Published ahead of print on October 26, 2006, doi:10.1164/rccm.200603-411OC Am. J. Respir. Crit. Care Med., Volume 175, Number 2, January 2007, 120-125 A more recent version of this article appeared on January 15, 2007
Submitted on March 22, 2006 Aspirin and Decreased Adult-Onset Asthma: Randomized Comparisons from the Physicians' Health StudyR. Graham Barr1,1 Department of Medicine, and Department of Epidemiology, Columbia University Medical Center, New York, NY, USA; Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA, 2 Division of Aging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA, 3 Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA, 4 Departments of Medicine & Epidemiology and Public Health, University of Miami School of Medicine, Miami, FL, USA; Department of Biomedical Science, Center of Excellence, Florida Atlantic University, Boca Raton, FL, USA, 5 Division of Aging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Massachusetts Veteran Epidemiologic Research Center, Boston VA Healthcare System, Boston, MA, USA * To whom correspondence should be addressed. 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, age 40-84 years at baseline and tolerant of aspirin over an 18-week run-in period, to 325mg aspirin or placebo on alternate days. The aspirin component was terminated after 4.9 years 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, six months 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 and 145 in the placebo group. The hazard ratio was 0.78 (95% confidence interval, 0.61 to 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: aspirin, asthma, analgesic use, non-steroidal antiinflamatory drugs, randomized clinical trial
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