Long-term Aspirin Use Reduces Severity of Acute COPD Exacerbations, Study Reports

The long-term use of aspirin was found to reduce the severity of acute exacerbations in chronic obstructive pulmonary disease (AECOPD), including in-hospital mortality, invasive ventilation use, and hospital length-of-stay (LOS), researchers reported.

The study, “The association of aspirin use with severity of acute exacerbation of chronic obstructive pulmonary disease: a retrospective cohort study,” was published in the journal NPJ Primary Care Respiratory Medicine.

COPD is a chronic inflammatory lung disease characterized by wheezing, shortness of breath, chest tightness, and cough with mucus.

Acute exacerbations of COPD are caused by a viral or bacterial infection or by environmental pollutants, resulting in a sudden worsening of disease symptoms.

Typically, the aggravated symptoms last for several days and range from self-controlling episodes to respiratory failure requiring mechanical ventilation. They may even result in the patient’s death.

Recently, anti-platelet drugs, which were developed to prevent blood clots, were shown to improve clinical outcomes in COPD patients.

Aspirin, developed as an analgesic, was found to be a very effective anti-platetet drug. But little has been known about the effect of these therapies in COPD acute exacerbations.

Researchers at Massachusetts General Hospital investigated the effect of long-term aspirin use on the severity of acute exacerbations in COPD (AECOPD) patients, including in-hospital mortality rate, mechanical ventilation use, and hospital length of stay (LOS0.

The study collected data from more than 20o,000 patients ages 40 and older hospitalized for AECOPD, using the State Inpatient Database (SID) of seven U.S. states. Data was collected for the years 2012 and 2013.

Of the 206,686 patients included in the study, 13,826 (7%) were aspirin users. Aspirin users were found to be older and more likely to have comorbidities, or co-occurring diseases, compared to nonusers of aspirin.

Long-term aspirin users had lower in-hospital mortality rates compared to nonuser patients (1.0% vs. 1.4%), and a lower risk of invasive mechanical ventilation (1.7% vs. 2.6%). Similarly, shorter LOS was observed in aspirin users compared to nonusers (median of three days vs. four days).

The risk of noninvasive positive pressure ventilation — providing air under pressure by a mechanical respirator — was not significantly different between aspirin users and nonusers (7.6% vs. 7.2%).

The researchers suggested that the improved results in AECOPD outcomes in aspirin users may be linked to the anti-inflammatory properties of aspirin, as well as to the prevention of  blood clots or thrombi. Blood clots may accumulate in blood vessels and impede oxygen’s journey to reach tissues, causing tissue damage.

Still, “the nature of aspirin-acute severity association in COPD warrants further investigation,” the researchers wrote.

“In sum, by using a large population-based data set, we found that long-term aspirin users have lower rates of in-hospital mortality and invasive mechanical ventilation use, and shorter LOS,” researchers added.

“Although causal inferences remain premature, in conjunction with the prior studies, aspirin — a widely used and inexpensive medication — may be a potential therapeutic option for patients with COPD,” the team concluded.