Can pulmonary embolism (PE) exacerbate chronic obstructive pulmonary disease (COPD)?

From the Guidelines

Yes, pulmonary embolism (PE) can exacerbate chronic obstructive pulmonary disease (COPD). When a PE occurs in a COPD patient, it creates a dangerous compounding effect on respiratory function. The blood clot in the pulmonary arteries blocks blood flow to portions of the lung, creating ventilation-perfusion mismatch that worsens the already compromised gas exchange in COPD patients. This leads to increased hypoxemia, as areas of the lung continue to receive air but not adequate blood flow. COPD patients typically have limited respiratory reserve, making them particularly vulnerable to this additional stress. The body often responds by increasing respiratory rate, which can worsen air trapping and dynamic hyperinflation in COPD patients.

Key Points to Consider

• Clinically, this exacerbation presents as worsened shortness of breath, decreased exercise tolerance, increased oxygen requirements, and potentially respiratory failure that may be disproportionate to the patient's baseline COPD status.
• According to recent evidence, acute exacerbations of respiratory symptoms in patients with COPD may be caused by extrapulmonary mechanisms and exacerbations of concomitant chronic diseases, such as systemic arterial hypertension, acute heart decompensation, atrial fibrillation, and pulmonary embolism 1.
• Treatment requires addressing both conditions simultaneously - anticoagulation therapy for the PE while optimizing COPD management with bronchodilators, corticosteroids if indicated, and appropriate oxygen therapy.
• The mortality risk is higher when these conditions coexist, making prompt diagnosis and treatment essential, as supported by the fact that chronic comorbidities are prominent contributors to the clinical severity of patients with COPD, affecting important patient-centered outcomes 1.

From the Research

Relationship Between Pulmonary Embolism and COPD Exacerbation

• Pulmonary embolism (PE) can exacerbate chronic obstructive pulmonary disease (COPD) as the symptoms of PE may mimic those of a COPD exacerbation 2, 3.
• The presence of COPD can modify the initial presentation of venous thromboembolism (VTE) and worsen the short-term prognosis of patients with acute PE, particularly during a COPD exacerbation 2.
• Studies have shown that up to 25% of COPD exacerbations requiring hospitalization may be triggered by acute PE 3.

Prevalence of PE in COPD Patients

• The prevalence of PE in patients with COPD exacerbation varies among different studies, ranging from 6% to 25% 3, 4.
• Hospitalized patients with COPD exacerbation have a higher prevalence of PE compared to those evaluated in the emergency department 4.
• Factors such as obesity and lower limb asymmetry have been identified as independent predictors of PE in patients with COPD exacerbation 4.

Clinical Presentation and Diagnosis

• PE should be considered in patients presenting with acute chest pain, shortness of breath, or syncope, especially in those with COPD 5.
• The diagnosis of PE is determined by chest imaging, and clinical risk stratification is crucial in medical decision-making 5.
• The simplified pulmonary embolism severity index (sPESI) score has been shown to have predictive value in identifying patients with COPD and PE who are at risk of adverse outcomes 6.

Management and Prognosis

• Therapeutic anticoagulation does not preclude the presence of PE, and clinical risk stratification is essential in managing patients with COPD and PE 3.
• Patients with COPD and PE are at increased risk of death and prolonged hospital stay, highlighting the need for careful evaluation and management of thromboembolic risk 4.
• Severe pneumonia, respiratory failure, lower limb edema, and diastolic blood pressure <60 mmHg have been identified as correlative factors for adverse outcomes in patients with COPD complicated by PE 6.