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Abstract
Chronic obstructive pulmonary disease produce significant extra pulmonary (systemic) manifestations including nutritional abnormalities, weight loss, skeletal muscle dysfunction, anemia and patients are at increased risk for myocardial infarction, osteoporosis, depression and sleep disorders (Hersh et al., 2004).
There is limited information in current literature describing distribution of Hb and its impact on outcome in COPD population (Zielinski et al., 1999).
Anemia presence is expected to worsen dyspnea and limit exercise tolerance (Similoweski et al., 2006).
Aim of the work:
The aim of this study was to study the Hb level in COPD patients and its clinical impact on dyspnea and exercise tolerance.
Subjects and methods:
This study was conducted on fifty stable COPD outpatients and fifty COPD inpatients admitted to the ward with an acute exacerbation. COPD diagnosis was
based on Global Initiative for Chronic Obstructive Lung Disease guideline, 2008.
All patients were subjected to history taking, careful general and local examination, chest X ray, pulmonary function studies, complete blood picture and BODE index including Body mass index, Airflow obstruction measured by FEV1, Dyspnea (MMRC dyspnea scale) and Exercise capacity measured by 6MWDT.
Results:
• In the current study anemia was prevalent in (28%) among stable COPD patients while applying an anemia threshold for Hb <13gm.dl for males and <11.5gm.dl for females.
• When comparing stable COPD patients and patients in an exacerbation regarding the prevalence of anemia, there was no significant difference between the two groups as anemia was prevalent in (30%) among COPD inpatients admitted with exacerbation.
• Dyspnea and exercise capacity examined by 6MWDT differed significantly between anemic and non anemic COPD patients. Mean MRC Dyspnea scale were significantly higher (2.6±0.6 versus 1.4±0.7; p=0.037) and 6MWDT was significantly shorter (264.9±51.7 m versus 286.6±50.0 m; p=0.041) in anemic compared with non anemic stable COPD patients this is explained by that anemia may result in limited oxygen supply and early onset of anaerobic threshold with increase in ventilatory drive.
• Anemic COPD patients carried higher physiological dysfunction burden as evidenced by higher BODE index. And develop more frequent exacerbations and longer duration of hospital stay when compared with non anemic COPD patients.
• Polycythemia was present in 4% among stable COPD patients and 8% of inpatient group with insignificant difference between the two groups.
• Polycythemia was not associated with increased dyspnea but it was associated with increased COPD severity as all polycythemic patients were in stage IV limited exercise tolerance compared with non polycythemic COPD patients as they had shorter 6MWD.
• There was a linear relationship between declining Hb and exercise tolerance in Hb range (11-17) gm.dl, but at Hb level above 17 gm.dl. the exercise tolerance decreases.
• The use of long term oxygen therapy may account for the low prevalence of polycythemia observed in the current study as 25% of patients included in the study were on long term oxygen therapy.