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The potential impact of anaemia of chronic disease in COPD

¹ Service de Pneumologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and UPRES EA2397 Université Paris VI Pierre et Marie Curie, Paris, France. ² Servei Pneumología, Hospital Universitari Son Dureta, Palma de Mallorca, Spain. ³ Respiratory Medicine Unit, Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK. ⁴ Abteilung für Pneumologie und Intensivmedizin, Klinikum Hannover – Oststadtkrankenhaus, Hanover, Germany.

CORRESPONDENCE: T. Similowski, Service de Pneumologie & Reanimation, Groupe Hospitalier Pitie-Salpetriere, 47-83 Bd de l'Hopital, 75651 Paris 13, France. Fax: 33 142176708. E-mail: thomas.similowski{at}psl.ap-hop-paris.fr

Keywords: Anaemia, anaemia of chronic disease, chronic obstructive pulmonary disease, erythropoietin

Received: December 15, 2004
Accepted August 15, 2005

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.

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