This systematic review shows a high rate of pulmonary embolism (PE) in patients hospitalized for chronic obstructive pulmonary disease (COPD) exacerbations.
Symptoms of PE can overlap with those of acute exacerbations of chronic obstructive pulmonary disease (COPD) making the diagnosis of PE difficult. Further, the inflammation of COPD exacerbations might increase PE risk.
These authors conducted a systematic review to determine the prevalence of PE in patients hospitalized with acute exacerbations of COPD. All studies had to be prospective and cross-sectional and use computed tomography angiography to diagnose PE. They analyzed seven studies and 880 total patients.
The overall rate of PE was 16%, but there was high heterogeneity among studies. Some of the studies were ED-based studies and others studied patients hospitalized for a COPD exacerbation. It is unclear how many of the patients presented to the ED with a PE and how many patients developed a PE while hospitalized. Nevertheless, it is a reasonable strategy to evaluate patients for a concomitant PE if they do not have an obvious infectious precipitant, have a very severe exacerbation, or are not improving as quickly as expected with steroids, bronchodilators +/- antibiotics.
- Aleva FE et al. Prevalence and localization of pulmonary embolism in unexplained acute exacerbations of COPD: A systematic review and meta-analysis. Chest 2016 Aug 12; [e-pub]. (http://dx.doi.org/10.1016/j.chest.2016.07.034)