Efficacy of Vitamin C Supplementation on Chronic Obstructive Pulmonary Disease (COPD): A Systematic Review and Meta-Analysis

Abstract

Background In recent years, the pleiotropic roles of antioxidants have drawn extensive attention in various diseases. Vitamin C is a well-known antioxidant, and it has been used to treat patients with chronic obstructive pulmonary disease (COPD). This systematic review and meta-analysis aim to demonstrate the impact of vitamin C supplementation in patients with COPD. Methods We searched PubMed, Embase, Cochrane Library, Web of Science, Chinese National Knowledge Infrastructure (CNKI), SinoMed, Wanfang, and China Science and Technology Journal Database (cqvip.com) for eligible randomized controlled trials (RCTs) from their respective inception to May 18 th , 2021, by using the searching terms of COPD, vitamin C, and RCTs. A meta-analysis was performed to evaluate the effects of vitamin C on lung function, antioxidant levels, and nutritional conditions in COPD patients by using Review Manager (Version 5.4). Results Ten RCTs including 487 participants were eligible for our study. Meta-analysis results showed that vitamin C supplementation (≥400 mg/day) can significantly improve the forced expiratory volume in one second as a percentage (FEV1%) in COPD (SMD:1.08, 95% CI:0.03, 2.12, P =0.04). Moreover, vitamin C supplementation significantly improved the ratio of forced expiratory volume in 1 second and forced vital capacity (FEV1/FVC) (WMD:0.66, 95% CI: 0.26, 1.06, P =0.001), vitamin C level in serum (SMD:0.63, 95% CI: 0.02, 1.24, P =0.04) and glutathione (GSH) level in serum (SMD:2.47, 95% CI: 1.06, 3.89, P =0.0006). While no statistically significant difference was observed in body mass index (BMI), fat-free mass index (FFMI), vitamin E level and superoxide dismutase (SOD) level in serum. Conclusion Vitamin C supplementation could increase the levels of antioxidation in serum (vitamin C and GSH) and improve lung function (FEV1% and FEV1/FVC), especially in patients treated with vitamin C supplementation greater than 400 mg/day. However, further prospective studies are needed to explore the role of vitamin C in improving nutritional status.

The Role of Nutrition in the Development and Management of Chronic Obstructive Pulmonary Disease

“…Similarly, people that use combustible tobacco and consume a diet rich with vitamin C exhibit slower rates of pulmonary decline (FEV 1 ) when compared to those with low vitamin C intake [ 112 ]. This finding was confirmed in patients with COPD, with daily doses of 400 milligrams of vitamin C associated with better lung function (FEV 1 percent predictive and FEV 1 /FVC) [ 15 ], and daily doses of 2 g/day were associated with fewer pulmonary exacerbations over a six-month period [ 113 ]. Additionally, significant improvements in antioxidant capacity and vascular function were also observed in patients with COPD (GOLD stage I–IV) after an acute dose of a combination of vitamin C, vitamin E, and α-lipoic acid [ 114 ].…”

“…The role of these vitamins in COPD should be further investigated due to their potential benefits such as reducing oxidative stress [ 122 ] and protecting the airways [ 118 , 119 , 123 ]. In regard to vitamin C, a meta-analysis of ten randomized controlled trials including nearly 500 participants showed a significant improvement in lung function in individuals that supplemented 400 milligrams of oral vitamin C per day [ 15 ]. Additional benefits with fewer pulmonary exacerbations have been described in patients with COPD that received two grams of daily oral vitamin C supplementation [ 113 ].…”

“…Weight loss and appetite suppression occur in nearly half of patients with COPD [ 13 ], making malnutrition a common comorbidity [ 14 ]. Multiple factors precipitate this, including heightened physical demands of ventilation and increased sedentary behaviors [ 15 ]. Consequently, individuals with COPD scarcely obtain adequate amounts of micronutrients [ 16 ].…”

Rhodomyrtus tomentosa (Aiton) Hassk. (haramonting) protects against allethrin-exposed pulmo damage in rats: mechanistic interleukins

“…It helps overcome chronic respiratory disorders. Oxidative stress from toxins and free radicals damages lung tissue, especially in chronic lung disease patients ( Lei et al, 2022 ). Vitamin C protects alveoli and reduces COPD risk ( Lei et al, 2022 ).…”

Extrapulmonary Comorbidities Associated with Chronic Obstructive Pulmonary Disease: A Review

“…Vitamin C is recognized as a powerful antioxidant, while vitamin D has the potential to exhibit anti-inflammatory effects. 84 , 85 Although it is currently unclear whether the effectiveness of treating the inflammation response is more effective in the primary disease. There are novel treatment strategies available related to the iron regulatory pathway and hypoxia-inducible factor stabilizers for inflammatory anemia, but their efficacy needs to be further evaluated in clinical trials.…”