Aspirin Use and Respiratory Morbidity in COPD: A Propensity Score-Matched Analysis in Subpopulations and Intermediate Outcome Measures in COPD Study

Ashraf Fawzy; Nirupama Putcha; Carrie P Aaron; Russell P Bowler; Alejandro P Comellas; Christopher B Cooper; Mark T Dransfield; MeiLan K Han; Eric A Hoffman; Richard E Kanner; Jerry A Krishnan; Wassim W Labaki; Robert Paine III; Laura M Paulin; Stephen P Peters; Robert Wise; R Graham Barr; Nadia N Hansel; SubPopulations and InteRmediate Outcome Measures In COPD Study (SPIROMICS) Investigators

doi:10.1016/j.chest.2018.11.028

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Aspirin Use and Respiratory Morbidity in COPD: A Propensity Score-Matched Analysis in Subpopulations and Intermediate Outcome Measures in COPD Study

Journal article

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Aspirin Use and Respiratory Morbidity in COPD: A Propensity Score-Matched Analysis in Subpopulations and Intermediate Outcome Measures in COPD Study

Ashraf Fawzy, Nirupama Putcha, Carrie P Aaron, Russell P Bowler, Alejandro P Comellas, Christopher B Cooper, Mark T Dransfield, MeiLan K Han, Eric A Hoffman, Richard E Kanner, …

Chest, Vol.155(3), pp.519-527

03/2019

DOI: 10.1016/j.chest.2018.11.028

PMCID: PMC6414789

PMID: 30593776

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https://europepmc.org/articles/pmc6414789View

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Abstract

Aspirin use in COPD has been associated with reduced all-cause mortality in meta-regression analysis with few equivocal studies. However, the effect of aspirin on COPD morbidity is unknown. Self-reported daily aspirin use was obtained at baseline from SPIROMICS participants with COPD (FEV /FVC < 70%). Acute exacerbations of COPD (AECOPD) were prospectively ascertained through quarterly structured telephone questionnaires up to 3 years and categorized as moderate (symptoms treated with antibiotics or oral corticosteroids) or severe (requiring ED visit or hospitalization). Aspirin users were matched one-to-one with nonusers, based on propensity score. The association of aspirin use with total, moderate, and severe AECOPD was investigated using zero-inflated negative binomial models. Linear or logistic regression was used to investigate the association with baseline respiratory symptoms, quality of life, and exercise tolerance. Among 1,698 participants, 45% reported daily aspirin use at baseline. Propensity score matching resulted in 503 participant pairs. Aspirin users had a lower incidence rate of total AECOPD (adjusted incidence rate ratio [IRR], 0.78; 95% CI, 0.65-0.94), with similar effect for moderate but not severe AECOPD (IRR, 0.86; 95% CI, 0.63-1.18). Aspirin use was associated with lower total St. George's Respiratory Questionnaire score (β, -2.2; 95% CI, -4.1 to -0.4), reduced odds of moderate-severe dyspnea (modified Medical Research Council questionnaire score ≥ 2; adjusted odds ratio, 0.69; 95% CI, 0.51-0.93), and COPD Assessment Test score (β, -1.1; 95% CI, -1.9 to -0.2) but not 6-min walk distance (β, 0.7 m; 95% CI, -14.3 to 15.6). Daily aspirin use is associated with reduced rate of COPD exacerbations, less dyspnea, and better quality of life. Randomized clinical trials of aspirin use in COPD are warranted to account for unmeasured and residual confounding. ClinicalTrials.gov; No.: NCT01969344; URL: www.clinicaltrials.gov.

Anti-Bacterial Agents - therapeutic use

Aspirin - therapeutic use

Correlation of Data

Female

Glucocorticoids - therapeutic use

Humans

Male

Middle Aged

Platelet Aggregation Inhibitors - therapeutic use

Prospective Studies

Pulmonary Disease, Chronic Obstructive - diagnosis

Pulmonary Disease, Chronic Obstructive - drug therapy

Pulmonary Disease, Chronic Obstructive - epidemiology

Pulmonary Disease, Chronic Obstructive - physiopathology

Respiratory Function Tests - methods

Severity of Illness Index

Symptom Assessment - methods

Symptom Assessment - statistics & numerical data

Symptom Flare Up

United States - epidemiology

Details

Title: Subtitle: Aspirin Use and Respiratory Morbidity in COPD: A Propensity Score-Matched Analysis in Subpopulations and Intermediate Outcome Measures in COPD Study
Creators: Ashraf Fawzy - Johns Hopkins University
Nirupama Putcha - Johns Hopkins University
Carrie P Aaron - Columbia University
Russell P Bowler - National Jewish Health
Alejandro P Comellas - University of Iowa
Christopher B Cooper - University of California, Los Angeles
Mark T Dransfield - University of Alabama at Birmingham
MeiLan K Han - University of Michigan
Eric A Hoffman - University of Iowa
Richard E Kanner - University of Utah
Jerry A Krishnan - University of Illinois Chicago
Wassim W Labaki - University of Michigan
Robert Paine III - University of Utah
Laura M Paulin - Dartmouth–Hitchcock Medical Center
Stephen P Peters - Wake Forest University
Robert Wise - Johns Hopkins University
R Graham Barr - Columbia University
Nadia N Hansel - Johns Hopkins University
SubPopulations and InteRmediate Outcome Measures In COPD Study (SPIROMICS) Investigators
Resource Type: Journal article
Publication Details: Chest, Vol.155(3), pp.519-527
DOI: 10.1016/j.chest.2018.11.028
PMID: 30593776
PMCID: PMC6414789
NLM abbreviation: Chest
ISSN: 0012-3692
eISSN: 1931-3543
Grant note: HHSN268200900017C / NHLBI NIH HHS P30 ES005605 / NIEHS NIH HHS HHSN268200900019C / NHLBI NIH HHS HHSN268200900020C / NHLBI NIH HHS U24 HL141762 / NHLBI NIH HHS U01 HL137880 / NHLBI NIH HHS F32 ES028576 / NIEHS NIH HHS HHSN268200900015C / NHLBI NIH HHS I01 CX000911 / CSRD VA HHSN268200900013C / NHLBI NIH HHS K24 HL137013 / NHLBI NIH HHS HHSN268200900016C / NHLBI NIH HHS HHSN268200900018C / NHLBI NIH HHS HHSN268200900014C / NHLBI NIH HHS S10 OD018526 / NIH HHS K23 HL130627 / NHLBI NIH HHS K23 HL123594 / NHLBI NIH HHS
Language: English
Date published: 03/2019
Academic Unit: Roy J. Carver Department of Biomedical Engineering; Radiology; Pulmonary, Critical Care, and Occupational Medicine; ICTS; Internal Medicine
Record Identifier: 9984318717302771

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