COPD: daily aspirin linked to lower exacerbation rate

  • Fawzy A & al.
  • Chest
  • 26 Dec 2018

  • curated by Jenny Blair, MD
  • Clinical Essentials
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  • Among patients with COPD, daily aspirin use is associated with fewer moderate acute exacerbations of COPD (AECOPD), especially among those with chronic bronchitis. 
  • Randomized clinical trials are needed.

Why this matters

  • Standard COPD therapies do not address systemic component, including inflammation.
  • Some studies link aspirin use to lower mortality, other favorable outcomes in COPD.

Key results

  • 764 participants (45%) reported daily aspirin use at baseline.
  • Propensity-matched pairs followed for median 2.7 years.
  • Among aspirin users vs nonusers:
    • AECOPD incidence rate ratio (IRR): 0.78 (95% CI, 0.65-0.94).
    • Result driven by reductions in moderate but not severe exacerbation.
    • Subgroup with chronic bronchitis experienced greater benefit (IRR, 0.66; 95% CI, 0.51-0.86).
  • On cross-sectional analysis:
    • Aspirin users had less moderate-to-severe dyspnea.
    • They had numerically but not clinically significant advantages in baseline health status, health-related QoL.
    • No significant between-group difference in 6-minute walk distance.

Study design

  • Analysis of participants with COPD in observational cohort SPIROMICS study (n=1698).
  • Researchers compared outcomes in 503 propensity-matched pairs of self-reported aspirin users and nonusers.
  • Primary outcome: number of moderate and severe AECOPD.
  • Funding: NIH; multiple industry contributors.


  • Self-report can be unreliable.
  • Dose, duration, and adherence not assessed.
  • Mild AECOPD not investigated.
  • Potential residual confounders.

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