A study to assess the relationship between vitamin D3 levels and the risk of acute exacerbation in patients with chronic obstructive pulmonary disease

Submitted: December 20, 2023
Accepted: February 15, 2024
Published: March 1, 2024
Abstract Views: 556
PDF_EARLY VIEW: 301
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

Chronic obstructive pulmonary disease (COPD) is one of the top three causes of mortality worldwide. Vitamin D deficiency in COPD has been associated with poor lung function and decreased muscle power, which further increases the risk of exacerbations. The role of vitamin D in preventing acute exacerbations of COPD has conflicting results in the literature. Hence, we planned this study to assess the relationship between vitamin D3 levels and the risk of acute exacerbations among COPD patients in a tertiary care center in north India. This was a prospective randomized control trial that was performed on 100 consecutive stable COPD patients attending the Department of Respiratory Medicine at Maharishi Markandeshwar Medical College and Hospital, Solan, India. The patients with subnormal vitamin D3 levels (i.e., less than 30 ng/mL) were divided into the intervention and control groups. Baseline demographic profiles, lung function, COPD assessment test (CAT) score, modified Medical Research Council grade and chest radiology were performed and repeated after 12 months in all these patients. All these parameters were recorded and compared with the baseline values obtained at the beginning of the study. Out of 100 subjects, 96 had vitamin D deficiency, of which 48 were assigned to the intervention group and 48 to the control group. Among the 100 subjects, 74 (74%) were males and 26 (26%) were females, with a mean age of 66.9±9.4 years. The mean vitamin D level was 14.71±6.69 in these 96 patients. The vitamin D level improved after 3 months of supplementation to the mean level of 45.56±16.18 in the intervention group. Vitamin D supplementation was positively correlated with a decrease in the rate of acute exacerbations in the intervention group in terms of reduction in mean CAT score (4.17 in intervention and 1.43 in non-interventional group, p<0.001), number of acute exacerbations (1.7 in intervention and -1.05 in non-interventional group, p<0.001), and number of emergency visits (p=0.0121) during the 9-month period after attainment of a normal vitamin D level. Vitamin D supplementation plays a key role in COPD patients with D3 hypovitaminosis in decreasing COPD acute exacerbations, improving the CAT score, and reducing the number of emergency visits.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

