The Indian Journal of Chest Diseases and Allied Sciences

Register      Login

VOLUME 64 , ISSUE 4 ( October-December, 2022 ) > List of Articles

Original Article

Potential Impact of Anemia and Iron Deficiency in Chronic Obstructive Pulmonary Disease Patients and its Relation to Serum Levels of Erythropoietin

Seema Singh, S K Verma

Keywords : Anemia, Chronic obstructive pulmonary disease, Erythropoietin, Iron deficiency, Renal failure

Citation Information : Singh S, Verma SK. Potential Impact of Anemia and Iron Deficiency in Chronic Obstructive Pulmonary Disease Patients and its Relation to Serum Levels of Erythropoietin. Indian J Chest Dis Allied Sci 2022; 64 (4):247-252.

DOI: 10.5005/jp-journals-11007-0039

License: CC BY-NC 4.0

Published Online: 05-01-2023

Copyright Statement:  Copyright © 2022; The Author(s).


Background: Little is known about iron deficiency (ID) and anemia in chronic obstructive pulmonary disease (COPD). To study the prevalence and treatment of anemia in patients of COPD and to check the hemoglobin level in all patients with COPD and to assess the quality of life (QOL) by administering the questionnaire in anemic COPD patients and comparing it with nonanemic COPD patients. Methods: We examined the subjects and administered a questionnaire based on dyspnea score to assess the impact of anemia on quality of life in patients of COPD. A total of 250 COPD patients were enrolled in the study, in that 62 patients were anemic and 188 patients were nonanemic in COPD patients. Results: The proportion of patients of nonanemic was found to be higher as compared with anemia having modified medical research council (mMRC) grade I (35.71% vs 20.00%), grade II (40.48% vs 26.67%), and grade IV (11.90% vs 6.67%), while the proportion of patients of anemia was found to be higher than that of nonanemic having mMRC grade III (46.67% vs 11.90%). Difference in mMRC grade of patients of anemia and nonanemic was found to be statistically highly significant. Out of 250 patients of COPD, hemoglobin levels of 62 (26.32%) were found to be below normal levels and were diagnosed as anemic and classified as anemia in the present study, while hemoglobin levels of the rest 188 (73.68%) patients were found to be normal and were classified as nonanemic. Prevalence of anemia in COPD = 24.87%. Conclusion: Anemia occurs frequently in patients of COPD and is associated with poor quality of life and increased morbidity in the form of number of exacerbations and hospital admissions. Correcting anemia in these patients may improve their clinical outcomes.

