Journal Information
Vol. 43. Issue 7.
Pages 392-398 (January 2007)
Share
Share
Download PDF
More article options
Vol. 43. Issue 7.
Pages 392-398 (January 2007)
Review Article
Full text access
Anemia in COPD: Should It Be Taken Into Consideration?
Visits
16231
Karina Portillo Carroz
Corresponding author
karisoe@yahoo.es

Correspondence: Dra K. Portillo Carroz. Servicio de Neumología. Consorcio Sanitario Integral. Hospital Dos de Maig. Dos de Maig, 301. 08025 Barcelona. España
Servicio de Neumología, Consorcio Sanitario Integral, Hospital Dos de Maig, Barcelona, Spain
This item has received
Article information
Abstract
Bibliography
Download PDF
Statistics

Recent recognition of the importance of nonpulmonary signs and symptoms in the management and prognosis of chronic obstructive pulmonary disease (COPD) has led to a shift in the focus of diagnostic and therapeutic strategies to encompass these aspects. We no longer concentrate on assessing a single functional variable (forced expiratory volume in 1 second) as a predictor of survival in these patients. Most of the research undertaken to date into COPD-related systemic disorders has targeted weight loss, muscular dysfunction, osteoporosis, and cardiovascular disease. However, the abnormal inflammatory response associated with COPD may provoke other disorders such as anemia. Moreover, comorbid anemia has been shown to be an independent predictor of mortality in several chronic diseases including cancer and heart failure. Anemia is, therefore, an entity that should be taken into consideration in the overall management of respiratory disease because it may have a clear detrimental impact on various aspects of the patient's health, including dyspnea, exercise tolerance, and quality of life.

There is a growing body of literature on the relationship between anemia and COPD. Our aim is to briefly review the pathophysiologic aspects of this association before going on to discuss some of the most recent evidence published.

Key words:
Anemia
COPD
Erythrocytosis

El reconocimiento reciente de la importancia que tienen las manifestaciones extrapulmonares, tanto en el manejo como en el pronóstico de la enfermedad pulmonar obstructiva crónica (EPOC) ha llevado a que reconduzcamos las estrategias diagnósticas y terapéuticas hacia ellas, y que no centremos nuestros esfuerzos en valorar sólo una variable funcional (el volumen espiratorio forzado en el primer segundo) como marcador de supervivencia en estos pacientes. Los trastornos sistémicos relacionados con la EPOC más estudiados son la pérdida de peso, la disfunción muscular, la osteoporosis y la enfermedad cardiovascular. Sin embargo, hay otros posibles efectos, como el síndrome anémico, que también podría ser consecuencia de la anormal respuesta inflamatoria que se produce en esta enfermedad. Por otra parte, la anemia como comorbilidad asociada a ciertas enfermedades crónicas, caso del cáncer y de la insuficiencia cardíaca, ha demostrado actuar como un marcador de mortalidad independiente. Se trata, por lo tanto, de una entidad que debe tenerse en cuenta en el manejo integral del paciente respiratorio, ya que puede tener un impacto claramente perjudicial en diversos aspectos de la enfermedad, como la disnea, la tolerancia al ejercicio y la calidad de vida.

En la literatura médica hay un número creciente de estudios que abordan la relación entre la anemia y la EPOC. Esta revisión se centrará en revisar brevemente los aspectos fisiopatológicos relacionados con el tema y en discutir algunas de las últimas evidencias publicadas hasta el momento.

