A. Kovchun, V. Kmita, L. Prystupa
Medical Institute Sumy State University
Introduction. Chronic obstructive pulmonary disease (COPD) was associated with polycythemia as a result of respiratory failure and regarded as a compensatory response of erythropoiesis to chronic hypoxia for a long time. Recent epidemiological studies have shown that anemia is observed in 17.0-24.0 % of patients with COPD and only 6.0-10.0 % of such patients have polycythemia
Aim. To find out the clinical and functional features of COPD course, depending on the red branch of blood and content of soluble transferrin receptors (sTFR).
Materials and methods. The study enrolled 202 patients aged >40 years with COPD who have signed the consent to participate in the study. The exclusion criteria were: severe concomitant diseases (pulmonary tuberculosis, oncopathology, alcohol and/or drug addiction, AIDS, heart failure – class ІІВ stage III, and decompensated liver failure, kidney failure, or other failures); defined source of bleeding (complications of peptic ulcer, nonspecific ulcerative colitis, chronic hemorrhoids, etc.); diagnosed true anemias (megaloblastic, aplastic, hemolytic); use of angiotensin-converting enzyme inhibitors; pregnancy or lactation; chronic administration of systemic corticosteroids. All examined patients underwent the general clinical, laboratory and instrumental examination. The degree of obstruction and severity of the disease were determined in accordance with GOLD (2014) recommendations: the degree of obstruction was determined by computer spirography (FEVp detected 15 minutes after inhalation of 400.0 mcg of salbutamol), the severity of dyspnea was determined by the modified Medical Research Council (mMRC), and quality of life was determined by COPD Assessment Test (CAT). Patients with COPD were divided into 4 study groups depending on the hemogram parameters and sTFR: 1 group included 144 patients without anemia, 2 group – 33 with anemia of chronic disease (ACD), 3 group – 12 with erythrocytosis, and 4 group – 13 with iron deficiency anemia (IDA). Statistical analysis of the results was performed using SPSS-21 program.
Results. As a result of the detailed analysis of the anamnesis, objective examination and laboratory results in patients from group 4, the cause of IDA was established, namely, 5 patients were diagnosed with chronic non-atrophic gastritis, 4 had chronic gastroduodenitis, 2 had peptic ulcer of stomach, 1 had peptic ulcer of duodenum, and in 1 – chronic gastroduodenitis and chronic pancreatitis with exocrine insufficiency. It has been found that ACD is present in patients with COPD II – IV stage of obstruction and is not observe among COPD patients with degree I obstruction. It is established that the frequency of ACD increases according to the degree of obstruction and the severity of the disease. Patients with COPD with ACD and IDA had significantly lower levels of FEVj compared to patients without anemia and erythrocytosis. It was revealed that patients with COPD with ACD and COPD with IDA had a higher rate according to CAT and, lower quality of life compared with patients without anemia and erythrocytosis accordingly. As a result of the correlation analysis, it was found that there is negative correlation between the degree of obstruction and the results of mMRC (r = – 0.591; p = 0.001) and CAT (r = – 0.608; p = 0.001). Consequently, dyspnea significantly increases and the quality of life decreases in the patients with COPD and ACD with the increase of the degree of obstruction. The frequency of exacerbations was higher in patients with COPD and ACD compared with other groups.
Conclusions. Anemia is detected in 22.7 % of patients with COPD, specifically, IDA – in 6.4 % of patients, and ACD – in 16.3 %. The frequency of ACH increases with the degree of obstruction and the severity of COPD. Patients with COPD with anemia (ACD or IDA) have significantly lower levels of FEVP dyspnea and quality of life are significantly worsened with the increase of the obstruction degree in patients with COPD and ACD. The frequency of exacerbations was higher in patients with COPD and ACD.
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