Clinical Citations: Recognizing pulmonary embolism in patients with COPD exacerbation

When a patient with chronic obstructive pulmonary disease (COPD) presents with what appears to be an acute exacerbation, you should consider the possibility of pulmonary embolism (PE). This is the message conveyed by a prospective cohort study in France.

The study included 197 patients with COPD who were hospitalized for severe exacerbation of unknown origin. All were current or former smokers, and none required mechanical ventilation. The Geneva score was used to categorize the probability of PE as low, intermediate, or high. All patients underwent spiral CT angiography of the pulmonary circulation and ultrasonographic assessment of the legs.

Results indicated a 25% prevalence of PE. The clinical factors associated with increased risk of PE were previous thromboembolic disease (risk ratio [RR], 2.43), malignant disease (RR, 1.82), and a decrease in PaCO₂ of at least 5 mm Hg (RR, 2.10).

The incidence of PE was 9.2% in patients identified as having a low probability of PE. However, the incidence fell to 3.2% when the Geneva score was modified to accommodate the high rate (29%) of malignant disease in the study population (the modification involved substituting "associated underlying malignant disease" for "surgery").