Jacques Rizkallah1, S F Paul Man1, Don D Sin2. 1. 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. 2. 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. Electronic address: dsin@mrl.ubc.ca.
Abstract
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.
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 COPDpatients 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 COPDpatients 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.
Authors: Evelyn Tsantikos; Maverick Lau; Cassandra Mn Castelino; Mhairi J Maxwell; Samantha L Passey; Michelle J Hansen; Narelle E McGregor; Natalie A Sims; Daniel P Steinfort; Louis B Irving; Gary P Anderson; Margaret L Hibbs Journal: J Clin Invest Date: 2018-04-30 Impact factor: 14.808
Authors: Christian Mongiardi; Francesco Dentali; Walter Ageno; Andrea Maria Maresca; Alessandro Squizzato; Andrea Bertolini; Edoardo Verna; Achille Venco Journal: Intern Emerg Med Date: 2010-12-14 Impact factor: 3.397
Authors: Victor Kim; Nishant Goel; Jinal Gangar; Huaqing Zhao; David E Ciccolella; Edwin K Silverman; James D Crapo; Gerard J Criner Journal: Chronic Obstr Pulm Dis Date: 2014
Authors: D B Sprunger; A L Olson; T J Huie; E R Fernandez-Perez; A Fischer; J J Solomon; K K Brown; J J Swigris Journal: Eur Respir J Date: 2011-07-07 Impact factor: 16.671
Authors: Dheeraj Gupta; Ritesh Agarwal; Ashutosh Nath Aggarwal; V N Maturu; Sahajal Dhooria; K T Prasad; Inderpaul S Sehgal; Lakshmikant B Yenge; Aditya Jindal; Navneet Singh; A G Ghoshal; G C Khilnani; J K Samaria; S N Gaur; D Behera Journal: Lung India Date: 2013-07