Abstract
Linked Comment: Boutou et al. Int J Clin Pract 2014; 68: 139–40. We thank Dr Boutou and colleagues for their kind interest and valuable comments on our paper entitled ‘Unsuspected risk factors of frequent exacerbations requiring hospital admission in Chronic Obstructive Pulmonary Disease’ 1. In their letter, the authors discussed the link between/readmission within 2 months after an exacerbation and anaemia and they pointed out that this relationship does not give insight into the direction of the relationship. Anaemia could be a marker of general illness severity and thereby associated with frequent hospitalisations or it may also be a consequence rather than a reason, driven by the increased inflammatory response. We clearly agree with this idea. The possible underlying reasons of anaemia in chronic obstructive pulmonary disease (COPD) are probably multifactorial. Systemic inflammation, chronic renal failure, decreased level of androgens, iron depletion, the therapy used (i.e. angiotensin converting enzyme inhibitors, theophylline and LTOT, long-term oxygen therapy) and exacerbations were potential factors related to anaemia in COPD 2. In addition, recent reports point out that anaemia is more frequent in more severely ill COPD patients. In a recent Spanish report, Charlson Comorbidity index was found to be higher in COPD patients with anaemia 3 and anaemia was found significantly more frequent in COPD patients on LTOT 4. In addition, Kollert et al. have investigated the relationship between haemoglobin levels and long-term survival in COPD with chronic respiratory failure. They showed that the 58th percentiles of Hb (14.3 g/dl in females, 15.1 g/dl in males), a threshold markedly higher than the World Health Organization's definitions of anaemia, was conferring the highest predictive value for survival 5. As a result, anaemia in COPD is certainly an exciting topic that merits continued intensive research in the near future. None.
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