Hypothesis:

The first part of the study is a survey on the prevalence of anemia of chronic disease (ACD) among COPD patients. The 2nd and 3rd part will test 2 null hypotheses (Ho): 1.serum inflammatory markers and plasma erythropoietin do not differ between COPD patients with and without ACD and 2. exercise capacity does not differ between COPD patients with and without ACD.

Rationale-Aim:

ACD is an immune driven disorder, developing in subjects suffering from chronic inflammatory diseases. COPD is a disorder very likely to be associated to ACD due to its systemic inflammatory dimension. Currently, data on the prevalence of ACD and on the level of inflammatory markers which are implicated in the pathogenesis of ACD in COPD subjects are limited and controversial. Furthermore, there is no data on the effect of ACD on exercise capacity of COPD subjects.

Based to the aforementioned, this study has three goals:

1. to determine the prevalence and the epidemiologic characteristics of ACD in a population of clinical stable COPD patients
2. to investigate whether the levels of serum inflammatory markers and of plasma erythropoietin differ between COPD patients with ACD and without ACD
3. to determine potential differences regarding the aerobic exercise capacity between these two groups, using the cardiopulmonary exercise testing (CPET).

Inclusion Criteria:

• 1st part of the study:

  • COPD clinically stable (patients with post-bronchodilation FEV1/FVC <0.7 and no acute exacerbations, hospital admissions or treatment changes in the last 3 months).
  • 2nd and 3rd part:
  • As above.

Exclusion Criteria:

• 1st part of the study:

  • history of asthma,
  • history of respiratory infection in the last 3 months

• 2nd and 3rd part: As above and additionally:

  • history of malignancy or haematologic disorder
  • acute or chronic inflammatory disease
  • systematic or autoimmune disorder
  • thyroid disease
  • liver cirrhosis
  • heart failure (ejection fraction <55%)
  • history of gastrointestinal or other hemorrhage
  • renal failure (GFR<60 ml/min/1.73m2)
  • blood transfusion in the last 4 months
  • administration of cortisone in the last month
  • pregnancy
  • mental impairment
  • medical conditions which are contraindications to exercise testing, such as:

• acute myocardial infarction (in the last 6 months)

• unstable angina

• left main coronary stenosis or its equivalent

• syncope

• symptomatic severe aortic stenosis or other moderate stenotic valvular disease

• uncontrolled arrhythmias causing symptoms

• acute pulmonary embolus or pulmonary infarction

• thrombosis of lower extremities

• suspected dissecting aneurysm

• pulmonary oedema

• room air desaturation at rest <85%

• severe untreated arterial hypertension at rest (>200 mmHg systolic, >120 mmHg diastolic)

• high degree atrioventricular block

• hypertrophic cardiomyopathy and

• orthopedic impairment that compromises exercise performance