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*Corresponding Author: Shah Murad, HOD, Pharmacology at IMDC, Islamabad, Pakistan
Citation: Masood S., Firdous A., Murad S. (2022) The Brain Fog by COVID 19: An Illustration. Psychology and Mental Health Care, 6(4): DOI: 10.31579/2637-8892/168
Copyright: © 2022, Shah Murad, This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 11 April 2022 | Accepted: 21 April 2022 | Published: 18 June 2022
Keywords: chronic obstructive pulmonary disease (COPD); anemia; hemoglobin.
Background: Chronic Obstructive Pulmonary Disease (COPD) is a chronic inflammatory disease due to smoking. It is avertable as well as treatable. COPD is a one of the main cause of morbidity and mortality affecting developed and developing countries. We aim to estimate burden of anemia at a tertiary care public sector hospital.
Methods: This is a descriptive cross sectional study, done at JPMC Karachi in 2014. All COPD patients admitted in medicine and pulmonology departments were enrolled in this study. After informed consent, data of complete blood count was accessed from medical record and anemia was labeled as per operational definition. Data analyzed by SPSS version 16.0. Frequency and percentage proportion of qualitative variables, mean and standard deviation of numerical values were calculated with P value <0.05 was taken as significant.
Results: Of 137 cases, 118(86.13%) were males and 19(13.87%) were females while male to female ratio was 6.2: 1. The average age and weight of the patients was 58.31±12.17 years and 59.36±10.56kg, similarly average duration of disease and hemoglobin of the patients was 5.69±4.42 years and 12.34±1.58 mg/dl respectively. 37.96% (52/137) patients were anemic in our study. Rate of anemia in COPD patients was not significant among age groups (p=0.076) and with duration of disease (p=0.22).
Conclusion: Anemia seems to be a common feature in COPD (37.96%), mechanisms involved in the genesis of anemia in COPD are poorly studied. Low hemoglobin level can have adverse effects on certain respiratory parameters in COPD, increasing morbidity and mortality.
Chronic obstructive airway disease (COAD) or chronic obstructive pulmonary disease (COPD) is progressive inflammatory airway disease that is associated with poor quality of life. COPD is one of the leading illness causing mortality worldwide. It includes previously two disease processes that are emphysema and chronic bronchitis. It manifests as a chronic breathing problem and poor airflow with air trapping in lungs. According to recommendation of the Global Initiative for chronic obstructive lungDisease (GOLD), that the chronic obstructive airway disease (COAD) or chronic obstructive pulmonary disease (COPD) will be diagnosed on the basis of clinical features (signs and symptoms) i-e productive cough (cough with sputum) for at least 3 months/year for at least two years are characteristic of chronic bronchitis and shortness of breathing or dyspnea and cough are characteristic of emphysema. These diseases processes are measured by Spirometry. On the basis of Spirometry COPD patients were staged on the basis of severity of symptoms into four stages[ stage I (FEV1≥80%), stage II(50%≤FEV1<80>
Anemia is caused by chronicity of disease or chronicity of illness, systemic inflammatory or oxidative process.[12] although it is “traditionally” associated with secondary polycythemia but practically many patients are found to be anemic. This anemia is known as anemia of chronic disease (ACD). The systemic effects or systemic inflammation had direct effects of the disease with having a relationship with cause-and-effect output. Screening and treatment of these co-morbid conditions i-e Ischemic heart disease (IHD), Osteoporosis, Skeletal muscle dysfunction (wasting), Depression, nutritional disorders (malnutrition) and blood disorders (anemia) had a role in management of COPD. Chronic systemic inflammation had a vital role in the development of extra-pulmonary manifestations of COPD. Anemia worsens dyspnea or shortness of breathing and limit exercise tolerance.[13] The Hemoglobin (Hb%) levels correlated with reduced functional capacity, increased shortness of breathing, reduced exercise tolerance or capacity, reduced or impaired quality of life (QOL), increased stay in hospital, early morbidity and mortality with severe inflammation in COPD patients.[14]
There are many cofounders in chronic obstructive pulmonary disease patients like old age, nutritional disorders (malnutrition) and cardiovascular disease (IHD, CCF), and leads to development of anemia. Nutritional disorders or Malnutrition had association development of anemia due to with iron, folate or vitamin B12 deficiency.[11] The objective of this study is to assess the burden of anemia in chronic obstructive pulmonary disease patients at a tertiary care hospital Karachi.
Operational definition
Anemia is defined as a decrease in the total number of erythrocytes or decreased concentration of hemoglobin in the blood, in our study hemoglobin levels <13 xss=removed>15, 16]
This study was a descriptive cross-sectional, which included 137 COPD patients. These COPD patients were admitted in departments of medicine and pulmonology. This study was conducted for six months in 2014 in Jinnah Postgraduate Medical center Karachi. Sample size was calculated by formula:
Sample Size*: n=Nz2p (1-P)/d2 (N-1)+z2 p(1-P).
