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. 2015 May 8:15:58.
doi: 10.1186/s12890-015-0050-y.

Anemia and hemoglobin serum levels are associated with exercise capacity and quality of life in chronic obstructive pulmonary disease

Marcello Ferrari  1   2 , Lorenzo Manea  3   4 , Kamel Anton  5 , Paola Bruzzone  6 , Mara Meneghello  7 , Francesco Zamboni  8 , Luigi Purgato  9 , Lucia Cazzoletti  10 , Pietro Ferrari  11 , Renato Testi  12
Affiliations

Anemia and hemoglobin serum levels are associated with exercise capacity and quality of life in chronic obstructive pulmonary disease

Marcello Ferrari et al. BMC Pulm Med. .

Abstract

Background: Little is known about the relationship between hemoglobin concentrations, functional status and health related quality of life (HRQL) in chronic obstructive pulmonary disease (COPD). Our aim was to investigate the prevalence of anemia and the association of hemoglobin with shortness of breath, exercise capacity, muscle strength and HRQL, in COPD patients.

Methods: A total of 105 COPD patients (77 males, 71.6 ± 9.2 years) were studied. Patients were classified as anemic and non anemic using the WHO criteria. We used the Medical Research Council Dyspnoea scale (MRCs) to measure shortness of breath. Exercise capacity was assessed using the six minute walking distance (6MWD) and the peak of VO2 during the maximal cycle ergometer test (VO2max). We used the Quadriceps and Handgrip strength assessment to determine muscle strength. The Saint George Respiratory Questionnaire was used to investigate HRQL. The physiological/functional characteristics of the two groups were compared. Regression models adjusting for confounders examined the independent association of anemia and of hemoglobin levels with clinical and functional outcomes.

Results: Anemic patients (12.3%) showed a significantly higher MRCs, a lower 6MWD, VO2max, and a worse quality of life. On the contrary, there was no difference in muscle strength between the two groups. In the regression models, hemoglobin was independently associated with reduced exercise capacity and HRQL.

Conclusions: Anemia in COPD was a risk factor for poorer exercise capacity and quality of life, and these outcomes were linearly associated with hemoglobin. Our results should stimulate further research into exploring whether increasing hemoglobin has a beneficial effect on the outcomes in COPD.

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Figures

Figure 1
Figure 1
Hemoglobin and exercise capacity. Relationship between hemoglobin (Hb) level and six Minutes Walking Distance (6MWD), maximal oxygen consumption (VO2max) and Medical Research Council dysnoea scale (MRCs).
Figure 2
Figure 2
Hemoglobin and quality of life. Relationship between hemoglobin (Hb) level and the St George Respiratory Questionnaire (SGRQ) total ( formula image ), activity ( formula image ), symptoms ( formula image ) and impact ( formula image ) scores.
Figure 3
Figure 3
Relationship between hemoglobin, six Minutes Walking Distance and St George Respiratory Questionnaire. Results of a multivariate analysis of the relationship between hemoglobin (Hb) level and six Minutes Walking Distance (6MWD) (panel A) and the St George Respiratory Questionnaire (SGRQ) total score (panel B). The predicted values of the 6MWT and SGRQ score were obtained by a regression model adjusted for sex, age, Body Mass Index (BMI), smoking habits, FEV1, the Charlson’s Comorbidity Index and the serum concentration of C-reactive Protein.
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