CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Should pulmonary embolism be suspected in exacerbation of chronic obstructive pulmonary disease?

Olivier T Rutschmann¹, Jacques Cornuz², Pierre-Alexandre Poletti³, Pierre-Olivier Bridevaux², Olivier W Hugli⁴, Salah D Qanadli⁵, Arnaud Perrier¹

¹ Division of General Internal Medicine, Department of Medicine, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
² Policlinique médicale universitaire, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
³ Division of Radiodiagnosis and Interventional Radiology, Department of Medical Radiology and Informatics, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
⁴ Emergency Department, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
⁵ Cardiovascular and Metabolic Diseases Centre, Department of Radiology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland

Correspondence to:
Dr O T Rutschmann
Division of General Internal Medicine, Geneva University Hospitals, 24 rue Micheli-du-Crest, 1211 Geneva 14, Switzerland;olivier.rutschmann{at}hcuge.ch

Background: The cause of acute exacerbation of chronic obstructive pulmonary disease (COPD) is often difficult to determine. Pulmonary embolism may be a trigger of acute dyspnoea in patients with COPD.

Aim: To determine the prevalence of pulmonary embolism in patients with acute exacerbation of COPD.

Methods: 123 consecutive patients admitted to the emergency departments of two academic teaching hospitals for acute exacerbation of moderate to very severe COPD were included. Pulmonary embolism was investigated in all patients (whether or not clinically suspected) following a standardised algorithm based on D-dimer testing, lower-limb venous ultrasonography and multidetector helical computed tomography scan.

Results: Pulmonary embolism was ruled out by a D-dimer value <500 µg/l in 28 (23%) patients and a by negative chest computed tomography scan in 91 (74%). Computed tomography scan showed pulmonary embolism in four patients (3.3%, 95% confidence interval (CI), 1.2% to 8%), including three lobar and one sub-segmental embolisms. The prevalence of pulmonary embolism was 6.2% (n = 3; 95% CI, 2.3% to 16.9%) in the 48 patients who had a clinical suspicion of pulmonary embolism and 1.3% (n = 1; 95% CI, 0.3% to 7.1%) in those not suspected. In two cases with positive computed tomography scan, the venous ultrasonography also showed a proximal deep-vein thrombosis. No other patient was diagnosed with venous thrombosis.

Conclusions: The prevalence of unsuspected pulmonary embolism is very low in patients admitted in the emergency department for an acute exacerbation of their COPD. These results argue against a systematic examination for pulmonary embolism in this population.

Abbreviations: COPD, chronic obstructive pulmonary disease

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