Aspirin Therapy in Acute Respiratory Distress Syndrome

Aspirin has emerged as a candidate pharmacotherapy in the management of ARDS through its anti-inflammatory and antithrombotic properties. ARDS is characterised by diffuse alveolar damage, inflammatory cell infiltration and dysregulated coagulation, resulting in impaired gas exchange and high mortality. Aspirin’s inhibition of cyclooxygenase-1 and cyclooxygenase-2 attenuates prostanoid synthesis, reducing platelet activation, microthrombosis and leucocyte recruitment in pulmonary microvasculature. By modulating platelet–leucocyte interactions and endothelial function, aspirin may preserve alveolar–capillary integrity, mitigate alveolar oedema and enhance resolution of inflammation. Preclinical models have demonstrated that aspirin reduces lung injury severity and improves oxygenation. Clinically, observational analyses suggest that both pre-hospital and in-ICU aspirin administration are associated with shorter intensive care unit stays, lower incidence of ventilator-associated complications and decreased in-hospital mortality in patients with established ARDS. Safety concerns, including bleeding risk, appear acceptable at low-dose regimens when carefully monitored. The repurposing of this widely available drug holds global significance, offering a cost-effective adjunct to ventilatory support and anti-inflammatory strategies, with potential to improve outcomes in diverse populations affected by ARDS.

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Aspirin Therapy in Acute Respiratory Distress Syndrome publication trend

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Technical terms

Acute Respiratory Distress Syndrome (ARDS): A severe form of acute lung injury characterised by diffuse alveolar damage, hypoxaemia and respiratory failure.

Cyclooxygenase: Enzyme responsible for conversion of arachidonic acid to prostaglandins and thromboxanes, targets of aspirin inhibition.

Platelet aggregation: The clumping of platelets in blood vessel walls, a key step in clot formation that can exacerbate microvascular injury in ARDS.

Antiplatelet therapy: Use of agents that inhibit platelet function to prevent thrombosis and modulate inflammatory responses.

References

1. Aspirin therapy in patients with acute respiratory distress syndrome (ARDS) is associated with reduced intensive care unit mortality: a prospective analysis. Critical Care (2015).
2. Aspirin as a potential treatment in sepsis or acute respiratory distress syndrome. Critical Care (2015).
3. Effect of Antiplatelet Therapy on Acute Respiratory Distress Syndrome and Mortality in Critically Ill Patients: A Meta-Analysis. PLOS ONE (2016).