Abstract
Background/ObjectivesThe ageing process is associated with gradual decline in respiratory system performance. Anemia is highly prevalent among older adults and usually associated with adverse outcomes. Myelodysplastic syndromes (MDS) are a heterogeneous group of hematologic malignancies with increasing incidence with age and characterized by anemia and other cytopenias. The main objectives of this study were to evaluate respiratory muscle strength and lung function in elderly patients with anemia, compare data between myelodysplastic syndromes and non-clonal anemias and evaluate the influence of serum IL-8 level and NF-kB activity on deteriorate pulmonary function in this specific population.ParticipantsIndividuals aged 60 and older with anemia secondary to MDS, non-clonal anemia and healthy elderly individuals.MeasurementsForced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and FEV1/ FVC ratio were measured by spirometry. Respiratory muscle strength was evaluated by maximal static respiratory pressures measurement. IL-8 analysis was performed by ELISA and activity of NF-kB by chemiluminescent assay.ResultsMean Hb concentration was comparable between patients with anemia. Significant differences were detected between all patients with anemia and controls for maximum-effort inspiratory mouth pressure (PImax) and also for maximum-effort expiratory mouth pressure (PEmax). The MDS group recorded a significantly lower PImax and PEmax percent predicted when compared to non-clonal anemia group. For FVC and FEV1, a significant difference was found in anemic patients, with even significantly lower values for FVC and FEV1 in MDS group. No significant differences were detected for PImax and PEmax and spirometry parameters when anemic patients were stratified according to the degree of anemia. A significant negative impact in FVC (% pred), PImax (% pred) and PEmax (% pred) was observed in patients with MDS and higher levels of IL-8 or increased activity of NF-kB.ConclusionA negative impact of anemia, independent of its degree, was demonstrated in respiratory muscle strength and lung function particularly in MDS. The well known elevated proinflammatory cytokines in MDS patients were proposed to play a role as was demonstrated by detrimental effect of higher IL-8 and NF-kB in pulmonary function tests in this population.
Highlights
Population aging is occurring worldwide with both the number and proportion of older adults increasing globally as fertility rates drop and mortality decreases
The Myelodysplastic syndromes (MDS) group recorded a significantly lower PImax and PEmax percent predicted when compared to non-clonal anemia group
For forced vital capacity (FVC) and Forced expiratory volume in 1 second (FEV1), a significant difference was found in anemic patients, with even significantly lower values for FVC and FEV1 in MDS group
Summary
Population aging is occurring worldwide with both the number and proportion of older adults increasing globally as fertility rates drop and mortality decreases. Adaptations taking place within the central nervous system controller help maintain effective gas exchange in these subjects These complex and interactive effects are reflected by considerable variability in what can be defined as normal respiratory function in the elderly, a matter that is further complicated by the common occurrence of age-related comorbidities [3]. Age-related changes in immune function such as increased circulating pro-inflammatory cytokines, a process formerly described as inflammaging, can be part of the complex mechanisms of gradual loss of muscle mass in aged individuals [4,5,6]. NF-kB is part of cells’ auto defense mechanism but its inappropriate activation can mediate inflammation with important role in pathogenesis of several diseases It triggers the expression of many genes involved in regulating the expression of inflammatory cytokines and pro-survival factors. In chronic obstructive pulmonary disease (COPD), quadriceps muscle strength has been reported to be negatively correlated with plasma IL-8 levels [9] and worse pulmonary function and exercise capacity have been associated with greater plasma concentrations of inflammatory markers, including IL-8 [10]
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