• Profile
Close

Iron Replenishment in COPD Patients Improves Exercise Tolerance: Shows FACE Trial Results

M3 India Newsdesk Dec 16, 2022

This article does a good job of explaining how the FACE trial found that intravenous iron carboxymaltose treatment is well tolerated and associated with improvements in exercise tolerance and symptoms in persons with COPD and iron insufficiency, with or without anaemia.


A significant global source of illness and death is a chronic obstructive pulmonary disease (COPD).

A few of the comorbidities that COPD is linked  which should be well managed since they independently affect mortality and hospitalisations are:

  • Heart disease
  • Cachexia
  • Osteoporosis
  • Metabolic syndrome
  • Depression
  • Pulmonary hypertension
  • Lung cancer
  • Anaemia 

As an independent predictor of dyspnea, activity restriction, anaerobic threshold, decreased health-related quality of life (QoL), and death, anaemia is becoming more well-recognised as significant comorbidity.


The FACE research

Along with frequent exacerbations, non-anaemic iron deficiency (NAID) has also been associated with inferior clinical outcomes and is a predictor of exercise intolerance.

The FACE research, which stands for "Ferinject Assessment in Patients with COPD and Iron Deficiency to Improve Exercise Tolerance," was created to investigate if intravenous iron replenishment would enhance exercise tolerance in Iron Deficiency patients as compared to a placebo.

  1. Iron deficiency is a typical symptom of COPD, and it may obviously impair exercise capacity. That shows a possible role for supplementation in iron-deficient individuals.
  2. A researcher observed that the exercise capacity of individuals with chronic obstructive pulmonary disease (COPD) rose significantly after a single IV iron infusion.

Using the 6-minute walk test (6MWT) and a constant work-rate exercise test to measure patients' tolerance for physical activity, a recently published study found that more than half of patients receiving the infusion achieved the primary endpoint of at least a 33% improvement, compared to 18% of patients receiving a placebo infusion (P=0.009).

In numerical terms, one secondary outcome also preferred iron therapy: COPD assessment

Test scores, a patient-reported measure of the quality of life, declined by a mean of 3.0 points (95% CI: 1.3-6.0) with active therapy against a loss of 1.0 points (95% CI: -2.3 to 4.0) in the placebo group (P=0.236). There were no differences in physical activity levels or adverse outcomes.

In 2015, an experiment of a similar kind was planned in Germany, however, it is unknown if it started or was finished. Another small research with IV iron done in the United Kingdom was reported; it demonstrated no change in blood oxygenation, however, like the current experiment in Barcelona, the 6MWT distance was increased with the active supplement.

For the infusion, all three studies used a ferric carboxymaltose product (Ferinject). The decision was influenced by practical considerations since a single dosage produces fascinating and rapid results. Iron used orally is often poorly absorbed and not always well tolerated.

This FACE study randomised 66 individuals at a ratio of 2:1 to receive either an iron infusion or a placebo. Iron deficiency was defined as serum ferritin less than 100 ng/mL or 100-299 ng/mL with concomitant transferrin saturation of less than 20%. Patients were not required to have obvious anaemia.

The exercise tolerance tests were administered at the beginning of the study and again four weeks after the infusion. During this time of follow-up, accelerometers were worn by patients to monitor their physical activity. Depending on the patient's weight and baseline haemoglobin level, the iron infusion dosage was either 500 or 1,000 mg. The iron injection triggered no allergic responses.

  1. The FACE trial found that intravenous iron carboxymaltose treatment is well tolerated and related to improvements in exercise tolerance and symptoms in individuals with COPD and iron insufficiency with or without anaemia. In individuals with low ferritin levels, these advantages were considerably more apparent.
  2. The measurement of the iron profile and correction of iron status may thus become a component of the monitoring and treatment of COPD patients.

 

Disclaimer- The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of M3 India.

About the author of this article: Dr Monish Raut is a practising super specialist from New Delhi.

Only Doctors with an M3 India account can read this article. Sign up for free or login with your existing account.
4 reasons why Doctors love M3 India
  • Exclusive Write-ups & Webinars by KOLs

  • Nonloggedininfinity icon
    Daily Quiz by specialty
  • Nonloggedinlock icon
    Paid Market Research Surveys
  • Case discussions, News & Journals' summaries
Sign-up / Log In
x
M3 app logo
Choose easy access to M3 India from your mobile!


M3 instruc arrow
Add M3 India to your Home screen
Tap  Chrome menu  and select "Add to Home screen" to pin the M3 India App to your Home screen
Okay