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Obstructive Lung Diseases |

Effect of Long-term Oxygen Therapy (LTOT) on Erythropoietin (EPO) Level and Hemoglobin in Patients With Chronic Obstructive Pulmonary Disease (COPD) - A Prospective Study

Rashid Nadeem, MD; Ahmed Ghadai, MD; Hasnain Bawaadam, MD; Nitesh Jain, MD; Imtiazali Kadri, RRT; Kovid Trivedi, MD; Ahmet Copur, MD; Ashok Fulambarker, MD; Zakwan Quwatli, MD; Adeel Rishi, MD; Aman Sethi, MD; Anne Baker, BS
Author and Funding Information

Chicago Medical School at Rosalind Franklin University of Medicine and Science/Capt James A Lovell FHCC, North Chicago, IL


Chest. 2013;144(4_MeetingAbstracts):723A. doi:10.1378/chest.1672085
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Abstract

SESSION TITLE: COPD Treatment Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Chronic obstructive pulmonary disease (COPD) is a disorder that is associated with hypoxemia, which is a well established factor for increase in erythropoietin (EPO) in order to increase the hemoglobin concentration. This, in turn, increases tissue oxygen delivery. Long term oxygen therapy (LTOT) has been shown to reduce the mortality in COPD patients by improving oxygen availability and reducing hypoxemia.

METHODS: This prospective, observational and single-center study was aimed to investigate if LTOT has a significant reduction in the level of EPO and hemoglobin in patients of COPD. Patients fulfilling GOLD criteria for LTOT were consented to have blood drawn for EPO and hemoglobin levels before starting LTOT and after LTOT was used for at least 30 days. 10% reduction in level of EPO and hemoglobin was statistically significant for a change. Interim analysis was done after 26 patients were enrolled.

RESULTS: Mean age was 70.46 years (SD 9.13), with average smoking history of 40.26 pack years. Mean EPO and hemoglobin before starting LTOT were 22.95 +/-19.41 and 13.43 +/- 2.0. After at least 30 days of therapy, EPO and hemoglobin were found to be 24.12 +/- 24.99 and 13.45 +/- 1.73, which were not statistically significant (p= 0.53 and 0.91 respectively). Subgroup analysis between these 2 groups, including analysis with respect to chronic heart failure (CHF), obstructive sleep apnea (OSA) and pulmonary hypertension were also not significant. The study was terminated as interim analysis did not show a trend towards positive correlation.

CONCLUSIONS: No correlation was noted between LTOT and EPO and Hemoglobin levels

CLINICAL IMPLICATIONS: EPO levels are increased in-vivo in response to hypoxemia that is sensed by renal peritubular cells. EPO is required for terminal maturation of erythroblastic colony forming unit (CFU-E) and also prevents apoptosis of erythroid cells. EPO levels are expected to return to baseline when the hypoxemia is resolved by LTOT in COPD patients. Our study fails to demonstrate this physiologically justified phenomenon in clinical scenario. This suggests that the relationship between EPO and oxygen therapy is much more complex

DISCLOSURE: The following authors have nothing to disclose: Rashid Nadeem, Ahmed Ghadai, Hasnain Bawaadam, Nitesh Jain, Imtiazali Kadri, Kovid Trivedi, Ahmet Copur, Ashok Fulambarker, Zakwan Quwatli, Adeel Rishi, Aman Sethi, Anne Baker

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