Anemia in Chronic Obstructive Pulmonary Disease: A Systematic Review of the Prevalence, Quality of Life, and Mortality

Abstract

PURPOSE: The aims of this systematic review are to up-date and synthesize the available data on the prevalence of anemia and its physiological consequences for patients with chronic obstructive pulmonary disease (COPD) with particular focus on quality of life (QoL), healthcare utilization and mortality. METHOD(S): The electronic databases explored included the following: PubMed, CINAHL, MEDLINE, AMED and the Cochrane library from 1966 through to March 2010. The following keywords were used: 'COPD' 'an(a)emia' 'h(a)ematocrit' 'erythropoietin' 'iron deficiency' 'red blood cells' and 'h(a)emoglobin level'. A supplementary hand search of bibliographic references of extracted articles and existing reviews was also conducted to identify potential studies not ascertained in the electronic database searches. Inclusion criteria: (1) studies that reported the prevalence of Anemia; (2) studies that explored the relationship between Anemia and COPD in either, community, in-patient or out-patient settings; and, (3) randomised or nonrandomised study design; either prospective or retrospective. RESULT(S): A total of 693 article titles were ascertained. Of these, 57 were classified as potentially appropriate. After the initial screening, 9 full text articles were determined appropriate for this analysis, but only seven fully met the inclusion criteria. The prevalence of comorbid Anemia in patients with COPD ranges from 7.5% to 34% depending upon the populations selected and diagnostic tools employed to determine the level of haemoglobin. Co-morbid Anemia in patients with COPD was associated with greater health care resource utilization, increased mortality, impaired QoL and older age. It is not clear the true prevalence of Anemia in patients with COPD. There is a lack of consensus agreement regarding this haematological abnormalities and true frequency. CONCLUSION(S): Anemia is common in patients with COPD. It is often associated with increased healthcare utilization, impaired quality of life, older age and premature mortality. CLINICAL IMPLICATIONS: Findings from the existing literature indicate that more work is required to establish the true prevalence of Anemia in patients with COPD. Robust and prospective clinical studies are needed to improve the management of COPD patients with comorbid Anemia.