie said she and her team had a "twofold" hypothesis: that montelukast might address both the viral and inflammatory phases of COVID-19. As an antiviral, some in vitro studies suggested the drug could inhibit some of the enzymes necessary for SARS-CoV-2 to replicate. And in its use for asthma and allergic rhinitis, the drug blocks several receptors in pro-inflammatory pathways in the body, acting as an anti-inflammatory.
However, Naggie added that because the disease has gotten milder, "I think over time, it's gotten harder and harder to be able to find a difference between groups who get the active drug and groups who don't. So we knew that going in, right? You'd have to find a drug that was highly, highly effective, and we did not see that."
In an invited commentary, John O'Horo, MD, MPH, of the Mayo Clinic in Rochester, Minnesota, noted that it can be relatively easy to demonstrate the benefit of a proposed therapeutic in a critically ill population, but in this study population, events like hospitalizations or deaths were rare.
"The safety profile needed for mild outpatient therapy is substantially more conservative and makes finding a cost-effective therapeutic more challenging," O'Horo pointed out.
"Montelukast can now be added to the list of failed therapeutics, but the importance of even negative results in this space cannot be overstated," he wrote. "All therapeutics come with potential harms and knowing that the risks outweigh putative benefits is crucial as outpatient management of COVID-19 becomes more important."
This study was part of ACTIV-6 (Accelerating COVID-19 Therapeutic Interventions and Vaccines), an ongoing platform trial program evaluating repurposed medications for mild to moderate COVID-19. It allowed patients to participate remotely, and the montelukast arm ran from January through June 2023 during circulation of Omicron subvariants. Eligible participants were age 30 and older, with confirmed SARS-CoV-2 infection and two or more acute COVID-19 symptoms for less than 7 days.
Patients with current or recent COVID-19 hospitalization, participation in other COVID-19 trials, or sensitivity or allergy to montelukast were excluded. COVID-19 vaccinations or current use of approved or emergency use authorization COVID-19 outpatient treatments were allowed.
In total, 1,250 participants across 104 sites were randomized into the placebo or montelukast groups. The median age was 53 years, 60.2% were women, 78.2% were white, and 56.3% reported having received two or more doses of a SARS-CoV-2 vaccine. They received montelukast 10 mg or placebo once daily for 14 days. Patients had doses delivered by a pharmacy, and took them orally.
Secondary outcomes included time to death; time to hospitalization or death; a composite of healthcare utilization events including hospitalization, urgent care visit, emergency department visit, or death; COVID-19 clinical progression scale score; and difference in mean time unwell.
No deaths occurred, and two participants in each group were hospitalized. There were no differences between groups in the composite of healthcare utilization events. Five participants had serious adverse events -- three in the montelukast group and two in the placebo group.
Study limitations included few observed clinical events due to increased population-level immunity to COVID-19, evolving viral variants over time, and the characteristics of the enrolled patients. In addition, sending the study drug through the mail introduced a delay between enrollment and receipt of the drug, a median of 5 days, which "might be significant for a proposed antiviral mechanism of action," the authors wrote.
Sophie Putka is an enterprise and investigative writer for MedPage Today. Her work has appeared in the Wall Street Journal, Discover, Business Insider, Inverse, Cannabis Wire, and more. She joined MedPage Today in August of 2021. Follow
Disclosures
Funding for the study came from the National Center for Advancing Translational Sciences at NIH, the Office of the Assistant Secretary for Preparedness and Response Biomedical Advanced Research and Development Authority, and the Vanderbilt University Medical Center Clinical and Translational Science Award.
Naggie reported financial relationships with the NIH, Gilead, AbbVie, and Vir Biotechnology; participation in data safety and monitoring boards for Personal Health Insights; serving on the event adjudication committee for BMS-PRA; and serving as deputy editor of Clinical Infectious Diseases.
Co-authors also reported a number of financial relationships, including with industry.
O'Horo reported no conflicts of interest.
Primary Source
JAMA Network Open
Source Reference: Rothman RL, et al "Time to sustained recovery among outpatients with COVID-19 receiving montelukast vs placebo: the ACTIV-6 randomized clinical trial" JAMA Netw Open 2024; DOI: 10.1001/jamanetworkopen.2024.39332.
Secondary Source
JAMA Network Open
Source Reference: O'Horo JC "Holding our breath -- looking for treatments for mild to moderate COVID-19" JAMA Netw Open 2024; DOI: 10.1001/jamanetworkopen.2024.39283.
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