Worsening symptoms in COPD may be due to concomitant PE finds JAMA study

COPD results in a substantial and increasing burden in terms of prevalence, incidence and mortality, and is predicted to be the third leading cause of global mortality by 2030 (WHO, 2013). Patients with COPD are at risk of developing PE due to various reasons, such as immobility, systemic inflammation, and polycythemia. Besides, COPD has been recently defined as an independent risk factor for PE. However, the prevalence of PE with COPD and acutely worsening respiratory symptoms remains uncertain. Therefore, researchers of France conducted a study to determine the prevalence of pulmonary embolism in patients with COPD admitted to the hospital for acutely worsening respiratory symptoms.

It was a multicentric, cross-sectional, prevalence study with prospective follow-up for 3 months in 7 French hospitals. A total of 740 COPD patients admitted to French hospitals were assessed for PE probability using the revised Geneva score within 48 hours of admission. Those with Geneva scores of 11 or above had a high PE probability. So, they were diagnosed with spiral computed tomographic pulmonary angiography and leg ultrasound. Patients with lower Geneva scores underwent D-dimer testing and those with levels at 500 ng/mL or above proceeded to further testing. The major outcome assessed was pulmonary embolism diagnosed within 48 hours of admission. They also assessed pulmonary embolism during a 3-month follow-up among patients deemed not to have venous thromboembolism at admission and who did not receive anticoagulant treatment as a secondary outcome. Other outcomes were venous thromboembolism (pulmonary embolism and/or deep vein thrombosis) at admission and during follow-up, and 3-month mortality, whether venous thromboembolism was clinically suspected or not.