Palabras clave:
Anemia
EPOC
Eritrocitosis
Full text is only aviable in PDF
REFERENCES
[1]
E Braunwald.
Hipoxia, policitemia y cianosis.
Harrison. Principios de medicina interna, pp. 235-239
[2]
R Hillman.
Anemia.
Harrison. Principios de medicina interna, pp. 379-384
[3]
World Health Organization.
Nutritional anemia: report of a WHO Scientific Group. Geneva: World Health Organization; 1968.
Tech Rep Ser, 405 (1968), pp. 5-37
[4]
G Pavlisa, V Vrbanic, V Kusec, B Jaksic.
Erythropoietin response after correction of severe hypoxaemia due to acute respiratory failure in chronic obstructive pulmonary disease patients.
Clin Sci, 106 (2004), pp. 43-51
[5]
R Hillman.
Anemia ferropénica y otras anemias hipoproliferativas.
Harrison. Principios de medicina interna, pp. 729-737
[6]
T Similowski, A Agustí, W MacNee, B Schonhofer.
The potential impact of anaemia of chronic disease in COPD.
Eur Respir J, 27 (2006), pp. 390-396
[7]
S Tassiopoulos, A Kontos, K Konstantopoulos, C Hadzistavrou, G Vaiopoulos, A Aessopos, et al.
Erythropoietic response to hypoxaemia in diffuse idiopathic pulmonary fibrosis, as opposed to chronic obstructive pulmonary disease.
Respir Med, 95 (2001), pp. 471-475
[8]
M John, S Hoernig, W Doehner, DD Okonko, C Witt, SD Anker.
Anemia and inflammation in COPD.
Chest, 127 (2005), pp. 825-829
[9]
AG Agusti.
Systemic effects of chronic obstructive pulmonary disease.
Proc Am Thorac Soc, 2 (2005), pp. 367-370
[10]
E Wouters.
Local and systemic inflammation in chronic obstructive pulmonary disease.
Proc Am Thorac Soc, 2 (2005), pp. 26-33
[11]
JR Hurst, WR Perera, TM Wilkinson, GC Donaldson, JA Wedzicha.
Systemic and upper and lower airway inflammation at exacerbation of chronic obstructive pulmonary disease.
Am J Respir Crit Care Med, 173 (2006), pp. 71-78
[12]
VM Pinto-Plata, H Mullerova, JF Toso, M Feudjo-Tepie, JB Soriano, RS Vessey, et al.
C-reactive protein in patients with COPD, control smokers and non-smokers.
Thorax, 61 (2006), pp. 23-28
[13]
DD Sin, SF Man.
Skeletal muscle weakness, reduced exercise tolerance, and COPD: is systemic inflammation the missing link?.
[14]
G Weiss, LT Goodnough.
Anemia of chronic disease.
N Engl J Med, 352 (2005), pp. 1011-1023
[15]
AE Tsantes, SI Papadhimitriou, ST Tassiopoulos, S Bonovas, G Paterakis, I Meletis, et al.
Red cell macrocytosis in hypoxemic patients with chronic obstructive pulmonary disease.
Respir Med, 98 (2004), pp. 1117-1123
[16]
E García-Pachón, I Padilla-Navas.
Red cell macrocytosis in COPD patients without respiratory insufficiency: a brief report.
Respir Med, 101 (2007), pp. 349-352
[17]
S Andreas, SD Anker, PD Scanlon, VK Somers.
Neurohumoral activation as a link to systemic manifestations of chronic lung disease.
Chest, 128 (2005), pp. 3618-3625
[18]
DV Vlahakos, KP Marathias, B Agroyannis, NE Madias.
Posttransplant erythrocytosis.
Kidney Int, 63 (2003), pp. 1187-1194
[19]
D Vlahakos, E Kosmas, I Dimopoulou, E Ikonomou, G Jullien, P Vassilakos, et al.
Association between activation of the reninangiotensin system and secondary erythrocytosis in patients with chronic obstructive pulmonary disease.
Am J Med, 106 (1999), pp. 158-164
[20]
I Pham, P Andrivet, S Sediame, C Defouilloy, S Moutereau, et al.
Increased erythropoietin synthesis in patients with COLD or left heart failure is related to alterations in renal haemodynamics.
Eur J Clin Invest, 31 (2001), pp. 103-109
[21]
AE Tsantes, ST Tassiopoulos, SI Papadhimitriou, S Bonovas, N Poulakis, A Vlachou, et al.
Theophylline treatment may adversely affect the anoxia-induced erythropoietic response without suppressing erythropoietin production.
Eur J Clin Pharmacol, 59 (2003), pp. 379-383
[22]
R Casaburi, S Bhasin, L Cosentino, J Porszasz, A Somfay, MI Lewis, et al.
