Association between anemia and quality of life in a population sample of individuals with chronic obstructive pulmonary disease

Krishnan, Gokul; Grant, Brydon J. B.; Muti, Paola; Mishra, Archana; Ochs‐Balcom, Heather M.; Freudenheim, Jo L.; Trevisan, Maurizio; Schünemann, Holger J.

doi:10.1186/1471-2466-6-23

Cited by 59 publications

(70 citation statements)

References 23 publications

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“…We found only one study (conducted in the USA) in which the hemoglobin levels of COPD patients correlated positively with the physical components of the SF-36 (r 2 = 0.0850; p = 0.003). (27) A study conducted in Brazil and involving renal failure patients on hemodialysis also showed that decreased hemoglobin levels correlated with pain (r = 0.22; p = 0.018), (28) suggesting that, regardless of the type of disease, low hemoglobin levels can increase the levels of bodily pain.…”

Section: Discussionmentioning

confidence: 99%

Influência das características sociodemográficas e clínicas e do nível de dependência na qualidade de vida de pacientes com DPOC em oxigenoterapia domiciliar prolongada

et al. 2012

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Objective: To evaluate and correlate the quality of life (QoL) of COPD patients on long-term home oxygen therapy (LTOT) with their sociodemographic/clinical characteristics and level of dependence. Methods: This was a crosssectional analytical study involving COPD patients on LTOT followed at the Oxygen Therapy Outpatient Clinic of the Federal University of São Paulo Hospital São Paulo, in the city of São Paulo, Brazil. Sociodemographic, clinical, and biochemical data were collected. We assessed QoL and level of dependence using the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) and the Katz index, respectively. Multiple linear regression models were constructed in order to determine the influence of these variables on QoL. Results: We included 80 patients in the study. The mean age was 69.6 ± 9.1 years, and 51.3% were female. The lowest SF-36 scores were for the physical functioning and role-physical domains. All sociodemographic characteristics (except gender) were found to correlate significantly with the SF-36 domains mental health, vitality, role-physical, and social functioning. We also found that body mass index, PaO 2 , post-bronchodilator FEV 1 , hemoglobin, and Katz index correlated significantly with the physical functioning, mental health, role-physical, and bodily pain domains. In addition, oxygen flows were found to correlate negatively with the physical functioning, mental health, vitality, and role-emotional domains. Conclusions: Low scores for SF-36 domains, as well as the variables that negatively influence them, should be considered and analyzed during the development and implementation of strategies for improving the QoL of COPD patients on LTOT.Keywords: Pulmonary disease, chronic obstructive; Quality of life; Oxygen inhalation therapy. ResumoObjetivo: Avaliar e correlacionar a qualidade de vida (QV) de pacientes com DPOC em uso de oxigenoterapia domiciliar prolongada (ODP) com suas características sociodemográficas/clínicas e o nível de dependência. Métodos: Estudo transversal analítico com portadores de DPOC em ODP acompanhados no Ambulatório de Oxigenoterapia do Hospital São Paulo, Universidade Federal de São Paulo, em São Paulo (SP). Os pacientes foram avaliados quanto aos dados sociodemográficos, clínicos e laboratoriais. A qualidade de vida e o nível de dependência foram avaliados pelo Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) e índice de Katz, respectivamente. Modelos de regressão linear múltipla foram construídos para verificar a influência dessas variáveis na QV. Resultados: A média de idade dos 80 pacientes incluídos foi 69,6 ± 9,1 anos, e 51,3% eram do sexo feminino. Os escores dos domínios do SF-36 mais baixos foram capacidade funcional e função física. Correlações significantes foram encontradas entre características sociodemográficas (exceto gênero) e os domínios saúde mental, vitalidade, função física e aspectos sociais, assim como entre várias características clínicas/laboratoriais (índice de massa corpórea, PaO 2 , VEF 1 pós-bro...

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Section: Discussionmentioning

confidence: 99%

Influência das características sociodemográficas e clínicas e do nível de dependência na qualidade de vida de pacientes com DPOC em oxigenoterapia domiciliar prolongada

et al. 2012

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“…Most studies addressing the importance of Hb and/or Hc in COPD have focused on the common definitions of anemia and polycythemia, [32][33][34] despite the fact that the respective cutoff values have never been validated with regard to their prognostic value in COPD. To evaluate the clinical impact of Hb levels in detail and to answer the question whether there is an optimal threshold and where it is, we checked all percentiles of Hb and found optimal cutoff values of 14.3 g/dL for females and 15.1 g/dL for males for predicting long-term survival.…”

