What is a "Lung Attack"?
"Lung attack" is not a standard medical term, but it has been proposed as a public health analogy to "heart attack" to describe acute pulmonary embolism (PE), emphasizing its life-threatening nature and need for urgent recognition and treatment. 1
The Concept Behind "Lung Attack"
The term attempts to convey the urgency of pulmonary embolism in the same way "heart attack" communicates the seriousness of myocardial infarction to the general public. 1
- Pulmonary embolism is a major cardiovascular emergency where blood clots obstruct the pulmonary arterial bed, leading to acute, potentially fatal but reversible right ventricular failure. 1
- PE is frequently missed because of non-specific clinical presentation, yet early diagnosis is fundamental since immediate treatment is highly effective. 1
- Untreated PE carries 25-30% mortality, but with adequate anticoagulant therapy, this drops to less than 8%. 1
Why the Term Matters Clinically
The analogy serves an important purpose because PE remains dangerously underdiagnosed:
- At autopsy, more than 70% of major pulmonary emboli had been missed by clinicians, with prevalence of unsuspected PE ranging from 3-8% in post-mortem studies. 1
- The prevalence of PE at autopsy (12-15% in hospitalized patients) has not changed over three decades, despite medical advances. 1
- In the ICOPER study of 2,454 consecutive PE patients, cumulative 3-month mortality was 17.5%—comparable to many acute coronary syndromes. 1
Clinical Classification of PE ("Lung Attack")
When PE does occur, it is classified by severity: 1
- Massive PE: Shock and/or hypotension (systolic BP <90 mmHg or pressure drop of 40 mmHg for >15 minutes not caused by arrhythmia, hypovolemia, or sepsis) 1
- Submassive PE: Non-massive PE with echocardiographic signs of right ventricular dysfunction, carrying different prognosis 1
- Non-massive PE: All other cases without hemodynamic compromise 1
Common Pitfall: PE Mimicking Other Conditions
PE can present as bronchospasm or acute respiratory distress that mimics asthma or COPD exacerbation, making it particularly dangerous to miss. 2, 3
- PE is a critical differential diagnosis in COPD exacerbations, especially in patients with reduced mobility or recent hospitalization. 4
- Bronchospasm in PE may present as acute asthma refractory to bronchodilators, related to regional alveolar hypocapnia and platelet-produced mediators through vagus nerve-mediated reflex. 3
- Among COPD patients hospitalized for acute exacerbation, PE prevalence is significant and PE itself can mimic COPD exacerbation symptoms. 2
The Epidemiological Burden
The scale of "lung attacks" (PE) justifies the urgent terminology: 1
- Annual incidence: Over 100,000 cases in France, 65,000 in hospitalized patients in England and Wales, at least 60,000 new cases per year in Italy 1
- General population incidence: Approximately 0.5 per 1,000 annually in Western populations 1
- Recurrence risk is highest in the first 4-6 weeks and is greatly increased without anticoagulant therapy. 1