title: Anemia and hemoglobin serum levels are associated with exercise capacity and quality of life in chronic obstructive pulmonary disease.
abstract: BACKGROUND
  Little is known about the relationship between hemoglobin concentrations, functional status and health related quality of life (HRQL) in chronic obstructive pulmonary disease (COPD). Our aim was to investigate the prevalence of anemia and the association of hemoglobin with shortness of breath, exercise capacity, muscle strength and HRQL, in COPD patients.
  
  
  METHODS
  A total of 105 COPD patients (77 males, 71.6 ± 9.2 years) were studied. Patients were classified as anemic and non anemic using the WHO criteria. We used the Medical Research Council Dyspnoea scale (MRCs) to measure shortness of breath. Exercise capacity was assessed using the six minute walking distance (6MWD) and the peak of VO2 during the maximal cycle ergometer test (VO2max). We used the Quadriceps and Handgrip strength assessment to determine muscle strength. The Saint George Respiratory Questionnaire was used to investigate HRQL. The physiological/functional characteristics of the two groups were compared. Regression models adjusting for confounders examined the independent association of anemia and of hemoglobin levels with clinical and functional outcomes.
  
  
  RESULTS
  Anemic patients (12.3%) showed a significantly higher MRCs, a lower 6MWD, VO2max, and a worse quality of life. On the contrary, there was no difference in muscle strength between the two groups. In the regression models, hemoglobin was independently associated with reduced exercise capacity and HRQL.
  
  
  CONCLUSIONS
  Anemia in COPD was a risk factor for poorer exercise capacity and quality of life, and these outcomes were linearly associated with hemoglobin. Our results should stimulate further research into exploring whether increasing hemoglobin has a beneficial effect on the outcomes in COPD.
authors.affiliation: Unit of Respiratory Diseases, Department of Medicine, University of Verona, Verona, Italy. marcello.ferrari@univr.it.|School of Sports Medicine, University of Padova, Verona, Trieste and Udine, Italy. marcello.ferrari@univr.it.
authors.forename: Marcello
authors.initials: M
authors.lastname: Ferrari
authors.affiliation: Unit of Respiratory Diseases, Department of Medicine, University of Verona, Verona, Italy. lorenzo.manea@gmail.com.|Servizio di Fisiopatologia Respiratoria, Policlinico G.B.Rossi, 37121, Verona, Italy. lorenzo.manea@gmail.com.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Manea
authors.affiliation: School of Sports Medicine, University of Padova, Verona, Trieste and Udine, Italy. kamel.anton@gmail.com.
authors.forename: Kamel
authors.initials: K
authors.lastname: Anton
authors.affiliation: School of Sports Medicine, University of Padova, Verona, Trieste and Udine, Italy. paolabruz@yahoo.it.
authors.forename: Paola
authors.initials: P
authors.lastname: Bruzzone
authors.affiliation: School of Sports Medicine, University of Padova, Verona, Trieste and Udine, Italy. mara.84@alice.it.
authors.forename: Mara
authors.initials: M
authors.lastname: Meneghello
authors.affiliation: School of Sports Medicine, University of Padova, Verona, Trieste and Udine, Italy. zambo987@libero.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Zamboni
authors.affiliation: Unit of Respiratory Diseases, Department of Medicine, University of Verona, Verona, Italy. xdarkcatx@gmail.com.
authors.forename: Luigi
authors.initials: L
authors.lastname: Purgato
authors.affiliation: Unit of Epidemiology and Medical Statistics, Department of Public Health and Community Medicine, University of Verona, Verona, Italy. lucia.cazzoletti@univr.it.
authors.forename: Lucia
authors.initials: L
authors.lastname: Cazzoletti
authors.affiliation: School of Sports Medicine, University of Padova, Verona, Trieste and Udine, Italy. pietro.ferrari82@gmai.com.
authors.forename: Pietro
authors.initials: P
authors.lastname: Ferrari
authors.affiliation: Unit of Respiratory Diseases, Department of Medicine, University of Verona, Verona, Italy. rtesti@qubisoft.it.
authors.forename: Renato
authors.initials: R
authors.lastname: Testi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000150:complications / Q000378:metabolism*; D004417:Dyspnea / Q000209:etiology / Q000378:metabolism* / Q000503:physiopathology; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D005541:Forced Expiratory Volume; D018737:Hand Strength; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D008297:Male; D053580:Muscle Strength; D010101:Oxygen Consumption; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000378:metabolism* / Q000503:physiopathology; D052097:Quadriceps Muscle; D011788:Quality of Life; D011795:Surveys and Questionnaires
chemical_list: D006454:Hemoglobins