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Aspirin and Decreased Adult-Onset Asthma

Randomized Comparisons from the Physicians' Health Study

Division of General Medicine, Department of Medicine, and Department of Epidemiology, Columbia University Medical Center, New York, New York; Channing Laboratory, and Divisions of Aging and Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Department of Epidemiology, Harvard School of Public Health, Massachusetts Veterans Epidemiology Research and Information Center, VA Healthcare System, Boston, Massachusetts; Departments of Medicine and Epidemiology and Public Health, University of Miami School of Medicine, Miami; and Department of Biomedical Science, Center of Excellence, Florida Atlantic University, Boca Raton, Florida

Correspondence and requests for reprints should be addressed to Tobias Kurth M.D., Sc.D., Brigham and Women's Hospital, Division of Aging, 1620 Tremont Street, Boston, MA 02120-1613. E-mail: tkurth{at}rics.bwh.harvard.edu

Rationale: In an observational cohort study, women who self-selected for frequent aspirin use developed less newly diagnosed asthma than women who did not take aspirin.

Objective: To explore whether low-dose aspirin decreased the risk of newly diagnosed asthma in a randomized, double-blind, placebo-controlled trial.

Methods: The Physicians' Health Study randomized 22,071 apparently healthy male physicians, aged 40–84 yr at baseline and tolerant of aspirin, over an 18-wk run-in period, to 325 mg aspirin or placebo on alternate days. The aspirin component was terminated after 4.9 yr due principally to the emergence of a statistically extreme 44% reduction in risk of first myocardial infarction among those randomly assigned to aspirin.

Measurements: Physicians could self-report an asthma diagnosis on questionnaires at baseline, 6 mo, and annually thereafter. Asthma was not an a priori endpoint of the trial.

Results: Among 22,040 physicians without reported asthma at randomization, there were 113 new asthma diagnoses in the aspirin group and 145 in the placebo group. The hazard ratio was 0.78 (95% confidence interval, 0.61–1.00; p = 0.045). This apparent 22% lower risk of newly diagnosed asthma among those assigned to aspirin was not modified by baseline characteristics including smoking, body mass index, or age.

Conclusions: Aspirin reduced the risk of newly diagnosed adult-onset asthma in a large, randomized clinical trial of apparently healthy, aspirin-tolerant men. This result requires replication in randomized trials designed a priori to test this hypothesis; it does not imply that aspirin improves symptoms in patients with asthma.

Key Words: asthma • aspirin • NSAIDs • analgesics • obstructive airways disease

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject Aspirin is known to worsen symptoms among a minority of patients with asthma. Recent epidemiologic and bench studies, however, suggest that frequent aspirin use might reduce the risk of developing asthma among adults. What This Study Adds to the Field This secondary analysis of a large randomized, double-blind, placebo-controlled trial of aspirin-tolerant men showed that randomization to aspirin reduced the risk of adult-onset asthma.

 

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