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Pulmonary Embolism Among Patients With Acute Exacerbation Of Chronic Obstructive Pulmonary Disease: Implications For Emergency Medicine

  • Ali Pourmand
    Correspondence
    Corresponding Address: Ali Pourmand, md, mph, rdms, Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, 2120 L St NW, Washington, DC 20037
    Affiliations
    Emergency Medicine Department, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
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  • Hannah Robinson
    Affiliations
    Emergency Medicine Department, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
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  • Maryann Mazer-Amirshahi
    Affiliations
    Department of Emergency Medicine, MedStar Washington Hospital Center and Georgetown University School of Medicine, Washington, District of Columbia
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  • Jesse M. Pines
    Affiliations
    Emergency Medicine Department, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia

    Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
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      Abstract

      Background

      Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Common in COPD are acute exacerbations (AE-COPD) that cause acute dyspnea, cough, and bronchospasm. Symptoms of AE-COPD mimic pulmonary embolism (PE).

      Methods

      We conducted a systematic review of the literature to assess the prevalence of PE in patients admitted to the hospital with a clinical diagnosis of AE-COPD. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, we queried PubMed and MEDLINE databases from 1990 to 2017. The search term “prevalence pulmonary embolism, COPD” was used, and Boolean operators were used to combine search terms. Data were extracted from each article, specifically the sample size, study setting, design, and the prevalence of PE.

      Results

      A total of 5 articles were included that demonstrated a prevalence of PE among patients with a clinical diagnosis of AE-COPD that ranged from 3.3–29.1%. Sample sizes varied from 49–197 patients. Studies occurred in both emergency department and inpatient settings, including intensive care units. Among the studies that reported patient characteristics associated with PE in AE-COPD, both obesity and immobility were important.

      Conclusion

      Studies reporting the prevalence of PE during AE-COPD vary considerably in their methods and results. Because of the relatively high prevalence of PE during AE-COPD, it is important for providers to be aware of this linkage between the 2 conditions and to screen patients using clinical gestalt and validated screening tools until more emergency department data are available.

      Keywords

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      References

        • Cosio M.G.
        • Saetta M.
        • Agusti A.
        Immunologic aspects of chronic obstructive pulmonary disease.
        N Engl J Med. 2009; 360: 2445-2454
        • Patil S.P.
        • Krishnan J.A.
        • Lechtzin N.
        • Diette G.B.
        In-hospital mortality following acute exacerbations of chronic obstructive pulmonary disease.
        Arch Intern Med. 2003; 163: 1180-1186
        • Rutschmann O.T.
        • Cornuz J.
        • Poletti P.A.
        • et al.
        Should pulmonary embolism be suspected in exacerbation of chronic obstructive pulmonary disease?.
        Thorax. 2007; 62: 121-125
        • Wells J.M.
        • Washko G.R.
        • Han M.K.
        • et al.
        Pulmonary arterial enlargement and acute exacerbations of COPD.
        N Engl J Med. 2012; 312: 913-921
        • Tapson V.F.
        Acute pulmonary embolism.
        N Engl J Med. 2009; 358: 1037-1052
        • Moua T.
        • Wood K.
        COPD and PE. A clinical dilemma.
        Int J Chron Obstruct Pulmon Dis. 2008; 3: 277-284
        • Palm K.
        • Decker W.
        Acute exacerbations of chronic obstructive pulmonary disease.
        Emerg Med Clin North Am. 2003; 21: 331-352
        • Crichlow A.
        • Cuker A.
        • Mills A.
        Overuse of computed tomography pulmonary angiography in the evaluation of patients with suspected pulmonary embolism in the emergency department.
        Acad Emerg Med. 2013; 19: 1219-1226
        • Moher D.
        • Liberati A.
        • Tetzlaff J.
        • et al.
        • The PRISMA Group
        Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement.
        PLoS Med. 2009; 6: e1000097
        • Akpinar E.
        • Hosgun D.
        • Akpinar S.
        • et al.
        Incidence of pulmonary embolism during COPD exacerbation.
        J Bras Pneumol. 2014; 40: 38-45
        • Tillie-Leblond I.
        • Marquette C.H.
        • Perez T.
        • et al.
        Pulmonary embolism in patients with unexplained exacerbation of chronic obstructive pulmonary disease: prevalence and risk factors.
        Ann Intern Med. 2006; 144: 390-396
        • Bahloul M.
        • Chaari A.
        • Tounsi A.
        • et al.
        Incidence and impact outcome of pulmonary embolism in critically ill patients with severe exacerbation of chronic obstructive pulmonary disease.
        Clin Respir J. 2015; 9: 270-277
        • Shapira-Rootman M.
        • Beckerman M.
        • Soimu U.
        • et al.
        The prevalence of pulmonary embolism among patients suffering from acute exacerbations of chronic obstructive pulmonary disease.
        Emerg Radiol. 2015; 22: 257-260
        • Aleva F.
        • Voets L.
        • Simons S.
        • et al.
        Prevalence and localization of pulmonary embolism in unexplained acute exacerbations of COPD: a systematic review and meta-analysis.
        Chest. 2017; 151: 544-554
        • Rizkallah J.
        • Man P.
        • Sin D.
        Prevalence of pulmonary embolism in acute exacerbations of COPD: a systematic review and meta analysis.
        Chest. 2009; 135: 786-793
        • Morgan A.D.
        • Herrett E.
        • De Stavola B.L.
        • et al.
        COPD disease severity and the risk of venous thromboembolic events: a matched case-control study.
        Int J Chron Obstruct Pulmon Dis. 2016; 11: 899-908
        • Børvik T.
        • Brækkan S.K.
        • Enga K.
        • et al.
        COPD and risk of venous thromboembolism and mortality in a general population.
        Eur Respir J. 2016; 47: 473-481
        • Ambrosetti M.
        • Ageno W.
        • Spanevello A.
        • et al.
        Prevalence and prevention of venous thromboembolism in patients with acute exacerbations of COPD.
        Thromb Res. 2003; 112: 203-207
        • Penaloza A.
        • Verschuren F.
        • Meyer G.
        • et al.
        Comparison of the unstructured clinician gestalt, the Wells Score, and the Revised Geneva Score to estimate pretest probability for suspected pulmonary embolism.
        Ann Emerg Med. 2013; 62: 117-124
        • Penaloza A.
        • Verschuren F.
        • Dambrine S.
        • et al.
        Performance of the Pulmonary Embolism Rule-out Criteria (the PERC rule) combined with low clinical probability in high prevalence population.
        Thromb Res. 2012; 129: e189-e193
        • Bach A.
        • Bandzauner R.
        • Nansalmaa B.
        • et al.
        Timing of pulmonary embolism diagnosis in the emergency department.
        Thromb Res. 2016; 137: 53-57
        • Ikesaka R.
        • Carrier M.
        Clinical significance and management of subsegmental pulmonary embolism.
        J Thromb Thrombolysis. 2015; 39: 311-314