Kim et al identified risk factors for venous thromboembolism (VTE) in a patient with chronic obstructive pulmonary disease (COPD). A pulmonary embolism can explain an exacerbation of COPD. The authors are from Temple University, Brigham and Women's Hospital and the University of Colorado.

Patient selection: COPD


Risk factors for venous thromboembolism:

(1) obesity or morbid obesity (odds ratio 1.037 per kilogram per square meter)

(2) congestive heart failure

(3) peripheral arterial disease, cerebrovascular disease and/or coronary arteriosclerosis

(4) low 6-minute walking distance (as an indication of reduced exercise capacity)

(5) gastroesophageal reflux disease (GERD)

(6) history of pneumothorax

(7) nonsmoking status (smoking reduces the risk of VTE


The risk might be further increased by other risk factors for thrombosis such as immobilization, cancer and hypercoagulability.


A patient with COPD who presents with worsening dyspnea or other sign of acute exacerbation should be evaluated for thromboembolism if risk factors are present. Thromboembolism can be present even if there is evidence of a respiratory tract infection.

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