Vitamin D and COPD: seasonal variation is important

Ampikaipakan, Sundari; Hughes, David A.; Hughes, Jackie C.; Amen, Talar; Bentham, Graham; Wilson, Andrew

doi:10.1136/thx.2009.134338

Cited by 10 publications

(9 citation statements)

References 3 publications

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“…Lower serum levels of calcidiol in COPD patients in spite of higher dietary intake of vitamin D and higher intake from supplements indicate that this patient group might be at the risk of vitamin D insufficiency. We also found a group of COPD patients with 25‐OH‐D levels above 75 nmol/L, in contrast to the results from a previous study . This might be explained by vitamin D supplementation.…”

Section: Discussioncontrasting

confidence: 99%

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Vitamin D status and dietary intake in a Swedish COPD population

Måhlin¹,

Sydow²,

Osmancevic

et al. 2013

Clinical Respiratory J

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The mean serum concentration of 25-OH-D was significantly higher in the reference group (57.6 ± 23 nmol/L) compared with the COPD group (51.5 ± 22 nmol/L) (P = 0.039). The dietary intake was predominantly below the recommendations in both groups. Mean total daily intake of vitamin D and mean daily supplementation of vitamin D was significantly higher in the COPD group (P = 0.012 and P = 0.030, respectively). Low intake of vitamin D and low serum levels of 25-OH-D are common in both COPD patients and an elderly Swedish population. Monitoring vitamin D status and possibly routinely treating COPD patients with vitamin D and calcium should be considered to minimise the risk of severe vitamin D deficiency among COPD patients.

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Section: Discussioncontrasting

confidence: 99%

“…COPD patients are even more vulnerable in this regard . Recently, a small British study on 24 patients with COPD found that in winter season as few as three patients had levels of 25‐OH‐D exceeding 50 nmol/L and none exceeding 75 nmol/L .…”

Section: Introductionmentioning

confidence: 99%

Vitamin D status and dietary intake in a Swedish COPD population

Måhlin¹,

Sydow²,

Osmancevic

et al. 2013

Clinical Respiratory J

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“…This may depend on several reasons. First, vitamin D was deliberately assessed in the winter season, when levels are supposed to be lowest [ 20 ], especially to the latitude of our city [ 21 , 22 ]. Anyway, it is presumable that our subjects were deficient throughout the year, as in Italy, at variance with other countries [ 23 ], there is no food fortification with vitamin D. It has been estimated that a summer vitamin D level around 40 ng/mL is needed to achieve a 20 ng/mL concentration the following winter [ 24 ] and similar variations appear to exist in COPD patients, with approximately 35% lower values in winter compared to summer [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Severe vitamin D deficiency is associated with frequent exacerbations and hospitalization in COPD patients

et al. 2014

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BackgroundAcute exacerbations of COPD (AECOPD) are common and strongly influence disease severity and relative healthcare costs. Vitamin D deficiency is frequent among COPD patients and its contributory role in disease exacerbations is widely debated. Our aim was to assess the relationship of serum vitamin D levels with COPD severity and AECOPD.MethodsSerum vitamin D (25-hydroxyvitamin D) levels were measured in 97 COPD patients and related to lung function, comorbidities, FEV1 decline, AECOPD and hospital admission during the previous year.ResultsMost patients (96%) had vitamin D deficiency, which was severe in 35 (36%). No significant relationship was found between vitamin D and FEV1 or annual FEV1 decline. No difference between patients with and without severe vitamin D deficiency was found in age, gender, BMI, smoking history, lung function, and comorbidities, apart from osteoporosis (60.9% in severe deficiency vs 22.7%, p = 0.001). In multiple logistic regression models, severe deficiency was independently associated with AECOPD [adjusted odds ratios (aOR) of 30.5 (95% CI 5.55, 168), p < 0.001] and hospitalization [aOR 3.83 (95% CI 1.29, 11.4), p = 0.02]. The odds ratio of being a frequent exacerbator if having severe vitamin D deficiency was 18.1 (95% CI 4.98, 65.8) (p < 0.001), while that of hospitalization was 4.57 (95% CI 1.83, 11.4) (p = 0.001).ConclusionsIn COPD patients severe vitamin D deficiency was related to more frequent disease exacerbations and hospitalization during the year previous to the measurement of vitamin D. This association was independent of patients’ characteristics and comorbidities.Electronic supplementary materialThe online version of this article (doi:10.1186/s12931-014-0131-0) contains supplementary material, which is available to authorized users.

