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Communications to the Editor |

Anemia and COPD FREE TO VIEW

Luca Mascitelli, MD; Francesca Pezzetta, MD
Author and Funding Information

Affiliations: Comando Brigata Alpina “Julia” Udine, Italy Ospedale di San Vito al Tagliamento San Vito al Tagliamento, Italy,  University Hospital Charité Berlin, Germany

Correspondence to: Luca Mascitelli, MD, Comando Brigata alpina “Julia”, Sanitary Service, Via S. Agostino 8, Udine 33100, Italy; e-mail: lumasci@libero.it



Chest. 2005;128(4):3084. doi:10.1378/chest.128.4.3084-a
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To the Editor:

John and colleagues reported in a recent issue of CHEST (March 2005)1 a relatively high frequency of anemia in patients with COPD. However, they did not mention whether the studied population was in treatment with angiotensin-converting enzyme (ACE) inhibitors or angiotensin II type 1 (AT1) receptor blockers.

Several observations suggested that an intact and activated renin-angiotensin system may be an important determinant of erythropoiesis,23 including a variety of clinical conditions such as hypertension, chronic renal insufficiency, heart failure, and COPD.4Consequently, the assumption of ACE inhibitors and AT1 receptor blockers has been shown to reduce hemoglobin concentrations both in healthy subjects5 and in those with pathologic conditions.4,68 Thus, therapy with ACE inhibitors and AT1 receptor blockers might have been a confounder in this study.1

John, M, Hoernig, S, Doehner, W, et al (2005) Anemia and inflammation in COPD.Chest127,825-829
 
Mrug, M, Stoppa, T, Julian, BA, et al Angiotensin II stimulates proliferation of normal early erythroid progenitors.J Clin Invest1997;100,2310-2314
 
Cole, J, Ertoy, D, Lin, H, et al Lack of angiotensin II-facilitated erythropoiesis causes anemia in angiotensin converting enzyme-deficient mice.J Clin Invest2000;106,1391-1398
 
Marathias, KP, Agroyannis, B, Mavromoustakos, T, et al Hematocrit-lowering effect following inactivation of renin-angiotensin system with angiotensin converting enzyme inhibitors and angiotensin receptor blockers.Curr Top Med Chem2004;4,483-486
 
Griffing, GT, Melby, JC Enalapril (MK-421) and the white cell count and haematocrit [letter]. Lancet. 1982;;1 ,.:1361
 
Gaston, RS, Julian, BA, Diethelm, AG, Curtis, JJ Effects of enalapril on erythrocytosis after renal transplantation.Ann Intern Med1991;115,954-955
 
Plata, R, Cornejo, A, Arratia, C, et al Angiotensin-converting-enzyme inhibition therapy in altitude polycythaemia: a prospective randomised trial.Lancet2002;359,663-666
 
Ishani, A, Weinhandl, E, Zhao, Z, et al Angiotensin-converting-enzyme inhibitor as a risk factor for the development of anemia, and the impact of incident anemia on mortality in patients with left ventricular dysfunction.J Am Coll Cardiol2005;45,391-399
 
To the Editor:

The author of this comment mentioned that therapy with angiotensin-converting enzyme (ACE) inhibitors might be a confounder in interpreting the results of our study.1 In this patient population, 23 patients of the nonanemic group (88 patients) were treated with ACE inhibitors or angiotensin type-1 (AT1) receptor blockers. In the anemic group (13 patients), 3 patients received cotherapy with ACE inhibitors or receptor blockers. The χ2 test revealed no difference in the occurrence of ACE inhibitor therapy between both groups (p = 0.813). Therefore, we conclude that the reported prevalence of anemia in COPD patients in our study is not influenced by an ACE inhibitor or AT1 receptor blocker medication. Overall, it is an interesting issue that should be taken into consideration for future studies.

References
John, MS, Hoernig, W, Doehner, C, et al Anemia and inflammation in chronic obstructive pulmonary disease.Chest2005;127,825-829
 

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References

John, M, Hoernig, S, Doehner, W, et al (2005) Anemia and inflammation in COPD.Chest127,825-829
 
Mrug, M, Stoppa, T, Julian, BA, et al Angiotensin II stimulates proliferation of normal early erythroid progenitors.J Clin Invest1997;100,2310-2314
 
Cole, J, Ertoy, D, Lin, H, et al Lack of angiotensin II-facilitated erythropoiesis causes anemia in angiotensin converting enzyme-deficient mice.J Clin Invest2000;106,1391-1398
 
Marathias, KP, Agroyannis, B, Mavromoustakos, T, et al Hematocrit-lowering effect following inactivation of renin-angiotensin system with angiotensin converting enzyme inhibitors and angiotensin receptor blockers.Curr Top Med Chem2004;4,483-486
 
Griffing, GT, Melby, JC Enalapril (MK-421) and the white cell count and haematocrit [letter]. Lancet. 1982;;1 ,.:1361
 
Gaston, RS, Julian, BA, Diethelm, AG, Curtis, JJ Effects of enalapril on erythrocytosis after renal transplantation.Ann Intern Med1991;115,954-955
 
Plata, R, Cornejo, A, Arratia, C, et al Angiotensin-converting-enzyme inhibition therapy in altitude polycythaemia: a prospective randomised trial.Lancet2002;359,663-666
 
Ishani, A, Weinhandl, E, Zhao, Z, et al Angiotensin-converting-enzyme inhibitor as a risk factor for the development of anemia, and the impact of incident anemia on mortality in patients with left ventricular dysfunction.J Am Coll Cardiol2005;45,391-399
 
John, MS, Hoernig, W, Doehner, C, et al Anemia and inflammation in chronic obstructive pulmonary disease.Chest2005;127,825-829
 
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