Polycythemia is Associated with Lower Incidence of Severe COPD Exacerbations in the SPIROMICS Study

Ashraf Fawzy; Han Woo; Aparna Balasubramanian; Igor Barjaktarevic; R. Graham Barr; Russell P. Bowler; Alejandro P. Comellas; Christopher B. Cooper; David Couper; Gerard J. Criner; Mark T. Dransfield; MeiLan K. Han; Eric A. Hoffman; Richard E. Kanner; Jerry A. Krishnan; Fernando J. Martinez; Meredith McCormack; Robert Paine III; Stephen Peters; Robert Wise; Prescott G. Woodruff; Nadia N. Hansel; Nirupama Putcha

doi:10.15326/jcopdf.2021.0216

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Polycythemia is Associated with Lower Incidence of Severe COPD Exacerbations in the SPIROMICS Study

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Polycythemia is Associated with Lower Incidence of Severe COPD Exacerbations in the SPIROMICS Study

Ashraf Fawzy, Han Woo, Aparna Balasubramanian, Igor Barjaktarevic, R. Graham Barr, Russell P. Bowler, Alejandro P. Comellas, Christopher B. Cooper, David Couper, Gerard J. Criner, …

Chronic obstructive pulmonary diseases, Vol.8(3), pp.326-335

07/29/2021

DOI: 10.15326/jcopdf.2021.0216

PMCID: PMC8428597

PMID: 34197703

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Abstract

Secondary polycythemia has long been recognized as a consequence of chronic pulmonary disease and hypoxemia and is associated with lower mortality and fewer hospitalizations among individuals with chronic obstructive pulmonary disease (COPD)-prescribed long-term oxygen therapy. This study investigates the association of polycythemia with COPD severity, phenotypic features, and respiratory exacerbations in a contemporary and representative sample of individuals with COPD. Current and former smokers with COPD (forced expiratory volume in 1 second [FEV 1 ] to forced vital capacity [FVC] ratio <70%) without a history of hematologic/oncologic disorders were selected from the SubPopulations and InteRmediate Outcomes Measures In COPD Study (SPIROMICS), a multi-center observational cohort. Participants with polycythemia (hemoglobin ≥15g/dL [females] or ≥17g/dL [males]), were compared to individuals without anemia (hemoglobin ≥12g/dL [females] or ≥13g/dL [males]). Cross-sectional outcomes including percent predicted FEV 1 , respiratory symptoms, quality of life, exercise tolerance, and percentage and distribution of emphysema (voxels<-950 Hounsfield units [HU] at total lung capacity) were evaluated using linear or logistic regression. Longitudinal acute exacerbation of COPD (AECOPD) and severe AECOPD (requiring an emergency department visit or hospitalization) were assessed using zero-inflated negative binomial models. Among 1261 participants, 148 (11.7%) had polycythemia. Average follow-up was 4.2±1.7 years and did not differ by presence of polycythemia. In multivariate analysis, compared to participants with normal hemoglobin, polycythemia was associated with a reduced rate of severe AECOPD (adjusted incidence rate ratio 0.57, 95% CI: 0.33-0.98), lower percent predicted FEV 1 , lower resting oxygen saturation, increased upper to lower lobe ratio of emphysema, and a greater degree of emphysema, though the latter was attenuated after adjusting for lung function. There were no significant differences in total AECOPD, patient-reported outcomes, or exercise tolerance. These findings suggest that polycythemia, while associated with less favorable physiologic parameters, is not independently associated with symptoms, and is associated with fewer severe exacerbations. Future studies should explore the potentially protective role of increased hemoglobin beyond the correction of anemia.

acute exacerbation of COPD

Brief Report

polycythemia

SPIROMICS

Details

Title: Subtitle: Polycythemia is Associated with Lower Incidence of Severe COPD Exacerbations in the SPIROMICS Study
Creators: Ashraf Fawzy - Johns Hopkins University
Han Woo - Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, United States.
Aparna Balasubramanian - Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, United States.
Igor Barjaktarevic - University of California, Los Angeles
R. Graham Barr - Columbia University
Russell P. Bowler - National Jewish Health
Alejandro P. Comellas - University of Iowa
Christopher B. Cooper - University of California, Los Angeles
David Couper - University of North Carolina at Chapel Hill
Gerard J. Criner - Temple University
Mark T. Dransfield - University of Alabama at Birmingham
MeiLan K. Han - University of Michigan
Eric A. Hoffman - University of Iowa
Richard E. Kanner - University of Utah
Jerry A. Krishnan - University of Illinois Chicago
Fernando J. Martinez - Cornell University
Meredith McCormack - Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, United States.
Robert Paine III - Division of Respiratory, Critical Care and Occupational Medicine, University of Utah, Salt Lake City, Utah, United States
Stephen Peters - Wake Forest University
Robert Wise - Johns Hopkins University
Prescott G. Woodruff - University of California, San Francisco
Nadia N. Hansel - Johns Hopkins University
Nirupama Putcha - Johns Hopkins University
Resource Type: Journal article
Publication Details: Chronic obstructive pulmonary diseases, Vol.8(3), pp.326-335
DOI: 10.15326/jcopdf.2021.0216
PMID: 34197703
PMCID: PMC8428597
NLM abbreviation: Chronic Obstr Pulm Dis
ISSN: 2372-952X
eISSN: 2372-952X
Publisher: COPD Foundation Inc
Alternative title: Polycythemia and Severe COPD Exacerbations
Language: English
Date published: 07/29/2021
Academic Unit: Roy J. Carver Department of Biomedical Engineering; Radiology; Pulmonary, Critical Care, and Occupational Medicine; ICTS; Internal Medicine
Record Identifier: 9984318784602771

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