Cigarette Smoking and Secondary Polycythemia in Hypoxic Cor Pulmonale1,2

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Abstract
We have related the red cell mass (RCM) in 47 hypoxic patients with COPD (mean P02,52.5 ± 5.2 SD mmHg; mean PC02, 51.7 ± 6.7 mmHg; mean FEV1, 0.6 ± 0.2 L; mean FVC, 1.7 ± 0.6 L) to their smoking habits and outpatient carboxyhemoglobin concentrations. The mean RCM was 42.5 ± 8.0 ml/kg in the 31 patients who still smoked, significantly (p < 0.01) higher than In the 16 who were currently nonsmokers (RCM, 29.7 ± 4.4 ml/kg). Measurements of arterial PO2, pH, P30, and COHb showed that the saturation of available hemoglobin (So2A) was less well correlated (r =-0.36, p < 0.05) with RCM in the smokers, than was So2T (r = -0.58, p < 0.001), So2T including a corrective term for COHb. The RCM correlated well with the mean outpatient COHb measured repeatedly over 6 to 36 months in 40 of the patients but poorly with their average arterial oxygen saturation (r = 0.15, p > 0.1). In 15 patients given long-term oxygen therapy (15 hours/24-hour period) for 12 months RCM decreased significantly only in those who stopped smoking, as shown by a decrease in COHb. We conclude that cigarette smoking may determine the severity of secondary polycythemia in patients with hypoxic COPD, and prevent its correction by long-term oxygen therapy.

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