Risk of deep vein thrombosis and pulmonary embolism in asthma

Abstract

Increasing evidence suggests that patients with asthma have activated coagulation within the airways. Whether this leads to an increase in venous thromboembolic events is unknown. We therefore assessed the incidence of venous thromboembolic events in patients with mild-to-moderate and severe asthma as compared with an age-and sex-matched reference population.648 patients with asthma (283 with severe and 365 patients with mild-to-moderate asthma) visiting three Dutch outpatient asthma clinics were studied. All patients completed a questionnaire about a diagnosis of deep vein thrombosis and pulmonary embolism in the past, their risk factors, history of asthma and medication use. All venous thromboembolic events were objectively verified.In total, 35 venous thromboembolic events (16 deep vein thrombosis and 19 pulmonary embolism) occurred at a median age of 39 (range 20-63) years. The incidence of pulmonary embolism in patients with severe asthma was 0.93 (95% CI 0.42-1.44) per 1000 person-years, 0.33 (95% CI 0.07-0.60) in mild-tomoderate asthma and 0.18 (95% CI 0.03-0.33) in the general population, respectively. Severe asthma and oral corticosteroid use were independent risk factors of pulmonary embolism (hazard ratios 3.33 (1.16-9.93) and 2.82 (1.09-7.30), respectively). Asthma was not associated with deep vein thrombosis.Severe asthma greatly enhances the risk of pulmonary embolism, particularly if chronic corticosteroids are used. @ERSpublications Severe asthma greatly enhances the risk of pulmonary embolism, particularly if chronic corticosteroids are used

COPD and risk of venous thromboembolism and mortality in a general population

“…Data from clinical registries have shown that PE presents more frequently than DVT in patients with COPD [31] or asthma [32]. Accordingly, we observed higher risk estimates of PE than DVT in subjects with severe COPD.…”

“…Awareness of a high prevalence of PE in hospitalised COPD patients among clinicians [1,10], may entail a preponderance to impose diagnostic procedures for detecting this disease. Presence of detection bias would lead to an overestimation of the association and could potentially explain the higher risk estimates for nonvalidated PEs observed in the registry-based studies [11][12][13][14] compared to our study and clinical registries [31,32]. Moreover, detection bias could also partly explain the strong association of COPD with PE rather than with DVT as found in most studies.…”

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

“…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].…”

Allergic burden and the risk of venous thromboembolism

“…We read with interest the article by PIFFERI et al [1] in the April issue of the European Respiratory Journal, describing a technique of soft computing analysis to increase the diagnostic accuracy of air liquid interface cultures for the diagnosis of primary ciliary dyskinesia (PCD).…”