Anemia in COPD: Should It Be Taken Into Consideration?

Carroz, Karina Portillo

doi:10.1016/S1579-2129(07)60091-3

Article information

Recent recognition of the importance of nonpulmonary signs and symptoms in the management and prognosis of chronic obstructive pulmonary disease (COPD) has led to a shift in the focus of diagnostic and therapeutic strategies to encompass these aspects. We no longer concentrate on assessing a single functional variable (forced expiratory volume in 1 second) as a predictor of survival in these patients. Most of the research undertaken to date into COPD-related systemic disorders has targeted weight loss, muscular dysfunction, osteoporosis, and cardiovascular disease. However, the abnormal inflammatory response associated with COPD may provoke other disorders such as anemia. Moreover, comorbid anemia has been shown to be an independent predictor of mortality in several chronic diseases including cancer and heart failure. Anemia is, therefore, an entity that should be taken into consideration in the overall management of respiratory disease because it may have a clear detrimental impact on various aspects of the patient's health, including dyspnea, exercise tolerance, and quality of life.

There is a growing body of literature on the relationship between anemia and COPD. Our aim is to briefly review the pathophysiologic aspects of this association before going on to discuss some of the most recent evidence published.

Key words:

Anemia

COPD

Erythrocytosis

El reconocimiento reciente de la importancia que tienen las manifestaciones extrapulmonares, tanto en el manejo como en el pronóstico de la enfermedad pulmonar obstructiva crónica (EPOC) ha llevado a que reconduzcamos las estrategias diagnósticas y terapéuticas hacia ellas, y que no centremos nuestros esfuerzos en valorar sólo una variable funcional (el volumen espiratorio forzado en el primer segundo) como marcador de supervivencia en estos pacientes. Los trastornos sistémicos relacionados con la EPOC más estudiados son la pérdida de peso, la disfunción muscular, la osteoporosis y la enfermedad cardiovascular. Sin embargo, hay otros posibles efectos, como el síndrome anémico, que también podría ser consecuencia de la anormal respuesta inflamatoria que se produce en esta enfermedad. Por otra parte, la anemia como comorbilidad asociada a ciertas enfermedades crónicas, caso del cáncer y de la insuficiencia cardíaca, ha demostrado actuar como un marcador de mortalidad independiente. Se trata, por lo tanto, de una entidad que debe tenerse en cuenta en el manejo integral del paciente respiratorio, ya que puede tener un impacto claramente perjudicial en diversos aspectos de la enfermedad, como la disnea, la tolerancia al ejercicio y la calidad de vida.

En la literatura médica hay un número creciente de estudios que abordan la relación entre la anemia y la EPOC. Esta revisión se centrará en revisar brevemente los aspectos fisiopatológicos relacionados con el tema y en discutir algunas de las últimas evidencias publicadas hasta el momento.

Palabras clave:

Anemia

EPOC

Eritrocitosis

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