Previous research indicates that aspirin use in patients with COPD appears to be associated with reduced all-cause mortality when compared with no aspirin use. However, the effect of aspirin on COPD morbidity is not well defined. “Current pharmacologic therapy for COPD consists of combination inhaler therapy focused on bronchodilation and decreasing pulmonary inflammation,” says Ashraf Fawzy, MD, MPH. “These therapies do not adequately address the systemic manifestations of COPD, including systemic inflammation.”
For a study published in CHEST, Dr. Fawzy and colleagues investigated the association of aspirin use in the stable state of COPD with respiratory morbidity, including COPD exacerbations, respiratory symptoms, and quality of life (QOL) in a large, well-characterized observational cohort. COPD exacerbations were collected over 3 years and included moderate exacerbations defined as respiratory symptoms treated with antibiotics or oral corticosteroids or requiring a physician’s office or urgent care visit, as well as severe exacerbations, defined as respiratory symptoms requiring an emergency department visit or hospitalization.
Among participants, 45% reported daily aspirin use at baseline. Aspirin users had a lower incidence rate of total acute exacerbations of COPD (AECOPD), with a similar effect for moderate, but not severe, AECOPD. Aspirin use was associated with lower total St. George’s Respiratory Questionnaire score, reduced odds of moderate-to-severe dyspnea, and COPD Assessment Test score, but not 6-minute walk distance.
“Daily aspirin use in a large, stable COPD cohort was associated with reduced incidence rate of COPD exacerbations,” says Dr. Fawzy. “It also resulted in better QOL and less dyspnea. Aspirin use was more strongly associated with reduced incidence of COPD exacerbations among participants reporting symptoms of chronic bronchitis than among those not reporting these symptoms.” He cautions that a randomized controlled trial is warranted to rigorously assess whether aspirin is truly beneficial in patients with COPD.
Aspirin Use and Respiratory Morbidity in COPD: a Propensity Score Matched Analysis in SPIROMICS