The World Health Organization's (WHO) definition of anemia is based on a hemoglobin level of less than 13 g/dL in men and 12 g/dL in women.
This review will focus on various causes of anemia, its pathogenesis, and its impact on patients with COPD. Conversely, anemia has been reported more frequently in association with COPD in recent years with an impact on the quality of life (QOL), healthcare utilization, and survival. However, nowadays this occurs less frequently due to more rigorous correction of hypoxemia by domiciliary long-term oxygen therapy.
Traditional teaching in clinical medicine considers polycythemia to be a common adverse event of hypoxemia in COPD. In recent years, anemia has become another comorbidity that has gained importance in patients with COPD. Systemic manifestations and comorbidities commonly reported in COPD include cardiovascular disease, malnutrition, osteoporosis, gastroesophageal reflux, and clinical depression and anxiety. Second, COPD is a part of the chronic systemic inflammatory syndrome and pulmonary manifestations are one part of the multiple organ compromise, due to the consequences of systemic inflammation. Systemic inflammation in COPD may be the direct consequence of a systemic ‘spill-over’ of the ongoing pulmonary inflammation. Systemic inflammation is a widely studied topic in COPD and has been potentially linked to comorbidities. The factors that have been linked to systemic consequence and comorbidities in COPD patients are systemic inflammation and shared risk factors, smoking and physical inactivity/deconditioning. Screening of the comorbidities should be an important component in the management of a COPD patient. Therefore, the systemic effects of COPD are direct consequences of the disease with a cause-and-effect relationship. When coexisting illnesses are a direct consequence of the patient's underlying COPD, it is called a systemic effect. Comorbidity is a disease process coexisting with COPD and is probably due to common risk factors. Systemic effects and/or comorbidities are important events in the natural history of the disease and have a capacity to increase the morbidity, economic burden, and mortality of COPD. Exacerbations and comorbidities contribute to the overall severity in individual patients. It is characterized by a persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response, in the airways and the lung, to noxious particles or gases. The global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease (COPD) defines COPD as a common preventable and treatable disease. We need large prospective studies to discern the association between anemia and COPD. Anemia in COPD is associated with greater healthcare resource utilization, impaired quality of life, decreased survival, and a greater likelihood of hospitalization. ACD is driven by COPD-mediated systemic inflammation. Anemia of chronic disease (ACD) is probably the most common type of anemia associated with COPD. The prevalence of anemia in patients with COPD varies from 7.5% to 33%. Recently, anemia has been recognized as a frequent comorbidity in COPD patients. Cardiac diseases, lung cancer, osteoporosis, and depression are common comorbidities reported for COPD. Comorbidities are important events in the natural history of the disease and have a negative effect on the morbidity and mortality of COPD patients. COPD is associated with significant morbidity and mortality worldwide. Chronic obstructive pulmonary disease (COPD) is a common preventable and treatable lifestyle-related disease with high global prevalence.
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