Citations

Terminology, definitions, and classification of chronic pulmonary emphysema and related conditions: a report of the conclusions of a ciba guest symposium. Thorax 1959;14:286-99. DOI: https://doi.org/10.1136/thx.14.4.286
World Health Organization. Chronic obstructive pulmonary disease (COPD). 2015. Available from: www.who.int/respiratory/copd/en/.
Barbera JA, Roca J, Ferrer A, et al. Mechanisms of worsening gas exchange during acute exacerbations of chronic obstructive pulmonary disease. Eur Respir J 1997;10:1285-91. DOI: https://doi.org/10.1183/09031936.97.10061285
Michael F, Holick, Neil C, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2011;96:1911-30. DOI: https://doi.org/10.1210/jc.2011-0385
Førli L, Halse J, Haug E, et al. Vitamin D deficiency, bone mineral density and weight in patients with advanced pulmonary disease. J Intern Med 2004;256:56-62. DOI: https://doi.org/10.1111/j.1365-2796.2004.01337.x
Janssens W, Bouillon R, Claes B, et al. Vitamin D deficiency is highly prevalent in COPD and correlates with variants in the vitamin D-binding gene. Thorax 2010;65:215-20. DOI: https://doi.org/10.1136/thx.2009.120659
Foumani AA, Mehrdad M, Jafarinezhad A, et al. Impact of vitamin D on spirometry findings and quality of life in patients with chronic obstructive pulmonary disease: a randomized, double-blinded, placebo-controlled clinical trial. Int J Chron Obstruct Pulmon Dis 2019;14:1495-501. DOI: https://doi.org/10.2147/COPD.S207400
Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. 2020. Available from: www.goldcopd.org. Accessed on: 20/06/2020.
Jackson AS, Hopkinson NS. Vitamin D in COPD - a pleiotropic micronutrient in a multisystem disease. Curr Respir Med Rev 2011;7:414-20. DOI: https://doi.org/10.2174/157339811798072612
Persson LJ, Aanerud M, Hiemstra PS, et al. Chronic obstructive pulmonary disease is associated with low levels of vitamin D. PLoS One 2012;7:e38934 DOI: https://doi.org/10.1371/journal.pone.0038934
Monadi M, Heidari B, Asgharpour M, et al. Relationship between serum vitamin D and forced expiratory volume in patients with chronic obstructive pulmonary disease (COPD). Caspian J Intern Med 2012;3:451-5.
Xiaoyan Li, Jie he, Mi yu, et al. Efficacy of vitamin D therapy for patients with COPD: a meta analysis. Ann Palliat Med 2020;9:286-97. DOI: https://doi.org/10.21037/apm.2020.02.26
Lokesh KS, Chaya SK, Jayaraj BS, et al. Vitamin D deficiency is associated with chronic obstructive pulmonary disease and exacerbation of COPD. Clin Respir J 2021;15:389-99. DOI: https://doi.org/10.1111/crj.13310
Jolliffe DA, Greenberg L, Hooper RL, et al. Vitamin D to prevent exacerbations of COPD: systematic review and meta-analysis of individual participant data from randomised controlled trials. Thorax 2019;74:337-45. DOI: https://doi.org/10.1136/thoraxjnl-2018-212092
Schnell K, Weiss CO, Lee T, et al. The prevalence of clinically-relevant comorbid conditions in patients with physician-diagnosed COPD: a cross-sectional study using data from NHANES 1999-2008. BMC Pulm Med 2012;12:26. DOI: https://doi.org/10.1186/1471-2466-12-26
Lehouck A, Mathieu C, Carremans C, et al. High doses of vitamin D to reduce exacerbations in chronic obstructive pulmonary disease: a randomized trial. Ann Intern Med 2012;156:105-14. DOI: https://doi.org/10.7326/0003-4819-156-2-201201170-00004
Malinovschi A, Masoero M, Bellocchia M, et al. Severe vitamin D deficiency is associated with frequent exacerbations and hospitalization in COPD patients. Respir Res 2014;15:131. DOI: https://doi.org/10.1186/s12931-014-0131-0
Janssens W, Decramer M, Mathieu C, et al. Vitamin D and chronic obstructive pulmonary disease: hype or reality?. Lancet Respir Med 2013;1:804-12. DOI: https://doi.org/10.1016/S2213-2600(13)70102-4
Pfeffer PE, Lu H, Mann EH, et al. Effects of vitamin D on inflammatory and oxidative stress responses of human bronchial epithelial cells exposed to particulate matter. PLoS One 2018;13:e0200040. DOI: https://doi.org/10.1371/journal.pone.0200040
Scaramozzino MU, Giovanni S, Rago GF, et al. The association of various antioxidants (Zinc, Vitamins A and D) in a small population cohort with chronic obstructive pulmonary diseases: a retrospective observational pilot study. Pharmanutrition and Functional Foods 2023. [Article in Italian].

Ethics Approval

The institutional review board of the Maharishi Markandeshwar Medical College and Hospital, Solan, approved the study (approval number MMMCH/IEC/21/433).

How to Cite

Lakra, Ankit, Balbir Singh, Ashok Kumar Janmeja, Vanita Sharma, and Arjun Kumar. 2024. “A Study to Assess the Relationship Between Vitamin D3 Levels and the Risk of Acute Exacerbation in Patients With Chronic Obstructive Pulmonary Disease”. Monaldi Archives for Chest Disease, March. https://doi.org/10.4081/monaldi.2024.2885.

Similar Articles

1 2 3 4 5 6 7 8 9 10 > >> 

You may also start an advanced similarity search for this article.