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

SPIROMICS investigators

Research output: Contribution to journalArticle

Abstract

Background: 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. Methods: Self-reported daily aspirin use was obtained at baseline from SPIROMICS participants with COPD (FEV 1 /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. Results: 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). Conclusions: 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. Trial Registry: ClinicalTrials.gov; No.: NCT01969344; URL: www.clinicaltrials.gov

Original languageEnglish (US)
Pages (from-to)519-527
Number of pages9
JournalCHEST
Volume155
Issue number3
DOIs
StatePublished - Mar 1 2019

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Propensity Score
Chronic Obstructive Pulmonary Disease
Aspirin
Outcome Assessment (Health Care)
Morbidity
Dyspnea
Incidence
Quality of Life
Exercise Tolerance
Statistical Models
Telephone
Registries
Meta-Analysis
Biomedical Research
Linear Models
Adrenal Cortex Hormones
Hospitalization
Randomized Controlled Trials
Logistic Models
Odds Ratio

Keywords

  • acute exacerbation of chronic bronchitis
  • antiplatelet drugs
  • COPD
  • dyspnea
  • quality of life

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

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

In: CHEST, Vol. 155, No. 3, 01.03.2019, p. 519-527.

Research output: Contribution to journalArticle

@article{238813a235974232af64afa32d5ad911,
title = "Aspirin Use and Respiratory Morbidity in COPD: A Propensity Score-Matched Analysis in Subpopulations and Intermediate Outcome Measures in COPD Study",
abstract = "Background: 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. Methods: Self-reported daily aspirin use was obtained at baseline from SPIROMICS participants with COPD (FEV 1 /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. Results: 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). Conclusions: 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. Trial Registry: ClinicalTrials.gov; No.: NCT01969344; URL: www.clinicaltrials.gov",
keywords = "acute exacerbation of chronic bronchitis, antiplatelet drugs, COPD, dyspnea, quality of life",
author = "{SPIROMICS investigators} and Ashraf Fawzy and Nirupama Putcha and Aaron, {Carrie P.} and Bowler, {Russell P.} and Comellas, {Alejandro P.} and Cooper, {Christopher B.} and Dransfield, {Mark T.} and Han, {Mei Lan K.} and Hoffman, {Eric A.} and Kanner, {Richard E.} and Krishnan, {Jerry A.} and Labaki, {Wassim W.} and Robert Paine and Paulin, {Laura M.} and Peters, {Stephen P.} and Wise, {Robert A} and Barr, {R. Graham} and Nadia Hansel and Alexis, {Neil E.} and Anderson, {Wayne H.} and Igor Barjaktarevic and Bleecker, {Eugene R.} and Boucher, {Richard C.} and Carretta, {Elizabeth E.} and Christenson, {Stephanie A.} and Couper, {David J.} and Criner, {Gerard J.} and Crystal, {Ronald G.} and Curtis, {Jeffrey L.} and Doerschuk, {Claire M.} and Freeman, {Christine M.} and Hastie, {Annette T.} and Kaner, {Robert J.} and Kleerup, {Eric C.} and LaVange, {Lisa M.} and Lazarus, {Stephen C.} and Martinez, {Fernando J.} and Meyers, {Deborah A.} and Moore, {Wendy C.} and Newell, {John D.} and Laura Paulin and Stephen Peters and Cheryl Pirozzi and Oelsner, {Elizabeth C.} and O'Neal, {Wanda K.} and Ortega, {Victor E.} and Sanjeev Raman and Rennard, {Stephen I.} and Tashkin, {Donald P.} and Wells, {J. Michael}",
year = "2019",
month = "3",
day = "1",
doi = "10.1016/j.chest.2018.11.028",
language = "English (US)",
volume = "155",
pages = "519--527",
journal = "Chest",
issn = "0012-3692",
publisher = "American College of Chest Physicians",
number = "3",

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TY - JOUR

T1 - Aspirin Use and Respiratory Morbidity in COPD

T2 - A Propensity Score-Matched Analysis in Subpopulations and Intermediate Outcome Measures in COPD Study

AU - SPIROMICS investigators

AU - Fawzy, Ashraf

AU - Putcha, Nirupama

AU - Aaron, Carrie P.

AU - Bowler, Russell P.

AU - Comellas, Alejandro P.

AU - Cooper, Christopher B.

AU - Dransfield, Mark T.

AU - Han, Mei Lan K.

AU - Hoffman, Eric A.

AU - Kanner, Richard E.

AU - Krishnan, Jerry A.

AU - Labaki, Wassim W.

AU - Paine, Robert

AU - Paulin, Laura M.

AU - Peters, Stephen P.

AU - Wise, Robert A

AU - Barr, R. Graham

AU - Hansel, Nadia

AU - Alexis, Neil E.

AU - Anderson, Wayne H.

AU - Barjaktarevic, Igor

AU - Bleecker, Eugene R.

AU - Boucher, Richard C.

AU - Carretta, Elizabeth E.

AU - Christenson, Stephanie A.

AU - Couper, David J.

AU - Criner, Gerard J.

AU - Crystal, Ronald G.

AU - Curtis, Jeffrey L.

AU - Doerschuk, Claire M.

AU - Freeman, Christine M.

AU - Hastie, Annette T.

AU - Kaner, Robert J.

AU - Kleerup, Eric C.

AU - LaVange, Lisa M.

AU - Lazarus, Stephen C.

AU - Martinez, Fernando J.

AU - Meyers, Deborah A.

AU - Moore, Wendy C.

AU - Newell, John D.

AU - Paulin, Laura

AU - Peters, Stephen

AU - Pirozzi, Cheryl

AU - Oelsner, Elizabeth C.

AU - O'Neal, Wanda K.

AU - Ortega, Victor E.

AU - Raman, Sanjeev

AU - Rennard, Stephen I.

AU - Tashkin, Donald P.

AU - Wells, J. Michael

PY - 2019/3/1

Y1 - 2019/3/1

N2 - Background: 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. Methods: Self-reported daily aspirin use was obtained at baseline from SPIROMICS participants with COPD (FEV 1 /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. Results: 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). Conclusions: 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. Trial Registry: ClinicalTrials.gov; No.: NCT01969344; URL: www.clinicaltrials.gov

AB - Background: 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. Methods: Self-reported daily aspirin use was obtained at baseline from SPIROMICS participants with COPD (FEV 1 /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. Results: 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). Conclusions: 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. Trial Registry: ClinicalTrials.gov; No.: NCT01969344; URL: www.clinicaltrials.gov

KW - acute exacerbation of chronic bronchitis

KW - antiplatelet drugs

KW - COPD

KW - dyspnea

KW - quality of life

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U2 - 10.1016/j.chest.2018.11.028

DO - 10.1016/j.chest.2018.11.028

M3 - Article

C2 - 30593776

AN - SCOPUS:85061695660

VL - 155

SP - 519

EP - 527

JO - Chest

JF - Chest

SN - 0012-3692

IS - 3

ER -