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 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.

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.

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.