Asthma and risk of pulmonary thromboembolism

Abstract

Asthma and risk of pulmonary thromboembolismTo the Editor:We read with interest the article by CHUNG et al.[1] about the risk of pulmonary thromboembolism in asthmatic patients. This nationwide population cohort study suggests that the risk of developing pulmonary thromboembolism significantly is increased in asthmatic patients compared to those of the general population, with a multivariable-adjusted hazard ratio of 3.24 (95% CI 1.74-6.01). The authors considered that as concentrations of thrombin were elevated in the sputum and bronchoalveolar lavage of asthmatic patients, and as local coagulation activation existed in asthma, it is possible that the results of this study may, in part, be explained through this mechanism. However, there are other plausible mechanisms that might explain the risk.In asthmatic patients, plasma oxidant-antioxidant status was abnormal, with increased plasma malondialdehyde and decreased plasma ascorbic acid, which support the emerging concept of free-radical injury in asthma [2]. The pathogenesis of venous thromboembolism is also linked to oxidative stress [3]. Therefore, the involvement of oxidative stress may potentiate the increased risk of pulmonary thromboembolism in asthmatic patients.Moreover, as the study by MAJOOR et al.[4] suggested, on one hand, that inactivity of severe asthmatic patients might be a potential trigger for venous thromboembolic events, but on the other hand, asthmatic patients, especially severe cases, continuously use high doses of glucocorticoids, receive bursts of systemic glucocorticoid during exacerbations and often need chronic oral glucocorticoid treatment for control of their asthma. Recent studies suggested that use of glucocorticoids may be at an increased risk of venous thromboembolism [5] and pulmonary embolism [6]. Just as CHUNG et al.[1] recognised when discussing the limitations of their study, glucocorticoid use information was lacking in the multivariable Cox proportional-hazards regression analysis.Notably, MAJOOR et al. [4] found that the risk of pulmonary embolism was increased in severe asthma only, not in mild-to-moderate asthma.@ERSpublications Asthma and risk of pulmonary thromboembolism: more epidemiological studies are required http://ow.ly/qy3whWan-Jie Gu and Jing-Chen Liu Dept of Anesthesiology, the First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China.Correspondence: J-C. Liu, Dept of Anesthesiology, the First Affiliated Hospital, Guangxi Medical University, 22 Shuangyong Road, Nanning 530021, Guangxi, China. E-mail: jingchenliu1964@sina.

Trends in and Maternal Outcomes of Delivery Hospitalizations of Patients With an Asthma Diagnosis

“…29 Other studies in nonobstetric patients have demonstrated increased risk for venous thromboembolism among patients with asthma with risk highest among patients with frequent exacerbations and hospitalizations. [30][31][32] Studies have demonstrated that asthma is associated with increased prothrombotic factors and endothelial dysfunction leading to atherothrombosis and pulmonary embolism. 30 Although attributable risk for venous thromboembolism among deliveries with asthma is low, further investigation is indicated to determine to what degree asthma is a meaningful risk factor for this complication.…”

Pulmonary Embolism and Severe Asthma: Case Report and Literature Review

“…Common causes of an inherited hypercoagulable state include the following: Factor V Leiden; prothrombin gene mutations; and defects in protein S, protein C, or antithrombin [6,7]. Acquired risk factors include prior thrombotic event, recent major surgery, central venous catheter indwelling, trauma, immobilization, malignancy, pregnancy, medications (e.g., oral contraceptives), antiphospholipid syndrome, and chronic inflammation [3,4,6,8].…”

“…The development of pulmonary embolism is classically considered due to risk factors named Virchow’s triad (alterations in blood flow; factors associated with endothelium damage in the vessel wall; and factors affecting blood properties). Increasing evidence suggests that asthma is associated with greater risks of pulmonary embolism [1,2,3,4,5]. Here, we report a case of a 62-year-old female who, having been diagnosed with severe asthma, had developed recurrent pulmonary embolism.…”