Asthma increases pulmonary thromboembolism risk: a nationwide population cohort study

Abstract

Studies on the association between asthma and pulmonary thromboembolism are considerably limited. We investigated whether pulmonary embolism is associated with asthma using a nationwide cohort study.We identified 31 356 patients with newly diagnosed asthma in 2002-2008 and 125 157 individuals without asthma randomly selected from the general population, frequency matched by age, sex and index year using the National Health Insurance Research Database. Both cohorts were followed-up until the end of 2010 to measure the incidence of pulmonary embolism. Cox proportional hazards regression analysis was used to measure the hazard ratio of pulmonary embolism for the asthmatic cohort, compared with the nonasthmatic cohort.We followed 186 182 person-years for asthmatic patients and 743 374 person-years for nonasthmatic subjects. The hazard ratio of pulmonary embolism was 3.24 for the asthmatic cohort, compared with the nonasthmatic cohort after adjusting for sex, age, comorbidities and oestrogen supplementation. The risk of developing pulmonary embolism significantly increased with the increased frequency of asthma exacerbation and hospitalisation.This nationwide cohort study suggests that the risk of developing pulmonary embolism is significantly increased in asthmatic patients compared to the general population. Frequent asthma exacerbation and hospitalisation are significantly associated with pulmonary embolism risk. @ERSpublications Risk of pulmonary embolism in an asthmatic cohort was 3.24-fold compared with a nonasthmatic cohort

Asthma and pulmonary embolism: bringing airways and vessels closer together

“…The message of the study by CHUNG et al [1] is consistent with that of the study by MAJOOR et al [20] and with the studies on patients with COPD: inflammatory airway diseases are a predisposing or risk factor for PE, perhaps more so than for DVT. All these observations suggest that both systemic and local inflammatory mechanisms may link inflammation of the airways and thrombosis, and that perhaps some of the reported cases may be due to in situ pulmonary arterial thrombosis rather than VTE.…”

“…In contrast to the impact on PE, patients with asthma did not exhibit a significant increase in the incidence of DVT compared with the control group [20]. Although less impressive, the results of the study by CHUNG et al [1] now confirm, complement and extend the findings of MAJOOR et al [20], showing a hazard ratio for PE of 3.24 in the asthmatic cohort compared with non-asthmatic controls; the rate of DVT was not examined in the present study.…”

“…In the present issue of the European Respiratory Journal, CHUNG et al [1] report the results of a longitudinal epidemiological study in Taiwan which adds significant evidence for the existence of a link between asthma and the risk of developing pulmonary embolism (PE). The authors are to be congratulated for following 31 356 asthmatic patients for a total of 186 182 patient-years and matching them with 125 157 nonasthmatic individuals (743 374 person-years).…”

Incidence of venous thromboembolism in COPD: linking inflammation and thrombosis?

“…The study by BØRVIK et al [16] is in accordance with these data reporting a higher pulmonary embolism incidence rate in COPD patients (2.7 per 1000 personyears, 41 events in 15 446 person-years) compared with non-COPD patients (1.6 per 1000 person-years, 68 events in 41 744 person-years). Further evidence in line with these observations, although less pronounced, is provided by recent studies demonstrating a higher incidence of pulmonary embolism in patients with asthma: In 31 356 asthma patients from Taiwan's National Health Insurance Research Database, the incidence of pulmonary embolism was higher (0.10 per 1000 person-years) compared with 125 157 individuals without asthma (0.03 per 1000 person-years; HR 3.24, 95% CI 1.74-6.01) [28,29]. Additionally, the incidence of pulmonary embolism was higher in Dutch patients with severe asthma (0.93 per 1000 person-years) compared with mild-to-moderate asthma (0.33 per 1000 person-years) and a general population in Norway (0.18 per 1000 person-years) [30].…”

Cell-derived microparticles and the lung

“…The interplay between inflammation and blood coagulation is well recognised; accordingly, an increased risk of pulmonary embolism in asthmatics, with an association with exacerbations, has been described [88,89]. MAJOOR et al [47] investigated the role of viral infections in the haemostatic balance in asthmatic subjects.…”