Numbers of participants were calculated i-e 137 subjects. After taking approval of synopsis from college of physicians and surgeons of Pakistan (CPSP), subjects were enrolled from admitted patients. Diagnosed cases of COPD, of both male and female sex and Age >35 years and <70>0.05) P-value.
137 COPD patients were enrolled and included in this study, out of this 118(86.13%) were males (M) and 19(13.87%) females (F) while M to F ratio was 6.2:1. The mean age and weight of the COPD patients was 58.31±12.17 years (median age 60 years) and 59.36±10.56 kg, similarly mean duration of disease and hemoglobin of the patients was 5.69±4.42 years and 12.34±1.58 mg/dl respectively as shown in table-1.1. In COPD patients included in our study frequency of anemia, smoking, hypertension and diabetes mellitus was 37.96% (52/137), 100% (137), 6.6% (9/137) and 2.2%(3/137) respectively as shown in Table- no 1.2.
In this study anemia in COPD patients has no significant association with age (p>0.076), gender (p>0.36), and duration of the disease (p>0.22) respectively as shown in Table 1.3
Anemia is one of the extra-pulmonary manifestations in patients having signs and symptoms of chronic obstructive pulmonary disease (COPD). In this study frequency of anemia has been observed in patients was 37.96%, median hemoglobin (Hb%) level was 12.5 gm/ dl and gender based comparison showed frequency of anemia was 36.4% (43/118) in males and 47.4% (9/19) in females which is not statistically significant (p>0.36). Similar results are reported in a study which includes 53 patients with median hemoglobin level (12.8 gm/dl) and gender based comparison showed frequency of anemia was (49.4% [41/83] in males and 52.2% [12/23] in females with P-value (P=1.00).[17] this study supports our results. In 2015, study was published in British Medical Journal (BMJ), in which anemia prevalence is in range b/w 33%–44% in COPD patients.18Perveen et al. done a hospital-based cross-sectional study in which she founded 18% anemia in chronic obstructive airway disease (COPD) patients.[19] Shorr et al. had done data analysis of chronic obstructive airway disease (COPD) patients retrospectively in which 33% patients were reported anemic [20]. Anemia is directly associated with worsening of clinical features that leads to mortality or death in chronic obstructive airway disease (COPD) patients. It is considered as predictor, which is affecting the prognosis (long term), so that it is causing mortality in exacerbations of admitted patients. During Exacerbation of symptoms in COPD patients, leads to increase in concentration of oxidative stress, plasma fibrinogen and serum interleukin (IL-6) levels, so comorbiditiesincreases in patients.The secretion of C-reactive protein (CRP) is increased by the liver due to interleukin 6(IL-6). C-reactive protein (CRP) is an acute phase reactant and is sensitive marker of inflammation [11] The anemia had multiple complex mechanisms in COPD patients like systemic inflammation and anemia of chronic disease (ACD).Multiple inflammatory cytokines like interleukins (IL-1&IL-6), and tumor necrosis factor (TNF-alpha) are responsible for inhibition or harmful effect in erythropoietic pathway (erythropoiesis) in COPD patients.The patients having lower levels of hemoglobin (Hb%) concentration or anemia will be associated with poor prognosis in COPD sufferers.21ACD occurs due to alternation in iron metabolism. There is increased level of hepcidin, and increased inflammatory cytokines or interleukins (IL-1&IL-6), and tumor necrosis factor (TNF-alpha) in chronic obstructive airway disease (COPD) patients. These are regulating iron homeostasis in human body. Functional iron deficiency is related to decreased oxygen concentration in the blood leads to decreased tolerance of exercise and limitation in response to pulmonary rehabilitation [22,23] Yuruk et al. had observed in his study that decreased hemoglobin (Hb%) concentrations or anemia was showing association with oxygen saturation within capillaries or microcirculation and after treatment of anemia resulted in improvement of transport capacity of oxygen and oxygen saturation in tissue cells [24]
Anemia is associated with shortness of breathing and it worsens the health related quality of life.25 Anemia or decreased hemoglobin concentration is major risk factor for repeated admissions (25%) and worsening of dyspnea than non-anemic COPD patients. Dyspnea and easy fatigability are main symptoms of COPD patients and it exerts negative effects on health related quality of life (QOL) of these patients. Hemoglobin correction (whether anemia or polycythemia) in COPD patients may improve QOL and decrease co-morbidity and mortality of these patients [26]
Anemia is quite common in our study (37.96%), as opposed to medical literature which mentions polycythemia in these patients. Mechanisms involved in the genesis of anemia in COPD are poorly studied; moreover low hemoglobin level can have adverse effects on oxygen saturation and functional class of patients in COPD, leading to increased morbidity and mortality.
Further studies are needed to look up if treatment of anemia in COPD patients results into better outcomes.
None to declare.
From College of Physicians & Surgeons, Pakistan (CPSP), Acceptance number: REU NO: 8813
Nil
Informed conset taken from the patients or their guardian, if language barrier via translator.
Single centre study.
Future studies with more number of patients and effect of anemia correction on COPD should be studied.
I dedicate this study to my patients who allowed me to publish their data.
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