title: Risk of deep vein thrombosis and pulmonary embolism in asthma.
abstract: Increasing evidence suggests that patients with asthma have activated coagulation within the airways. Whether this leads to an increase in venous thromboembolic events is unknown. We therefore assessed the incidence of venous thromboembolic events in patients with mild-to-moderate and severe asthma as compared with an age- and sex-matched reference population. 648 patients with asthma (283 with severe and 365 patients with mild-to-moderate asthma) visiting three Dutch outpatient asthma clinics were studied. All patients completed a questionnaire about a diagnosis of deep vein thrombosis and pulmonary embolism in the past, their risk factors, history of asthma and medication use. All venous thromboembolic events were objectively verified. In total, 35 venous thromboembolic events (16 deep vein thrombosis and 19 pulmonary embolism) occurred at a median age of 39 (range 20-63) years. The incidence of pulmonary embolism in patients with severe asthma was 0.93 (95% CI 0.42-1.44) per 1000 person-years, 0.33 (95% CI 0.07-0.60) in mild-to-moderate asthma and 0.18 (95% CI 0.03-0.33) in the general population, respectively. Severe asthma and oral corticosteroid use were independent risk factors of pulmonary embolism (hazard ratios 3.33 (1.16-9.93) and 2.82 (1.09-7.30), respectively). Asthma was not associated with deep vein thrombosis. Severe asthma greatly enhances the risk of pulmonary embolism, particularly if chronic corticosteroids are used.
authors.affiliation: Dept of Respiratory Medicine, Academic Medical Centre, Amsterdam, The Netherlands. c.j.majoor@amc.uva.nl
authors.forename: Christof J
authors.initials: CJ
authors.lastname: Majoor
authors.forename: Pieter W
authors.initials: PW
authors.lastname: Kamphuisen
authors.forename: Aeilko H
authors.initials: AH
authors.lastname: Zwinderman
authors.forename: Anneke
authors.initials: A
authors.lastname: Ten Brinke
authors.forename: Marijke
authors.initials: M
authors.lastname: Amelink
authors.forename: Lucia
authors.initials: L
authors.lastname: Rijssenbeek-Nouwens
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Sterk
authors.forename: Harry R
authors.initials: HR
authors.lastname: Büller
authors.forename: Elisabeth H
authors.initials: EH
authors.lastname: Bel
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities; D001249:Asthma / Q000188:drug therapy / Q000453:epidemiology*; D016022:Case-Control Studies; D003276:Contraceptives, Oral / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000453:epidemiology; D016016:Proportional Hazards Models; D011655:Pulmonary Embolism / Q000453:epidemiology*; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D020246:Venous Thrombosis / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D003276:Contraceptives, Oral