Association of aspirin with lung carcinoma in patients with chronic obstructive pulmonary

Abstract

Introduction: Patients with chronic obstructive pulmonary disease (COPD) is associated with a high risk of lung carcinoma. The effect of low-dose aspirin use (≤160 mg) among patients with COPD on incidence of lung carcinoma and the risk of bleeding is nonetheless unknown. Methods: Using a territory-wide clinical information registry, aspirin use was ascertained among all eligible COPD patients from 2005 to 2018. Inverse probability of treatment weighting was used to balance baseline covariates between aspirin non-users (35 049 patients) with new aspirin users (7679 patients). Competing risk regression with Cox proportional hazards models were performed to estimate the risk subdistribution hazard ratio (SHR) of lung carcinoma with low-dose aspirin (≤160 mg daily) and the associated bleeding events associated with aspirin use. Results: Of all eligible subjects, 1779 (4.2%) were diagnosed with lung carcinoma. Aspirin use was associated with a 25% lower risk of lung carcinoma (SHR=0.75, 95% confidence interval [CI]=0.65-0.87). Subgroup analysis reveals that aspirin is beneficial regardless of whether above or below the age of 75, but is also beneficial among populations who are male, non-diabetic, and non-hypertensive. Aspirin was associated with lower small cell carcinoma risk (SHR=0.53, 95% CI=0.30-0.95) but not non-small cell carcinoma. Aspirin use was not associated with an increased risk of upper gastrointestinal bleeding (UGIB) [SHR=1.19, 95% CI=0.94-1.53], but was associated with an increased risk of haemoptysis (SHR=1.96, 95% CI=1.73-2.23). Conclusion: Our study suggests that low-dose aspirin use was associated with a lower risk of lung carcinoma, in particular small cell carcinoma, among COPD patients. Whilst aspirin was not associated with an increased risk of UGIB, the risk of haemoptysis was elevated.