Introduction Miguel Ángel Martínez-García1,2, Mina Gaga 3,4 and Kwun M. Fong 5,6 1 Respiratory Dept, University and Polytechnic La Fe Hospital, Valencia, Spain. 2 CIBER de enfermedades respiratorias, Instituto de Salud Carlos III, Madrid, Spain. 3 Third Dept of Medicine, School of Medicine, Athens Chest Hospital “Sotiria”, National and Kapodistrian University of Athens, Athens, Greece. 4 7th Respiratory Dept, Athens Chest Hospital “Sotiria”, Athens, Greece. 5 Pulmonary Malignancy Unit, The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Queensland, Australia. 6 Thoracic Research Centre, University of Queensland, Brisbane, Queensland, Australia. Corresponding author: Miguel Ángel Martínez-García ( @ERSpublications Respiratory diseases and cancer are frequently linked as both are highly prevalent. Their bidirectional relationship means that each can be a risk factor or a protective factor for the other, significantly impacting diagnosis, management and outcome. Copyright ©ERS 2022. Print ISBN: 978-1-84984-154-2. Online ISBN: 978-1-84984-155-9. Print ISSN: 2312-508X. Online ISSN: 2312-5098. Respiratory diseases and cancer are two of the most frequent causes of morbidity and mortality in the world. As such, the coexistence of both diseases in the same person is a frequent occurrence. There is a consistent body of scientific evidence to suggest that this goes beyond chance in fact, both disease types are associated and the presence of one of them can be a risk factor or protective factor for the other. Notably, one of the fundamental characteristics is the bidirectionality of this relationship. There are multiple reasons why respiratory diseases can be related to cancer. 1) Some respiratory diseases share environmental or genetic risk factors with cancer. For example, the relationship between COPD and cancer is mediated by smoking, where tobacco smoke is a powerful carcinogen as well as an inducer of inflammation. 2) Beyond association, a clear causative relationship has been established in some cases, such as the relationship between asbestos exposure and pleural mesothelioma. 3) Respiratory diseases and cancer can share common pathophysiological pathways, such as those relating to pulmonary inflammation, infection and/or hypoxaemia. 4) Cancer can first present with symptoms associated with lung diseases, such as pulmonary thromboembolism. 5) Treatment for some respiratory diseases can pose an elevated risk of adverse events, such as the loss of cancer immunosurveillance from immunosuppressants. Conversely, some treatments for respiratory diseases can reduce the risk of cancer, such as the use of inhaled corticosteroids in certain circumstances. 6) There is speculation that certain respiratory diseases may protect against cancer, as has been proposed proposed in allergic diseases. There are also a number of reasons why certain individuals diagnosed with cancer may be predisposed to the development of some types of lung diseases. 1) Direct cancer involvement in the lung, e.g. lung cancer. 2) The large vascular bed and filtration function of the lung, which xi
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