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“…The main strengths of our study include its large sample size (the largest to date regarding 25[OH]D levels in a COPDspecific cohort); use of an experienced laboratory to perform the 25(OH)D assays; a wide distribution of 25(OH)D levels; and the standardized, prospective collection of AECOPD data in the context of a clinical trial using AECOPD as its primary outcome. However, there are certain limitations to the data.…”

Section: Discussionmentioning

confidence: 99%

Vitamin D Levels and Risk of Acute Exacerbations of Chronic Obstructive Pulmonary Disease

Kunisaki

Niewoehner

Connett

2012

Am J Respir Crit Care Med

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Rationale: Low blood levels of 25-hydroxyvitamin D (25[OH]D) have been associated with a higher risk of respiratory infections in general populations and higher risk of exacerbations of lung disease in people with asthma. We hypothesized that low blood levels of 25(OH)D in patients with chronic obstructive pulmonary disease (COPD) would be associated with an increased risk of acute exacerbations of COPD (AECOPD). Objectives: To determine if baseline 25(OH)D levels relate to subsequent AECOPD in a cohort of patients at high risk for AECOPD. Methods: Plasma 25(OH)D was measured at baseline in 973 participants on entry to a 1-year study designed to determine if daily azithromycin decreased the incidence of AECOPD. Relationships between baseline 25(OH)D and AECOPD over 1 year were analyzed with time to first AECOPD as the primary outcome and exacerbation rate as the secondary outcome. Measurements and Main Results: In this largely white (85%) sample of North American patients with severe COPD (mean FEV 1 1.12L; 40% of predicted), mean 25(OH)D was 25.7 6 12.8 ng/ml. A total of 33.1% of participants were vitamin D insufficient (>20 ng/ml but ,30 ng/ml); 32% were vitamin D deficient (,20 ng/ml); and 8.4% had severe vitamin D deficiency (,10 ng/ml). Baseline 25(OH)D levels had no relationship to time to first AECOPD or AECOPD rates. Conclusions: In patients with severe COPD, baseline 25(OH)D levels are not predictive of subsequent AECOPD. Clinical trial registered with www.clinicaltrials.gov (NCT00119860).Keywords: chronic obstructive pulmonary disease; vitamin D; exacerbations Acute exacerbations of chronic obstructive pulmonary disease (AECOPDs) are associated with increased risk of short-term mortality (1, 2) and impaired respiratory health status (3). Exacerbations are also costly (4-7), making prevention of AECOPDs an important goal of COPD management. Proven therapies to reduce AECOPDs include long-acting inhaled bronchodilators, inhaled corticosteroids, and macrolide antibiotics, but they are only modestly effective, and additional interventions are needed.Viral and bacterial respiratory infections are thought to trigger most COPD exacerbations (8). As such, therapies that reduce respiratory infection risk might reduce the frequency of AECOPDs. A growing body of evidence suggests an important role for vitamin D in mounting appropriate innate and adaptive immune responses to infections (9-11). Cross-sectional (12) and prospective cohort (13) studies show that lower 25-hydroxyvitamin D (25[OH]D) levels are associated with a higher frequency of respiratory infections in healthy adults and more frequent asthma exacerbations in children (14, 15). A randomized trial of 430 Japanese schoolchildren during influenza season showed that, compared with placebo, vitamin D supplementation lowered the frequency of influenza A, although a secondary outcome of influenza B infections showed a nonstatistically significant trend toward higher frequency in the children who received supplements (16).Vitamin D insufficiency and deficie...

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Vitamin D and COPD: seasonal variation is important

Cited by 10 publications

References 3 publications

Vitamin D status and dietary intake in a Swedish COPD population

Vitamin D status and dietary intake in a Swedish COPD population

Severe vitamin D deficiency is associated with frequent exacerbations and hospitalization in COPD patients

Vitamin D Levels and Risk of Acute Exacerbations of Chronic Obstructive Pulmonary Disease

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