The potential impact of anaemia of chronic disease in COPD

Abstract

Anaemia of chronic disease (ACD), with chronically low levels of circulating haemoglobin, is an immune driven abnormality that occurs in many inflammatory diseases, and also in chronic heart failure. Although chronic obstructive pulmonary disease (COPD) is ''traditionally'' associated with polycythaemia, the systemic inflammation that is now recognised as a feature of COPD makes it a possible cause of ACD. If present in COPD, anaemia could worsen dyspnoea and limit exercise tolerance.Preliminary evidence suggests that anaemia in COPD patients may be more prevalent than expected, concerning 10-15% of patients suffering from severe forms of the disease. A database study conducted in 2,524 COPD patients being prescribed long-term oxygen therapy has shown that a low haematocrit is a strong predictor of survival in this population, before body mass index, and is associated with more hospitalisations and a longer cumulative duration of hospitalisation. COPD patients with low haemoglobin levels have a poorer prognosis than COPD patients with normal haemoglobin levels in the event of acute gastrointestinal bleeding or after elective aneurysm repair. Raising haemoglobinaemia through transfusion decreases minute ventilation and work of breathing in COPD patients.These preliminary evidences point to the need to study the prevalence of anaemia, and its physiological and clinical impact in chronic obstructive pulmonary disease. When this body of knowledge is available, the question of the putative benefits of raising haemoglobinaemia in chronic obstructive pulmonary disease will have to be addressed.

Study of Chronic Kidney Disease and Anemia in Chronic Obstructive Pulmonary Disease (Copd) Patients

“…Portillo et al (38) suggested that the rate of anemia is likely elevated in severe COPD when comparison was done between them and general COPD patients. In discordance to our result, Similowski et al (30) suggested that anemia in COPD patients may be more common than expected, presents in 10-15% of COPD patients who have severe forms of the disease. And Casanova et al (39) found that patients who had anemia tend to have more severe form of COPD in terms of FEV1, with a prevalence of anemia in cases with very severe COPD near 9%.…”

Diagnostics in anaemia of chronic disease in general practice: a real-world retrospective cohort study

“…If the patient was known to suffer from diabetes, chronic lung disease, or heart failure, and no other underlying cause of ACD could be established, these diseases were assigned as the underlying cause of ACD. [7][8][9][10][11][12][13] Any prescription of oral iron supplementation, as well as the time (in weeks) from the confirmation of ACD to the establishment of the underlying cause were also recorded.…”

“…[3][4][5][6] This type of anaemia can be caused by a variety of conditions, including acute and chronic infections, chronic diseases, autoimmune disorders, acute trauma, surgical interventions, renal failure, heart failure, and malignancies. [7][8][9][10][11][12][13] ACD is described as a functional iron deficiency caused by elevated hepcidin levels, which implies that oral iron supplementation is unnecessary. [14][15][16] Patients with ACD aged 50 years have a relative risk for mortality of 1.48 compared to adults without anaemia.…”

Chronic obstructive pulmonary disease prognostic score: A new index

“…Anemia is observed in 10 -15% of patients with COPD (ref. 34 ). Anemic COPD patients have a higher risk of death, morbidities, and hospital admission in comparison to non-anemic COPD patients [34][35][36] .…”

“…New findings from a variety of published studies were incorporated during the development of the COPD prognostic score . Hemoglobin levels were also regarded as a candidate component as studies have reported hemoglobin levels have considerable impact on the mortality of COPD patients [34][35][36][37] . In a conscious effort to simplify the use of this prognostic score, factors needing specialized facilities such as exercise tolerance tests or tests that are not easily duplicated, were excluded.…”