Objective: In light of the rising global burden of chronic obstructive pulmonary disease (COPD), concurrent associated thrombo-embolic risk cannot be denied. Our objectives were to estimate the incidence of pulmonary embolism in patients presenting with acute exacerbation of COPD (AECOPD), to identify diagnostic shortcomings, and to suggest strategies for improved detection and management of pulmonary embolism in COPD patients, with the goal of enhancing emergency care protocols and patient survival.

Methods: This was a prospective observational study conducted at a tertiary level care corporate hospital in the city of Mumbai, India. We included consecutive patients who were hospitalized from the Emergency Department for an acute exacerbation of COPD (AECOPD) between January of 2023 and January of 2024. All patients underwent clinical risk assessment (Wells’ and revised Geneva scores), arterial blood gas analyses, d-Dimer testing, bedside two-point compressibility test of both lower limbs, two-dimensional echocardiography, and computed tomography pulmonary angiography (CTPA) using a 16-detector system.

Results: Our study included 20 patients, with a mean age of 57 years, with 11 males (55%) and 9 females (45%). The distribution of GOLD (Global Initiative for Chronic Obstructive Lung Disease) stages was as follows: Stage I (5%), Stage II (50%), Stage III (25%), and Stage IV (20%). Approximately 80% of the patients had comorbidities such as obesity, diabetes mellitus, hypertension, and coronary artery disease. The prevalence of pulmonary embolism (PE) was 25%, and 15% of all patients had deep vein thrombosis (DVT). The thrombi were localized in the main pulmonary artery (5%), segmental (5%), unilateral (10%), and sub segmental (5%). Compression ultrasonography revealed thrombi in the popliteal vein (10%) and femoral vein (5%). The clinical probability of PE was assessed using the revised Geneva and Wells’ scores. The revised Geneva score classified 45% of patients as low risk, 35% as moderate risk, and 20% as high risk. The Wells’ score classified 40% as low risk, 25% as moderate risk, and 35% as high risk.

Conclusion: Our study underscores the importance of maintaining vigilance, ensuring early recognition, and conducting systematic diagnostic evaluations for pulmonary embolism in AECOPD cases. We acknowledge the value of careful clinical assessment and the appropriate use of predictive tools to enhance early detection of pulmonary embolism in AECOPD.