COPD: Anaemia Is An Independent Risk Factor For Reduced Functional Capacity

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Anaemia is a condition affecting patients who suffer from a variety of chronic illness. It has been found to be present in people with congestive heart failure, arthritis, cirrhosis of the liver, kidney failure and AIDS among others. Chronic obstructive pulmonary disease or COPD is also a chronic illness affecting adults. Although it is a disease of the lungs, it is also one that has important systemic consequences.


Because of the close relationship between oxygenation and haemoglobin (Hb) production and the fact that prior to the widespread use of oxygen to treat the hypoxia of severe COPD many patients had increased Hb (polycythaemia), it has been assumed that anaemia was a rare occurrence among these people.
However, as COPD is associated with inflammation it has become possible that the levels of Hb are abnormal in the patients as we see them today.



To answer that question, Claudia Cote (Dept of Medicine, Respiratory Disease Section, Bay Pines VAMC, Florida, USA) and her colleagues have investigated the prevalence and association of abnormal Hb with clinical outcomes.


Analysis of a prospective cohort of 683 stable COPD outpatients in a US Veterans Administration pulmonary clinic was performed.


The results show that anaemia is present in 116 (17%) and polycythaemia in 40 (6%) patients. While the only value that differs between polycythaemic and non-polycythaemic patients is mean Hb, anaemic patients have a significantly higher sensation of shortness of breath, lower capacity to exercise and shorter median survival (49 vs 74 months) than non-anaemic patients. Anaemia independently predicts dyspnoea and reduced exercise capacity.



The American team concludes that anaemia in COPD is an independent risk factor for reduced functional capacity. Polycythaemia prevalence is low and has no association with worsened outcomes. Further work is required to evaluate the effect of anaemia correction on outcomes in COPD.



"Haemoglobin level and its clinical impact in a cohort of patients with COPD"

European Respiratory Journal (ERJ)