Impact of Pulmonary Embolism on Acute Chronic Obstructive Pulmonary Disease Exacerbation

Murat Türk, Fatma Yıldırım, Nurgül Sevimli, Nurdan Köktürk


Purpose: This study aims to assess effect of pulmonary embolism (PE) on clinical and laboratory parameters of patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Risk factors for PE development were also evaluated.

Methods:In this retrospective study, patients who were hospitalized for AECOPD and underwentcomputed tomographic pulmonary angiography scan (CTPA) between 2009 and 2011 were included. Patients with PE were evaluated separately as those diagnosed at initial examination and those suspected during exacerbation therapy since they had inadequate response. Binary logistic regression analysis was used in order to determine risk factors on PE development.

Results: The study consisted of 36 patients, 13 patients (36.1%) had PE. FEV1 and FEV1/FVC values were higher in PE group (53.7% vs 41.4%; 62.3% vs 52% respectively; p<0.05). There was no difference between D-dimer levels of PE and non-PE patients. Risk of PE development did not differ with analyzed variables. Those diagnosed at initial examination had significantly less number of exacerbations in the last one year than those diagnosed during therapy (1.1 vs 3.2; p<0.05).

Conclusion:PE should always be considered inAECOPDetiology, particularly in patients with frequent exacerbation history and D-dimer levels may bemisleading.


Pulmonary embolism, chronic obstructive pulmonary disease, exacerbation


Türk Toraks Derneği KOAH Çalışma Grubu. Kronik obstrüktif akciğer hastalığı (KOAH) koruma, tanı ve tedavi raporu. Turkish Thoracic Journal 2014: 15(Suppl 2).

Lozano R, Naghavi M, Foreman K, Lim S, Shibuya Ket al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2010; 380: 2095-128.

Donaldson GC, Wedzicha JA. COPD exacerbations. 1: Epidemiology. Thorax 2006; 61: 164-8.

Sapey E, Stockley RA. COPD exacerbations: 2. Aetiology. Thorax 2006; 61: 250-8.

Tillie-Leblond I, Marquette CH, Perez T, Scherpereel A, Zanetti C et al. Pulmonary embolism in patients with unexplained exacerbation of chronic obstructive pulmonary disease: prevalence and risk factors. Ann Intern Med 2006; 144: 390-6.

Chen WJ, Lin CC, Lin CY, Chang YJ, Sung FC et al. Pulmonary embolism in chronic obstructive pulmonary disease: a population-based cohort study. COPD 2014; 11: 438-43.

Rizkallah, J, Man SF, Sin DD. Prevalence of pulmonary embolism in acute exacerbations of COPD: a systematic review and metaanalysis. Chest 2009; 135: 786-93.

Gunen H, Gulbas G, In E, Yetkin O, Hacievliyagil SS.Venous thromboemboli and exacerbations of COPD. EurRespir J 2010; 35: 1243-8.

Choi KJ, Cha SI, Shin KM, Lee J, Hwangbo Y et al. Prevalence and predictors of pulmonary embolism in Korean patients with exacerbation of chronic obstructive pulmonary disease. Respiration 2013; 85: 203-9.

Akpinar EE, Hoşgün D, Akpinar S, Ataç GK, Doğanay B et al. Incidence of pulmonary embolism during COPD exacerbation. J Bras Pneumol 2014; 40: 38-45.

Kamel, MM. Moussa H, Ismail A. Prevalence of venous thrombo-embolism in acute exacerbations of chronic obstructive pulmonary disease. Egypt J Chest Dis Tuberc 2013; 62: 557-66.

Fernández C, Jiménez D, De Miguel J, Martí D, Díaz G et al. Chronic obstructive pulmonary disease in patients with acute symptomatic pulmonary embolism. Arch Bronconeumol 2009; 45: 286-90.

Hasegawa W, Yamauchi Y, Yasunaga H, Sunohara M, Jo T et al. Factors affecting mortality following emergency admission for chronic obstructive pulmonary disease. BMC Pulm Med 2014; 14: 151.

Bahloul M, Chaari A, Tounsi A, Baccouche N, Abid H et al. Incidence and impact outcome of pulmonary embolism in critically ill patients with severe exacerbation of chronic obstructive pulmonary diseases. ClinRespir J 2015; 9: 270-7.

Arregui MA, Ezquerra KL, López FC, Lacasa RC. Hypercoagulability state and endotelial injury in stable chronic obstructive pulmonary disease patients. An SistSanitNavar 2010; 33: 43-50.

Poulsen SH, Noer I, Møller JE, Knudsen TE, Frandsen JL. Clinical outcome of patients with suspected pulmonary embolism. A follow-up study of 588 consecutive patients. J Intern Med 2001; 250: 137-43.

Roberts CM, Lowe D, Bucknall CE, Ryland I, Kelly Y et al. Clinical audit indicators of outcome following admission to hospital with acute exacerbation of chronic obstructive pulmonary disease. Thorax 2002; 57: 137-141.

Wedzicha, JA, Hurst JR. Chronic obstructive pulmonary disease exacerbation and risk of pulmonary embolism. Thorax 2007; 62: 103-4.

Full Text: PDF

Creative Commons License
This work is licensed under a Creative Commons Attribution 3.0 License.