What if COPD Exacerbation Was Pulmonary Embolism?
SOURCE: Aleva FE, Voets LW, Simons SO, 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.
In contrast to most of the other top 10 causes of death, mortality from COPD has not declined in the past two decades. It now ranks as the number three cause of mortality worldwide. Exacerbations of COPD may be induced by viruses, bacteria, and inhaled toxins, but despite thorough evaluation as many as 30% of episodes lack a clear etiology. Might acute pulmonary embolism (PE) be mistaken for (or cause) a COPD exacerbation?
Aleva et al reviewed data from seven studies of patients admitted for acute COPD exacerbations (n = 880) who underwent pulmonary CT-angiography as part of their evaluation. Within the group lacking an identified etiology for their apparent COPD exacerbation, 16% were determined to have suffered a PE. Most of these emboli qualified for anticoagulant treatment.
When PE occurs in relation to apparent COPD exacerbations, pleuritic chest pain and heart failure signs were seen more often. D-dimer measurements might help exclude PE, as the authors clearly explained they are not suggesting pulmonary CT angiography become a routine part of evaluation. Rather, one hopes that awareness of PE as a cause of COPD exacerbations will be considered more routinely, especially in patients presenting with pleuritic chest pain and signs of heart failure.
One hopes that awareness of pulmonary embolism as a cause of COPD exacerbations will be considered more routinely.
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