Anemia and iron deficiency in COPD patients: prevalence and the effects of correction of the anemia with erythropoiesis stimulating agents and intravenous iron

Abstract

BackgroundLittle is known about iron deficiency (ID) and anemia in Chronic Obstructive Pulmonary Disease (COPD). The purposes of this study were: (i) To study the prevalence and treatment of anemia and ID in patients hospitalized with an exacerbation of COPD. (ii) to study the hematological responses and degree of dyspnea before and after correction of anemia with subcutaneous Erythropoiesis Stimulating Agents (ESAs) and intravenous (IV) iron therapy, in ambulatory anemic patients with both COPD and chronic kidney disease.Methods(i) We examined the hospital records of all patients with an acute exacerbation of COPD (AECOPD) to assess the investigation, prevalence, and treatment of anemia and ID. (ii) We treated 12 anemic COPD outpatients with the combination of ESAs and IV-iron, given once weekly for 5 weeks. One week later we measured the hematological response and the severity of dyspnea by Visual Analogue Scale (VAS).Results(i) Anemia and iron deficiency in hospitalized COPD patients: Of 107 consecutive patients hospitalized with an AECOPD, 47 (43.9%) were found to be anemic on admission. Two (3.3%) of the 60 non-anemic patients and 18 (38.3%) of the 47 anemic patients had serum iron, percent transferrin saturation (%Tsat) and serum ferritin measured. All 18 (100%) anemic patients had ID, yet none had oral or IV iron subscribed before or during hospitalization, or at discharge. (ii) Intervention outpatient study: ID was found in 11 (91.7%) of the 12 anemic ambulatory patients. Hemoglobin (Hb), Hematocrit (Hct) and the VAS scale scores increased significantly with the ESAs and IV-iron treatment. There was a highly significant correlation between the ∆Hb and ∆VAS; rs = 0.71 p = 0.009 and between the ∆Hct and ∆VAS; rs = 0.8 p = 0.0014.ConclusionsID is common in COPD patients but is rarely looked for or treated. Yet correction of the ID in COPD patients with ESAs and IV iron can improve the anemia, the ID, and may improve the dyspnea.

Independent Risk Factors for Mortality in Patients with Chronic Obstructive Pulmonary Disease Who Undergo Comprehensive Cardiac Evaluations

“…However, the prevalence in our cohort is a little lower than that in a recent report where 43.9% were found to be anemic on admission due to COPD with acute exacerbation [26]. …”

Non‐anaemic iron deficiency impairs response to pulmonary rehabilitation in COPD

“…5,6 It is of note that, while the NAID phenomenon on aerobic capacity has been explored in CHF 7,8 and IPAH, 9 data in COPD do not provide a clear response to the problem. One report 10 studied iron status in a marginal number of nonanaemic COPD patients, and two additional studies only studied iron deficiency in COPD patients with anaemia. 11,12 Moreover, to our knowledge, no previous studies have addressed the effects of endurance training in chronic patients suffering from NAID.…”

“…[7][8][9] In contrast, in patients with chronic obstructive pulmonary disease (COPD), iron deficiency has only been studied in the context of anaemia. [10][11][12] Patients with COPD often show oxygen delivery impairment during exercise. Moreover, skeletal muscle dysfunction is a well recognized systemic effect of the disease that can be associated to abnormal mitochondrial oxygen utilization.…”

Nutritional assessment and therapy in COPD: a European Respiratory Society statement

“…A recent study has extended this association to include the evolution of the disease, revealing that high cured meat consumption is linked to a higher risk of readmission to hospital with COPD [126]. Finally, albeit rarely assessed in clinical practice, iron deficiency often occurs in COPD, which may be caused by several factors including systemic inflammation, malabsorption of iron from the gut, renal failure (as a consequence of concomitant chronic kidney disease or diabetes mellitus), and medications such as angiotensin-converting enzyme inhibitors and corticosteroids [127]. Overall, the evidence indicates that a well-balanced diet with sufficient intake of fresh fruits and vegetables is beneficial to COPD patients, not only for its potential benefits on the lung, but also for its proven benefits on metabolic and cardiovascular risk.…”