Section: Discussionmentioning

confidence: 99%

Hemoglobin Levels Above Anemia Thresholds Are Maximally Predictive for Long-Term Survival in COPD With Chronic Respiratory Failure

et al. 2012

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BACKGROUND: In patients with COPD, chronic anemia is known as an unfavorable prognostic factor. Whether the association between hemoglobin (Hb) levels and long-term survival is restricted to anemia or extends to higher Hb levels has not yet been systematically assessed. METHODS: We determined Hb levels in 309 subjects with COPD and chronic respiratory failure prior to initiation of noninvasive ventilation, accounting for confounders that might affect Hb. Subjects were categorized as anemic (Hb < 12 g/dL in females, Hb < 13 g/dL in males), polycythemic (Hb > 15 g/dL in females, Hb > 17 g/dL in males), or normocythemic. In addition, percentiles of Hb values were analyzed with regard to mortality from any cause. RESULTS: Two-hundred seven subjects (67.0%) showed normal Hb levels, 46 (14.9%) had anemia, and 56 (18.1%) had polycythemia. Polycythemic subjects showed a higher survival rate than anemic (P ‫؍‬ .01) and normocythemic subjects (P ‫؍‬ .043). In a univariate Cox hazards model, Hb was associated with long-term survival (hazard ratio 0.855; 95% CI 0.783-0.934, P < .001). The 58th percentiles of Hb (14.3 g/dL in females, 15.1 g/dL in males) yielded the highest discriminative value for predicting survival (hazard ratio 0.463, 95% CI 0.324 -0.660, P < .001). In the multivariate analysis this cutoff was an independent predictor for survival (hazard ratio 0.627, 95% CI 0.414 -0.949, P ‫؍‬ .03), in addition to age and body mass index. CONCLUSIONS: In subjects with COPD and chronic respiratory failure undergoing treatment with noninvasive ventilation and LTOT, high Hb levels are associated with better long-term survival. The optimal cutoff level for prediction was above the established threshold defining anemia. Thus, predicting survival only on the basis of anemia does not fully utilize the prognostic potential of Hb values in COPD.

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“…The level of haemoglobin is strongly and independently associated with increased functional dyspnoea and decreased exercise capacity, and is therefore an important contributor to functional capacity as well as a poor quality of life [115,117]. In some studies, anaemia is an independent predictor of mortality [118].…”

Section: Arterial Stiffness and Endothelial Functionmentioning

confidence: 99%

Systemic manifestations and comorbidities of COPD

Barnes¹,

Celli²

2009

European Respiratory Journal

1,465

1,113

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Increasing evidence indicates that chronic obstructive pulmonary disease (COPD) is a complex disease involving more than airflow obstruction. Airflow obstruction has profound effects on cardiac function and gas exchange with systemic consequences. In addition, as COPD results from inflammation and/or alterations in repair mechanisms, the ''spill-over'' of inflammatory mediators into the circulation may result in important systemic manifestations of the disease, such as skeletal muscle wasting and cachexia. Systemic inflammation may also initiate or worsen comorbid diseases, such as ischaemic heart disease, heart failure, osteoporosis, normocytic anaemia, lung cancer, depression and diabetes. Comorbid diseases potentiate the morbidity of COPD, leading to increased hospitalisations, mortality and healthcare costs. Comorbidities complicate the management of COPD and need to be evaluated carefully. Current therapies for comorbid diseases, such as statins and peroxisome proliferator-activated receptor-agonists, may provide unexpected benefits for COPD patients. Treatment of COPD inflammation may concomitantly treat systemic inflammation and associated comorbidities. However, new broad-spectrum anti-inflammatory treatments, such as phosphodiesterase 4 inhibitors, have significant side-effects so it may be necessary to develop inhaled drugs in the future. Another approach is the reversal of corticosteroid resistance, for example with effective antioxidants. More research is needed on COPD comorbidities and their treatment.

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Association between anemia and quality of life in a population sample of individuals with chronic obstructive pulmonary disease

Abstract: Background: Several studies investigated the association of anemia with health related quality of life (HRQL) in patients with chronic disease. However, there is little evidence regarding the association of anemia with HRQL in patients with chronic obstructive pulmonary disease (COPD).

Cited by 59 publications

References 23 publications

Influência das características sociodemográficas e clínicas e do nível de dependência na qualidade de vida de pacientes com DPOC em oxigenoterapia domiciliar prolongada

Influência das características sociodemográficas e clínicas e do nível de dependência na qualidade de vida de pacientes com DPOC em oxigenoterapia domiciliar prolongada

Hemoglobin Levels Above Anemia Thresholds Are Maximally Predictive for Long-Term Survival in COPD With Chronic Respiratory Failure

Systemic manifestations and comorbidities of COPD

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