Should pulmonary embolism be suspected in exacerbation of chronic obstructive pulmonary disease?

Abstract

Background: The cause of acute exacerbation of chronic obstructive pulmonary disease (COPD) is often difficult to determine. Pulmonary embolism may be a trigger of acute dyspnoea in patients with COPD. Aim: To determine the prevalence of pulmonary embolism in patients with acute exacerbation of COPD. Methods: 123 consecutive patients admitted to the emergency departments of two academic teaching hospitals for acute exacerbation of moderate to very severe COPD were included. Pulmonary embolism was investigated in all patients (whether or not clinically suspected) following a standardised algorithm based on D-dimer testing, lower-limb venous ultrasonography and multidetector helical computed tomography scan. Results: Pulmonary embolism was ruled out by a D-dimer value ,500 mg/l in 28 (23%) patients and a by negative chest computed tomography scan in 91 (74%). Computed tomography scan showed pulmonary embolism in four patients (3.3%, 95% confidence interval (CI), 1.2% to 8%), including three lobar and one sub-segmental embolisms. The prevalence of pulmonary embolism was 6.2% (n = 3; 95% CI, 2.3% to 16.9%) in the 48 patients who had a clinical suspicion of pulmonary embolism and 1.3% (n = 1; 95% CI, 0.3% to 7.1%) in those not suspected. In two cases with positive computed tomography scan, the venous ultrasonography also showed a proximal deep-vein thrombosis. No other patient was diagnosed with venous thrombosis. Conclusions: The prevalence of unsuspected pulmonary embolism is very low in patients admitted in the emergency department for an acute exacerbation of their COPD. These results argue against a systematic examination for pulmonary embolism in this population.

Extrapulmonary comorbidities in chronic obstructive pulmonary disease: state of the art

“…In addition to high rates of atherothrombotic arterial cardiovascular events in COPD, as described in previous sections, there is also some evidence of excess venous thromboembolism mainly during acute exacerbations, although prevalence varies widely in the literature [64,65].…”

Acute Exacerbations and Respiratory Failure in Chronic Obstructive Pulmonary Disease

“…Decreased cardiac output reduces oxygen delivery to respiratory muscles, contributing to respiratory decompensation in patients with COPD (1,24). Pulmonary embolism is an uncommon trigger for acute exacerbation (31), although in patients with acute exacerbation of unknown origin, the prevalence may be as high as 25% (32). Other conditions, such as nonpulmonary infections and pneumothorax, can mimic an acute exacerbation or possibly act as triggers (1)(2)(3).…”

Risk Factors for Venous Thromboembolism in Chronic Obstructive Pulmonary Disease

“…12 In contrast, a recent study reported a low incidence of PE in patients hospitalized for acute exacerbation of COPD: 6.2% of patients with a clinical suspicion of PE, and only 1.3% of those with low suspicion. 13 A meta-analysis found that the prevalence of PE in acute exacerbations of COPD was 19.9%. 14 Our study identified a small cohort of participants (5.7%) with VTE, which is consistent with some studies with similar prevalence rates.…”