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PE and COPD exacerbation

October 4, 2016

Short Attention Span Summary

Just a routine acute exacerbation of COPD (AE-COPD)?
In this systematic review, the prevalence of PE in 880 pooled patients with AE-COPD was 16.1%.  This is higher than the 15% or less gestalt to be PERC negative.  And most of the emboli found were large and needed treatment.

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PE prevalence is high in patients with AE-COPD.  Be especially aware when patients have fewer infectious respiratory complaints, have concomitant signs of heart failure, or have pleuritic pain.  Journal Watch has a free review of this article.

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Chest. 2016 Aug 11. pii: S0012-3692(16)53752-0. doi: 10.1016/j.chest.2016.07.034. [Epub ahead of print]

Prevalence and Localization of Pulmonary Embolism in Unexplained Acute Exacerbations of COPD: A systematic review and meta-analysis.

Aleva FE1, Voets LW2, Simons SO2, de Mast Q3, van der Ven AJ3, Heijdra YF2.

Author information:

1Department of Respiratory Medicine, Radboud University Medical Center; Department of Internal Medicine, Radboud University Medical Center. Electronic address: Floor.Aleva@radboudumc.nl.

2Department of Respiratory Medicine, Radboud University Medical Center.

3Department of Internal Medicine, Radboud University Medical Center.



COPD patients encounter episodes of increased inflammation, so-called acute exacerbations of COPD (AE-COPD). In 30% of AE-COPD no clear etiology is found. Since there is a well-known crosstalk between inflammation and thrombosis, the objectives of this study were to determine the prevalence, embolus localization and clinical relevance, and clinical markers of pulmonary embolism (PE) in unexplained AE-COPD.


A systematic search was performed using MEDLINE and EMBASE platforms from 1974 – October 2015. Prospective- and cross-sectional studies that included patients with an AE-COPD and used pulmonary CT-angiography for diagnosis of PE were included.


The systematic search resulted in 1650 records. Main reports of 22 articles were reviewed and 7 studies were included. The pooled prevalence of PE in unexplained AE-COPD was 16.1% (95% confidence-interval 8.3%-25.8%) in a total of 880 patients. Sixty-eight percent of the emboli found were located in the main pulmonary arteries, lobar arteries or inter-lobar arteries. Mortality and length of hospital admission seem to be increased in patients with unexplained AE-COPD and PE. Pleuritic chest pain and cardiac failure were more frequently reported in patients with unexplained AE-COPD and PE. In contrast, signs of respiratory tract infection was less frequently related to PE.


PE is frequently seen in unexplained AE-COPD. Two-thirds of emboli are found at localizations that have a clear indication for anticoagulant treatment. These findings merit clinical attention. PE should receive increased awareness in patients with unexplained AE-COPD, especially when pleuritic chest pain and signs of cardiac failure are present and no clear infectious origin can be identified.

Copyright © 2016. Published by Elsevier Inc.

PMID: 27522956 [PubMed – as supplied by publisher]

2 thoughts on “PE and COPD exacerbation

  • Importantly, only one of the studies included looked at ED patients, the rest were all hospitalized. In the ED population, the rate of PE was only 3.3%, less than the minimal clinical gestalt for PERCing these patients out.

    • True, there was only a single ED based study, but the prevalence of PE in that cohort was 13.7%, not 3.3%. But still below the PERC gestalt threshold of 15% if just that study is considered.

What are your thoughts?