Aspirin Use and Respiratory Morbidity in COPD Q&A With Ashraf Fawzy, MD, MPH

By: Vanessa Claude

March 19, 2019

1. What effect do you hope the findings of this study will have on recommended aspirin use among patients with COPD?

It is too early to make any definitive recommendations regarding aspirin use in COPD. However, many patients with COPD have comorbid cardiovascular risk factors or disease. The implication that aspirin use may improve respiratory morbidity in COPD, in addition to reducing risk for cardiovascular morbidity, may factor into a decision to initiate aspirin therapy.

2. What are some factors that could enhance this study further?

The observational nature of the study makes it difficult to fully account for unmeasured differences between participants or the reason why aspirin was prescribed to a group of participants but not others (residual confounding and confounding by indication respectively). We also had no way of knowing whether study participants were in fact taking aspirin daily as they had reported.

3. In the future, would you like to investigate the findings implying that aspirin use may reduce the risk of respiratory morbidity and improve symptoms in COPD? What results would you like to find?

These findings from an observational cohort study would need to be replicated in the context of a well-designed randomized controlled trial. It is also unclear through what mechanism aspirin may reduce respiratory morbidity in COPD and whether other antiplatelet therapies should be explored.

4. Are there any other findings you’d like to expand on in the future?

In the study we found that participants who reported symptoms of chronic bronchitis (cough and phlegm production) benefitted the most from aspirin. A future study that focuses on this population of patients with COPD would be worthwhile.

Read the full article: "Aspirin Use and Respiratory Morbidity in COPD: A Propensity Score-Matched Analysis in Subpopulations and Intermediate Outcome Measures in COPD Study"

Dr. Fawzy is a pulmonary and critical care fellow at Johns Hopkins University. His research is focuses on clinical outcomes in obstructive lung disease. (Corresponding author's email: afawzy1@jhmi.edu)