Pulmonary Embolism in Acute Exacerbations of COPD

Aleva FE et al., Chest 2016 Aug 12;

This systematic review shows a high rate of PE in patients hospitalized for exacerbation of chronic obstructive pulmonary disease.

Pulmonary embolism (PE) is a notoriously difficult clinical diagnosis, and symptoms of PE can overlap with those of acute exacerbations of chronic obstructive pulmonary disease (COPD). Further, the inflammation of COPD exacerbations might increase PE risk. These authors conducted a systematic review to determine the prevalence of PE in patients with acute exacerbations of COPD.

Inclusion requirements were that studies be prospective and cross-sectional and use computed tomography angiography to diagnose PE. Seven studies, involving 880 patients, met these criteria.

The overall pooled rate of PE was 16%, but there was high heterogeneity among studies. Notably, in the only study that recruited patients from the emergency department (as opposed to hospitalized patients), only 3.3% of patients had PE. Most emboli were in locations that would require anticoagulation — only 32.5% were subsegmental. The data do not show whether a PE was present on admission or occurred during hospitalization.

Comment Most emergency department patients with COPD exacerbations either have relatively mild symptoms or improve quickly with steroids, beta-agonists, and/or anticholinergics. In patients with COPD who are sick enough to require admission or whose symptoms don’t improve as expected, PE should be considered.