PDF Share
  1. Copur AS, Fulambarker A, Molnar J, et al. Role of anemia in home oxygen therapy in chronic obstructive pulmonary disease patients. Am J Ther 2015;22(5):361–366. DOI: 10.1097/MJT.0b013e3182785f7c.
  2. Kollert F, Müller C, Tippelt A, et al. Anaemia in chronic respiratory failure. Int J Clin Pract 2011;65(4):479–486. DOI: 10.1111/j.1742-1241.2011.02631.x.
  3. Kollert F, Tippelt A, Müller C, et al. Hemoglobin levels above anemia thresholds are maximally predictive for long-term survival in COPD with chronic respiratory failure. Respir Care 2013;58(7):1204–1212. DOI: 10.4187/respcare.01961.
  4. Kim J, Kim K, Kim Y, et al. The association between inhaled longacting bronchodilators and less in-hospital care in newly-diagnosed COPD patients. Respir Med 2014;108(1):153–161. DOI: 10.1016/j.rmed. 2013.08.003.
  5. Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2016. Available from:
  6. Rhee CK, Yoon HK, Yoo KH, et al. Medical utilization and cost in patients with overlap syndrome of chronic obstructive pulmonary disease and asthma. COPD 2014;11(2):163–170. DOI: 10.3109/15412555.2013. 831061.
  7. Carroz KP, Morera J. Anemia in Chronic Obstructive Pulmonary Disease. In: Donald Silverberg (Ed.), Anemia. London: IntechOpen; 2012 [Last accessed February 02 2018], ISBN: 978-953-51-0138-3.
  8. Boutou AK, Karrar S, Hopkinson NS, et al. Anemia and survival in chronic obstructive pulmonary disease: A dichotomous rather than acontinuous predictor. Respiration 2013;85(2):126–131. DOI: 10.1159/000338792.
  9. Boutou AK, Stanopoulos I, Pitsiou GG, et al. Anemia of chronic disease in chronic obstructive pulmonary disease: A case–control study of cardiopulmonary exercise responses. Respiration 2011;82(3):237–245. DOI: 10.1159/000326899.
  10. Zavarreh RH, Zahmatkesh MM, Vakili M, et al. Association between anemia and COPD in Iranian population. Int J Hematol Oncol Stem Cell Res 2013;7(2):6–10. PMCID: PMC3913136.
  11. Ferrari M, Manea L, Anton K, et al. Anemia and hemoglobin serum levels are associated with exercise capacity and quality of life in chronic obstructive pulmonary disease. BMC Pulm Med 2015;15:58. DOI: 10.1186/s12890-015-0050-y.
  12. Leshem-Rubinow E, Steinvil A, Zeltser D, et al. Association of angiotensin-converting enzyme inhibitor therapy initiation with a reduction in hemoglobin levels in patients without renal failure. Mayo Clin Proc 2012;87(12):1189–1195. DOI: 10.1016/j.mayocp.2012.07.020.
  13. Jankowska EA, von Haehling S, Anker SD, et al. Iron deficiency and heart failure: Diagnostic dilemmas and therapeutic perspectives. Eur Heart J 2013;34(11):816–829. DOI: 10.1093/eurheartj/ehs224.
  14. Parveen S, Rangreze I, Ahmad SN, et al. Prevalence of anemia in patients with COPD and its potential impact on morbidity of COPD patients. Int J Clin Med 2014;5(8):452–458. DOI: 10.4236/ijcm.2014.58063.
  15. Krishnan G, Grant BJ, Muti PC, et al. Association between anemia and quality of life in a population sample of individuals with chronic obstructive pulmonary disease. BMC Pulm Med 2006;23(6).
  16. Silverberg DS, Mor R, Weu MT, et al. Anemia and iron deficiency in COPD patients: Prevalence and the effects of correction of the anemia with erythropoiesis stimulating agents and intravenous iron. BMC Pulm Med 2014;14:24. DOI: 10.1186/1471-2466-14-24.
  17. Halpern MT, Zilberberg MD, Schmier JK, et al. Anemia, costs and mortality in chronic obstructive pulmonary disease. Cost Eff Resour Alloc 2006;17(4). DOI: 10.1186/1478-7547-4-17.
  18. John M, Hoernig S, Doehner W, et al. Anemia and Inflammation in COPD. Chest 2005;127. 825–829. 127.3.825.
  19. El-Korashy RI, Amin YM, Moussa HA, et al. Study the relationship of erythropoietin and chronic obstructive pulmonary disease. Egypt J Chest Dis Tuberc 2012;61(3):53–57. DOI: 10.1016/j.ejcdt.2012.10.026.
  20. Cote C, Zilberberg MD, Mody SH, et al. Haemoglobin level and its clinical impact in a cohort of patients with COPD. Eur Respir J 2007; 29(5):923–929. Epub 2007 Jan 24. DOI: 10.1183/09031936.00137106.
  21. Casanova LC, Echave-Sustaeta JM, Luján RG, et al. Prevalence of anaemia associated with chronic obstructive pulmonary disease. Study of associated variables. Arch Bronconeumol 2013;49(9): 383–387. DOI: 10.1016/j.arbres.2013.04.007.
  22. Ruiter G, Lankhorst S, Boonstra A, et al. Iron deficiency is common in idiopathic pulmonary arterial hypertension. Eur Respir J 2011; 37(6):1386–1391. DOI: 10.1183/09031936.00100510.
  23. Portillo K, Martinez-Rivera C, Ruiz-Manzano J. Anaemia in chronic obstructive pulmonary disease. Does it really matter? Int J Clin Pract 2013;67(6):558–565. DOI: 10.1111/ijcp.12125.
  24. Martinez-Rivera C, Portillo K, Muñoz-Ferrer A, et al. Anemia is a mortality predictor in hospitalized patients for COPD exacerbation. COPD 2012;9(3):243–250. DOI: 10.3109/15412555.2011.647131.
  25. Barba R, de Casasola GG, Marco J, et al. Anemia in chronic obstructive pulmonary disease: A readmission prognosis factor. Curr Med Res Opin 2012;28(4):617–622. DOI: 10.1185/03007995.2012.675318.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.