Mechanisms of dyspnoea relief following radiation treatment in a patient with severe COPD.

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].