Pulmonary Embolism in Patients Hospitalized for Exacerbated COPD and Wheezing

Claire Poulet Marine Woimant

doi:10.4172/2161-105x.1000264

Abstract

Background: Prevalence of pulmonary embolism (PE), a potentially lethal disease which can mimic exacerbation of chronic obstructive pulmonary disease (COPD) remains controversial. Objective of the study: The main objective was to determine prevalence of PE in COPD patients hospitalized for exacerbation with wheezing at presentation. The secondary objectives were to compare the prevalence of PE according to COPD GOLD stages and to identify predictive factors for PE in COPD population. Methods: We conducted a prospective study in all consecutive patients hospitalized for COPD exacerbation of unknown origin with wheezing at presentation. Patients underwent a spiral computed tomography (CT) angiography and venous lower-limb Doppler ultrasonography. Results: 87 patients (71 males, mean age: 67.1 ± 11.2 years, 32 GOLD stage-III and 24 GOLD stage-IV patients) had an interpretable spiral CT angiography which showed eight right and five bilateral unsuspected PEs. Deep vein thrombosis was found in nine patients (associated with PE in three). The prevalence of PE and venous thromboembolism (VTE) occurred respectively in 14.9% and 21.8%. No statistical differences were found between risk factors, Geneva score or clinical signs in patients with and without PE. PE was not related to the severity of COPD. Conclusion: There was a 14.9% prevalence of unexpected PE in patients with exacerbated COPD and wheezing at presentation. VTE events were not correlated with the severity of COPD.

Highlights

30% of exacerbated chronic obstructive pulmonary disease (COPD) have no clear aetiology [1]
venous thromboembolism (VTE) events were not correlated with the severity of COPD
In this subgroup of patients admitted for COPD exacerbation, available information on the prevalence of pulmonary embolism (PE) remains scarce and conflicting with data ranging from 0% [2] to 29% [3]

Summary

Introduction

30% of exacerbated chronic obstructive pulmonary disease (COPD) have no clear aetiology [1] In this subgroup of patients admitted for COPD exacerbation, available information on the prevalence of pulmonary embolism (PE) remains scarce and conflicting with data ranging from 0% [2] to 29% [3]. Because PE remains a potentially lethal disease with clinical symptoms that can mimic exacerbated COPD (increased dyspnoea, tachycardia, hypoxemia and/ or right-sided heart failure) and because Wells and/or Geneva scores are (usually) intermediate in exacerbated COPD patients, this issue is of great importance. In our experience, when exacerbated COPD is accompanied by wheezing at auscultation, the spectra of PE becomes substantial [3] When present, this clinical symptom which is not systematically found in exacerbated COPD could focus clinicians’ attention on the possibility of unsuspected PE [4]. Prevalence of pulmonary embolism (PE), a potentially lethal disease which can mimic exacerbation of chronic obstructive pulmonary disease (COPD) remains controversial

Methods

Results

Conclusion