Hospital del Mar Research Institute Hospital del Mar Research Institute


1/10/2021 - Press release

Iron supplements improve physical fitness and quality of life in COPD patients

Patients with chronic obstructive pulmonary disease (COPD) who also suffer from a blood iron deficiency significantly improve their physical fitness if they receive supplements of this mineral. This is a new approach to the disease, which has been validated by the first studies published in Spain in this field and the largest in the world, to date, involving 66 patients. The work, derived from the FACE-Ferinject Assessment study on improving Exercise Tolerance in patients suffering COPD and iron deficiency, was carried out by doctors and researchers in the Pneumology Department at Hospital del Mar and the Hospital del Mar Medical Research Institute (IMIM) and has been published in the journals Archivos de Bronconeumología and Biomedicines.


Membres de l'equip, d'esquerra a dreta, Anna Rodó, Clara Martín, Esther Barreiro, Diego Rodríguez, Mireia Admetlló i Maria Pérez

The work involved a randomised clinical trial that monitored 66 patients with moderate COPD and blood iron deficiency, some of whom were anaemic and some of whom were not. Forty-four received intravenous iron supplements, while the rest were given a placebo. Before treatment, they all underwent tests to analyse their physical fitness, including quality of life questionnaires and strength tests to assess their endurance capacity.

More than half improved

Once the baseline physical condition of the participants had been established, two-thirds of them received the iron supplement, ferric carboxymaltose, a drug that is already commonly used to treat a variety of conditions, usually in a single dose. One month later, they were returned to the clinic to repeat the tests and have a progress analysis. During this time, they were asked not to do any activities beyond their usual routine.


Pacient durant una prova d'esforç

The results demonstrated the benefits of this treatment. More than half of the patients in the group that received iron, 52.3% showed a more than 33% improved physical fitness (the threshold to consider this a significant improvement) compared to their baseline. At the same time, their quality of life improved by three points while their physical activity levels remained the same. In contrast, only 18% of those receiving the placebo achieved this goal and there was no change in their quality of life or physical activity. In addition, blood oxidant levels decreased between 50% and 66% for some of the markers tested. The iron supplement caused no side effects in any of the participants.

Dr. Diego Agustín Rodríguez-Chiaradía, a consultant in the Pneumology Service and an author on both studies, affirms that this work offers a new way of treating and improving this pathology that is quite different from the usual one, based on the inhalation of bronchodilators and corticoids, accompanied by the recommendation to stop smoking and do exercise. "This is a completely different approach to the usual one for COPD patients, although it is not suitable for everyone. Up to 50% of people with moderate to severe COPD suffer from iron deficiency and could benefit", he explains.

Dr. Esther Barreiro, a consultant in the same department, an IMIM researcher and also an author on both studies, explains that "If an excess of oxidants in the blood is not compensated for by antioxidants, this alters a series of structures at the cellular level, which conditions the pathology. In the specific case of COPD, it limits the patient's capacity for physical activity and exertion." In other words, the positive effect iron has on these elements influences the improved physical fitness detected in the patients.

The researchers' hypothesis is that "Iron is a factor in numerous cellular processes, especially in the muscles. Therefore, optimising iron levels improves both muscle and exercise capacity", says Dr Rodríguez-Chiaradia. In fact, iron is an essential micronutrient in the metabolism, not least because of its crucial role in the transport of oxygen in the blood. An adequate level of this mineral is important for cell activity, especially for the elements involved in musculoskeletal functions.

Chronic obstructive pulmonary disease is highly prevalent in Spain and Catalonia, affecting between 11% and 13% of the population. It is a leading cause of morbidity and mortality worldwide, and is associated with a number of comorbidities, including cardiovascular disease, cachexia, osteoporosis, metabolic syndrome, depression, pulmonary hypertension, lung cancer and anaemia.

Reference article

Intravenous Iron Replacement Improves Exercise Tolerance in COPD: A Single-Blind Randomized Trial. Clara Martín-Ontiyuelo, Anna Rodó-Pin, Daniel Echeverría-Esnal, Mireia Admetlló, Xavier Duran Jordà, Mariela Alvarado, Joaquim Gea, Esther Barreiro, Diego A. Rodríguez-Chiaradía. 10.1016/j.arbres.2021.08.011

Pérez-Peiró, M.; Martín-Ontiyuelo, C.; Rodó-Pi, A.; Piccari, L.; Admetlló, M.; Durán, X.; Rodríguez-Chiaradía, D.A.; Barreiro, E. Iron Replacement and Redox Balance in Non-Anemic and Mildly Anemic Iron Deficiency COPD Patients: Insights from a Clinical TrialBiomedicines 20219, 1191.

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