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Effect of intravenous ferric carboxymaltose on exercise capacity and quality of life in patients with COPD

A pilot study

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Summary

Background and objective

Chronic obstructive pulmonary disease (COPD) is associated with reduced exercise capacity. In COPD iron deficiency is found in up to 50% of patients and may impair exercise capacity, the potential therapeutic effect is yet unknown. We aimed to estimate the beneficial effect of intravenous ferric carboxymaltose on exercise capacity and quality of life in patients with COPD.

Methods

In this non-randomized, interrupted time series pilot trial we enrolled outpatients with stable COPD (GOLD II and III) and nonanemic iron deficiency (i.e., ferritin level < 100 μg/l or ferritin level 100–300 μg/l if transferrin saturation < 20%). Patients with cardiovascular-or inflammatory diseases were excluded. Participants performed 6‑minute walking test (6-MWT) and cardiopulmonary exercise testing (CPET) and completed the St. George’s Respiratory Questionnaire (SGRQ).

Results

From 35 screened patients, 11 (72% male, 63 ± 8 years, FEV1%predicted 44 ± 14) were included. Mean ferritin and hemoglobin were 70 ± 41 µg/l and 13.8 ± 1.7 g/dl, respectively. Four weeks after iron administration the 6‑MWT distance increased by 34.7 ± 34.4 m (95% CI, 10.0–59.3); p = 0.011. The VO2max increased by 1.87 ± 1.2 ml/kg/min (95% CI, 0.76–3); p = 0.006. Mean score of SGRQ was reduced by 7.56 ± 6.12 units (95% CI, 3 to 11); p = 0.004. The insignificant alteration in hemoglobin did not correlate with increase in exercise capacity.

Conclusion

Administration of intravenous iron was associated with improved exercise capacity and quality of life in stable COPD patients independent of hemoglobin. Our data provide a basis to calculate a statistically sufficient sample size for a randomized controlled follow-up study.

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Abbreviations

CHF:

Chronic heart failure

COPD:

Chronic obstructive pulmonary disease

CPET:

Cardiopulmonary exercise testing

FEV1:

Forced expiratory volume in one second

FVC:

Forced vital capacity

GOLD:

Global Initiative for Chronic Obstructive Lung Disease

Hb:

Hemoglobin

ID:

Iron deficiency

MCID:

Minimal clinically important difference

SGRQ:

St. George’s Respiratory Questionnaire

TSAT:

Transferrin saturation

VO2max:

Maximum oxygen uptake

6‑MWT:

6‑minute walking test

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Authors and Affiliations

  1. Department for Internal Medicine and Pneumology, Klinik Floridsdorf, Brünner Str. 68, 1210, Vienna, Austria

    Erwin Grasmuk-Siegl MD & Matthias Helmuth Urban MD

  2. Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, 1210, Vienna, Austria

    Erwin Grasmuk-Siegl MD, Matthias Helmuth Urban MD & Georg-Christian Funk MD

  3. 2. Innere Abteilung, Nardini Klinikum, Landstuhl, Germany

    Sebastian Scherrer MD

  4. 2. Medical Department with Pneumology, Klinik Ottakring, 1160, Vienna, Austria

    Georg-Christian Funk MD

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  1. Erwin Grasmuk-Siegl MD
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Correspondence to Erwin Grasmuk-Siegl MD.

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E. Grasmuk-Siegl, M.H. Urban, S. Scherrer and G.-C. Funk declare that they have no competing interests.

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Grasmuk-Siegl, E., Urban, M.H., Scherrer, S. et al. Effect of intravenous ferric carboxymaltose on exercise capacity and quality of life in patients with COPD. Wien Klin Wochenschr 135, 35–44 (2023). https://doi.org/10.1007/s00508-022-02073-4

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