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Abstract
Observational studies that have reported an association between aspirin use in chronic obstructive pulmonary disease (COPD) with reductions in mortality and COPD exacerbations were shown to be affected by time-related biases. We assessed this association using a prevalent new-user study design that avoids these biases. We used the United Kingdom’s Clinical Practice Research Datalink (CPRD) to form a cohort of patients with COPD. Aspirin initiators were matched on time and propensity score with nonusers during 2002–2018. The outcomes were all-cause mortality and COPD exacerbation within a one-year follow-up. Hazard ratios (HR) and 95% confidence interval (CI) of each outcome associated with aspirin use compared to nonuse were estimated using an as-treated approach. The study cohort included 10,287 initiators of aspirin and 10,287 matched nonusers. The cumulative incidence of all-cause mortality at one year was 11.5% for aspirin users and 9.2% for nonusers. The HR of all-cause mortality associated with aspirin initiation was 1.22 (95% CI: 1.08–1.37), while for severe exacerbation it was 1.21 (95% CI 1.08–1.37), compared with nonuse. The HR of a first moderate or severe exacerbation with aspirin use was 0.90 (95% CI 0.85–0.95). These estimates did not vary by platelet count. This large population-based study, designed to emulate a trial, found aspirin use in patients with COPD associated with a higher risk of all-cause mortality and severe exacerbation, but a lower risk of moderate or severe exacerbation. Further research is warranted to assess this reduction in moderate or severe exacerbations, particularly in patients with cardiovascular risk factors.
Authors contributions
Dr. Kouri participated in the study design, data interpretation, and wrote the initial draft of the manuscript. Ms Dell’Aniello participated in the study design, data analysis and writing of the manuscript. Dr. Ernst participated in the study design, data interpretation, and writing of the manuscript. Dr. Suissa participated in data acquisition, study design, data interpretation, writing of the manuscript, and acts as guarantor of this entire manuscript.
Disclosure statement
S.S. attended scientific advisory committee meetings or received speaking fees from AstraZeneca, Atara, Boehringer-Ingelheim, Bristol-Myers-Squibb, Merck, Novartis, Panalgo, Pfizer and Seqirus. Role of the sponsors: The funding sources had no role in the design, analysis, or interpretation of the results.