Venous thromboembolism associated with severe dyspnea and asthma in 21,205 adults from the Danish population

Long-term consequences after a pulmonary embolism include lung function deficits, dyspnea, and chronic thromboembolic pulmonary hypertension. Recent studies suggest patients who experience pulmonary embolism may also be at increased risk of asthma. We tested the hypothesis that individuals with pulmonary embolism or deep vein thrombosis (venous thromboembolism) have lower lung function, or higher risks of dyspnea and asthma using data from 21,205 random adults from the Danish General Suburban Population Study. Prevalences of pulmonary embolism, deep vein thrombosis, and venous thromboembolism were 0.60%, 1.7%, and 1.9% respectively. Individuals with pulmonary embolism or deep vein thrombosis had FEV₁% predicted of 86% and 89% compared with 95% in individuals without venous thromboembolism (t-test: P < 0.001). Corresponding values for FVC% predicted were 92% and 94% versus 99% (P < 0.001). Individuals with versus without venous thromboembolism had adjusted odds ratios for light, moderate, and severe dyspnea of 1.6 (95% CI: 1.1-2.2), 1.8 (1.2-2.6), and 2.6 (1.8-3.8), respectively. Individuals with versus without venous thromboembolism had adjusted odds ratios for asthma and use of asthma medication of 1.6 (1.2-2.2) and 1.9 (1.4-2.6), respectively. The adjusted odds ratio for asthma in individuals with versus without venous thromboembolism was increased among individuals who received no treatment with anticoagulants (2.0, 1.4-3.0) compared to those who received treatment (1.0, 0.6-1.6) (P for interaction = 0.02). Individuals with venous thromboembolism have lower lung function, 2.6 fold higher risk of severe dyspnea, and 1.6 fold higher risk of asthma in the Danish population.

肺栓塞（pulmonary embolism）后的长期并发症包括肺功能缺损、呼吸困难（dyspnea）以及慢性血栓栓塞性肺动脉高压。近期研究提示，发生肺栓塞的患者罹患哮喘的风险亦有所升高。本研究依托丹麦郊区普通人群研究（Danish General Suburban Population Study）中21205名随机招募的成年人数据，验证了如下假说：患有肺栓塞或深静脉血栓形成（deep vein thrombosis）的个体，其肺功能水平更低，或面临更高的呼吸困难与哮喘发病风险。研究对象中肺栓塞（pulmonary embolism）、深静脉血栓形成（deep vein thrombosis）及静脉血栓栓塞症（venous thromboembolism, VTE）的患病率分别为0.60%、1.7%与1.9%。与无静脉血栓栓塞症的个体相比，合并肺栓塞或深静脉血栓形成者的一秒用力呼气容积占预计值百分比（FEV₁% predicted）分别为86%与89%，而无VTE者的该指标为95%（t检验：P < 0.001）。用力肺活量占预计值百分比（FVC% predicted）的对应数值分别为92%、94%与99%（P < 0.001）。相较于无静脉血栓栓塞症的个体，合并静脉血栓栓塞症者发生轻度、中度及重度呼吸困难的校正后比值比（adjusted odds ratios）分别为1.6（95%置信区间：1.1~2.2）、1.8（1.2~2.6）与2.6（1.8~3.8）。相较于无静脉血栓栓塞症者，合并静脉血栓栓塞症者罹患哮喘及使用哮喘治疗药物的校正后比值比分别为1.6（1.2~2.2）与1.9（1.4~2.6）。在未接受抗凝治疗的个体中，合并与未合并静脉血栓栓塞症者的哮喘校正后比值比为2.0（95%CI：1.4~3.0），显著高于接受抗凝治疗者的1.0（95%CI：0.6~1.6）（交互作用P=0.02）。在丹麦人群中，合并静脉血栓栓塞症者的肺功能更低，重度呼吸困难风险升至2.6倍，哮喘发病风险升至1.6倍。