Effects of testosterone and resistance training in men with chronic obstructive pulmonary disease.
Am J Respir Crit Care Med, 170 (2004), pp. 870-878
[23]
L Ferrucci, M Maggio, S Bandinelli, S Basaria, F Lauretani, A Ble, et al.
Low testosterone levels and the risk of anemia in older men and women.
Arch Intern Med, 166 (2006), pp. 1380-1388
[24]
DS Silverberg, D Wexler, M Blum, D Schwartz, Y Wollman, A Iaina.
The cardio-renal anaemia syndrome: does it exist?.
Nephrol Dial Transplant, 18 (2003), pp. 7
[25]
J Lupón, A Urrutia, B González, J Herreros, S Altimir, R Coll, et al.
Significado pronóstico de los valores de hemoglobina en pacientes con insuficiencia cardíaca.
Rev Esp Cardiol, 58 (2005), pp. 48-53
[26]
T Horwich, G Fonarow, M Hamilton, W MacLellan, J Borenstein.
Anemia is associated with worse symptoms, greater impairment in functional capacity and a significant increase in mortality in patients with advanced heart failure.
J Am Coll Cardiol, 39 (2002), pp. 1780-1786
[27]
M John, A Lange, S Hoernig, C Witt, SD Anker.
Prevalence of anemia in chronic obstructive pulmonary disease: comparison to other chronic diseases.
Int J Cardiol, 111 (2006), pp. 365-370
[28]
A Tsantes, S Bonovas, S Tassiopoulos, K Filioussi, A Vlachou, J Meletis, et al.
A comparative study of the role of erythropoietin in the pathogenesis of deficient erythropoiesis in idiopathic pulmonary fibrosis as opposed to chronic obstructive pulmonary disease.
Med Sci Monit, 11 (2005), pp. CR177-CR181
[29]
TM O'Connor, McGrath DS, C Short, MJ O'Donnell, M Sheehy, CP Bredin.
Subclinical anaemia of chronic disease in adult patients with cystic fibrosis.
J Cyst Fibros, 1 (2002), pp. 31-34
[30]
V Gutiérrez, M Olivera, R Girón, F Rodríguez-Salvanés, P Caballero.
Fibrosis quística en adultos: acuerdos inter e intraobservador para las escalas de puntuación de Brasfield y Chrispin-Norman en la radiografía de tórax y relación con datos clínicos y espirométricos.
Arch Bronconeumol, 41 (2005), pp. 553-559
[31]
R Cantón, N Cobos, J de Gracia, F Baquero, J Honorato, S Gartner, et al.
(en representación del Grupo Español de Consenso del Tratamiento Antimicrobiano en el Paciente con Fibrosis Quística). Tratamiento antimicrobiano frente a la colonización pulmonar por Pseudomonas aeruginosa en el paciente con fibrosis quística.
Arch Bronconeumol, 41 (2005), pp. 1-25
[32]
B Schonhofer, M Wenzel, M Geibel, D Kohler.
Blood transfusion and lung function in chronically anemic patients with severe chronic obstructive pulmonary disease.
Crit Care Med, 26 (1998), pp. 1824-1828
[33]
B Schonhofer, H Bohrer, D Kohler.
Importance of blood transfusion in anemic patients with COPD and unsuccessful weaning from respirator.
Med Klin, (1999), pp. 108-110
[34]
BR Celli, CG Cote, JM Marín, C Casanova, M Montes de Oca, RA Méndez, et al.
The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease.
N Engl J Med, 350 (2004), pp. 1005-1012
[35]
A Chambellan, E Chailleux, T Similowski, ANTADIR Observatory Group.
Prognostic value of the hematocrit in patients with severe COPD receiving long-term oxygen therapy.
Chest, 128 (2005), pp. 1201-1208
[36]
FJ Martínez, G Foster, JL Curtis, G Criner, G Weinmann, A Fishman, et al.
NETT Research Group. Predictors of mortality in patients with emphysema and severe airflow obstruction.
Am J Respir Crit Care Med, 173 (2006), pp. 1326-1334
[37]
B Celli.
Predicting mortality in chronic obstructive pulmonary disease: chasing the “Holy Grail”.
Am J Respir Crit Care Med, 173 (2006), pp. 1298-1299
Copyright © 2007. Sociedad Española de Neumología y Cirugía Torácica (SEPAR)
Archivos de Bronconeumología
Article options
Tools

Are you a health professional able to prescribe or dispense drugs?