Daily Aspirin May Curb COPD Exacerbations

January 9, 2019

By David Douglas

NEW YORK (Reuters Health) - Daily aspirin use appears to reduce the risk of exacerbations and have other beneficial effects in patients with chronic obstructive pulmonary disease (COPD), according to an observational study.

As Dr. Ashraf Fawzy told Reuters Health by email, "We found that aspirin users with COPD had fewer flare-ups of their disease over three years, reported better quality of life and less shortness of breath compared to a similar group of participants who did not use aspirin."

In a paper online December 26 in Chest, Dr. Fawzy of Johns Hopkins School of Medicine in Baltimore, Maryland, and colleagues note that there is some evidence that aspirin use may reduce all-cause mortality in COPD, but its association with morbidity has not been defined.

The researchers examined data on nearly 1,700 participants in the SPIROMICS study of patients with COPD. Of these, 764 reported taking aspirin daily. Information about dose, adherence and duration of therapy was not available, but to help minimize differences, the researchers studied 503-propensity-matched pairs.

On average, they were 66.5 years old, had a post-bronchodilator lung function (FEV1) of 62% predicted, and 23% were home oxygen users. They were followed via quarterly telephone questionnaires for a median of 2.7 years.

Overall, aspirin users had an estimated 22% lower incidence rate of acute exacerbations (adjusted incidence rate ratio, 0.78; 95% confidence interval, 0.65 to 0.94).

This was similar for events deemed moderate, but did not reach significance for those considered severe (IRR, 0.86). In subgroup analysis, a reduced incidence of exacerbation was most strongly associated with symptoms of chronic bronchitis at baseline.

Aspirin use was also significantly associated with lower total St. George Respiratory Questionnaire score and reduced odds of moderate-severe dyspnea and COPD Assessment Test score.

"This study highlights that adding aspirin to current treatment regimens may potentially improve the well-being of patients suffering from a burdensome chronic disease while reducing healthcare utilization," Dr. Fawzy said.

"However," he added, "more research is necessary before making any definitive recommendations. Specifically, a randomized controlled trial of aspirin use in patients with COPD is warranted to rigorously assess whether aspirin is beneficial in this patient population."

Dr. Robert A. Wise of Johns Hopkins Asthma & Allergy Center, also in Baltimore, who was not involved in the study, noted that an estimated 22% reduction in COPD exacerbations "is of similar magnitude to most other COPD maintenance treatments. The results were most striking in patients who had chronic bronchitis with regular cough and phlegm."

"These findings, though not definitive, provide a strong rationale for a randomized controlled clinical trial of low-dose aspirin in exacerbation-prone COPD patients," he told Reuters Health by email. "Daily aspirin holds promise as a safe, inexpensive maintenance treatment for COPD patients with chronic bronchitis."


Chest 2018.

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