Indirect mechanisms involve tumor-associated inflammation and immune dysregulation: The tumor microenvironment secretes pro-inflammatory factors (e.g., IL-8, TNF-α), inducing bronchial mucosal edema and mucus hypersecretion, which leads to mucus plug formation and exacerbates airway obstruction (Oliviero et al., 2016; Cazzola et al., 2017; Ragnoli et al., 2024). This evidence concerns the gene TNF and neoplasm.