Exacerbation of chronic obstructive pulmonary disease as an initial manifestation of lung carcinoma: A case series

Introduction. Chronic obstructive pulmonary disease is frequently accompanied by exacerbations that significantly worsen patients’ clinical status. Although infections are the most common trigger, atypical, recurrent, or treatment-resistant exacerbations may indicate other underlying pathologies, including lung carcinoma. Early recognition of malignancy in patients with chronic obstructive pulmonary disease is crucial for timely initiation of therapy and improved outcomes. Case Reports. We present two patients with established chronic obstructive pulmonary disease in whom worsening respiratory symptoms were initially interpreted as exacerbations of the underlying disease. In the first case, chest computed tomography and bronchoscopy revealed a well-differentiated squamous cell carcinoma (stage IIIB), while in the second case histopathological analysis confirmed lung adenocarcinoma (stage IIIA). In both cases, the absence of response to standard therapy and the atypical clinical course raised suspicion of malignancy. Conclusion. Lung carcinoma in patients with chronic obstructive pulmonary disease patients may clinically manifest as an apparent exacerbation of the primary disease, potentially leading to diagnostic delay. Any atypical, frequent, or therapy-refractory exacerbation should prompt further diagnostic evaluation, particularly radiological assessment. Recognition of clinical “red flags,” such as unexplained weight loss, hemoptysis, new-onset chest pain, or radiological changes not attributable to infection, is essential for early cancer detection and improved prognosis. Early implementation of radiological diagnostics, supported by a multidisciplinary approach, represents a key component of successful patient management.