Prevalence of Pulmonary Embolism in Acute Exacerbations of COPD

October 13, 2014 admin Asthma

In conclusion, despite publication and revision of national and international guidelines, significant gaps persist in emergency management of asthma. Although the magnitude of care gaps varied among hospitals, the prevalence and magnitude of these gaps—such as underutilization of objective measures of airflow obstruction, underutilization of systemic steroids, and failure to refer to specialists—suggest a common and widespread need for successful knowledge translation initiatives, such as clinical pathways that support best practice, to enable adherence with guidelines, optimize resource use, reduce morbidity, and improve health care.

Background: Nearly 30% of all exacerbations of COPD do not have a clear etiology. Although pulmonary embolism (PE) can exacerbate respiratory symptoms such as dyspnea and chest pain, and COPD patients are at a high risk for PE due to a variety of factors including limited mobility, inflammation, and comorbidities, the prevalence of PE during exacerbations is uncertain. Methods: A systematic review of the literature was performed to determine the reported prevalence of PE in acute exacerbations of COPD in patients who did and did not require hospitalization. The literature search was performed using MEDLINE, CINAHL, and EMBASE, and complemented by hand searches of bibliographies. Only cross-sectional or prospective studies that used CT scanning or pulmonary angiography for PE diagnosis were included read more. Results: Of the 2,407 articles identified, 5 met the inclusion criteria (sample size, 550 patients). Overall, the prevalence of PE was 19.9% (95% confidence interval [CI], 6.7 to 33.0%; p = 0.014). In hospitalized patients, the prevalence was higher at 24.7% (95% CI, 17.9 to 31.4%; p = 0.001) than those who were evaluated in the emergency department (3.3%). Presenting symptoms and signs were similar between patients who did and did not have PE.

Viagra Australia Conclusions: One of four COPD patients who require hospitalization for an acute exacerbation may have PE. A diagnosis of PE should be considered in patients with exacerbation severe enough to warrant hospitalization, especially in those with an intermediate-to-high pretest probability of PE.