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Prevalence of Pulmonary Embolism in Acute Exacerbations of COPD

A Systematic Review and Metaanalysis
  • Jacques Rizkallah
    Affiliations
    Department of Medicine, Respiratory Division, University of British Columbia, Heart and Lung Center, James Hogg iCAPTURE Center for Cardiovascular and Pulmonary Research at St. Paul's Hospital, Vancouver, BC, Canada
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  • S.F. Paul Man
    Affiliations
    Department of Medicine, Respiratory Division, University of British Columbia, Heart and Lung Center, James Hogg iCAPTURE Center for Cardiovascular and Pulmonary Research at St. Paul's Hospital, Vancouver, BC, Canada
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  • Author Footnotes
    1 Dr. Sin is a Canada Research Chair in COPD and a senior scholar with the Michael Smith Foundation for Health Research.
    Don D. Sin
    Correspondence
    Correspondence to: Don D. Sin, MD, FCCP, James Hogg iCAPTURE Center for Cardiovascular and Pulmonary Research, St. Paul's Hospital, Room #368A, 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada
    Footnotes
    1 Dr. Sin is a Canada Research Chair in COPD and a senior scholar with the Michael Smith Foundation for Health Research.
    Affiliations
    Department of Medicine, Respiratory Division, University of British Columbia, Heart and Lung Center, James Hogg iCAPTURE Center for Cardiovascular and Pulmonary Research at St. Paul's Hospital, Vancouver, BC, Canada
    Search for articles by this author
  • Author Footnotes
    1 Dr. Sin is a Canada Research Chair in COPD and a senior scholar with the Michael Smith Foundation for Health Research.

      Background

      Nearly 30% of all exacerbations of COPD do not have a clear etiology. Although pulmonary embolism (PE) can exacerbate respiratory symptoms such as dyspnea and chest pain, and COPD patients are at a high risk for PE due to a variety of factors including limited mobility, inflammation, and comorbidities, the prevalence of PE during exacerbations is uncertain.

      Methods

      A systematic review of the literature was performed to determine the reported prevalence of PE in acute exacerbations of COPD in patients who did and did not require hospitalization. The literature search was performed using MEDLINE, CINAHL, and EMBASE, and complemented by hand searches of bibliographies. Only cross-sectional or prospective studies that used CT scanning or pulmonary angiography for PE diagnosis were included.

      Results

      Of the 2,407 articles identified, 5 met the inclusion criteria (sample size, 550 patients). Overall, the prevalence of PE was 19.9% (95% confidence interval [CI], 6.7 to 33.0%; p = 0.014). In hospitalized patients, the prevalence was higher at 24.7% (95% CI, 17.9 to 31.4%; p = 0.001) than those who were evaluated in the emergency department (3.3%). Presenting symptoms and signs were similar between patients who did and did not have PE.

      Conclusions

      One of four COPD patients who require hospitalization for an acute exacerbation may have PE. A diagnosis of PE should be considered in patients with exacerbation severe enough to warrant hospitalization, especially in those with an intermediate-to-high pretest probability of PE.

      Key words

      Abbreviations:

      CI (confidence interval), DVT (deep venous thrombosis), PE (pulmonary embolism), RR (relative risk), V (ventilation/perfusion), VTE (venous thromboembolism)
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      Linked Article

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        CHESTVol. 135Issue 3
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          Many physicians have become complacent in managing patients presenting with dyspnea. All too often, these patients receive the reflexive administration of a standard cardiopulmonary cocktail consisting of oxygen supplementation, bronchodilators, corticosteroids, and diuretics, particularly in the presence of underlying COPD and/or congestive heart failure. Clinical improvement in the majority of patients following this ad hoc approach has only served as positive reinforcement for continued laxity in managing patients with underlying lung disease.
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