Association Between Vitamin D Levels and FEV1, Number of Exacerbations, and CAT Score in Stable COPD Patients in Indonesia

Abstract

Purpose: This study aimed to assess the association between vitamin D levels and forced expiratory volume in one second (FEV1), number of exacerbations, and symptoms based on COPD assessment test (CAT) scores in stable COPD patients in Indonesia. Patients and Methods: An observational cross-sectional study was conducted. Subjects were stable COPD patients who were treated at a pulmonary clinic in a tertiary referral hospital in West Java from March to June 2018. Results: Thirty subjects were recruited this study with an average age 62±8 years. The mean vitamin D level was 20.17±8.91 ng/mL. Half of the patients had low vitamin D level (<20ng/ mL) (50%). The mean FEV1 (%) predicted value was 37.2±14. The median exacerbation per year was 1 (0-5) and symptoms based on CAT score was 14 (3-34). No correlation was found between vitamin D levels and FEV1 (%) predicted value (r=0.126, p=0.253). Vitamin D level was inversely correlated with number of exacerbations (r=−0.639, p<0.001) and CAT (r= −0.802, p<0.001). Conclusion: Low level of vitamin D was associated with more frequent exacerbation and higher CAT scores but was not associated with FEV1 (%) predicted.

Airway microbiome-immune crosstalk in chronic obstructive pulmonary disease

“…Moreover, in stable COPD, high levels of LL-37 predict acute exacerbation ( 296 , 361 ). As expected, COPD patients with vitamin D deficiency have significantly lower LL-37 ( 362 – 365 ). This association is even more evident among individuals with acute exacerbation ( 296 , 361 ).…”

Vitamin D deficiency in chronic obstructive pulmonary disease

“…This is supported by another retrospective cohort study that showed FEV 1 was 4.11% lower at enrolment in COPD patients with VDD compared with those with normal levels ( P = 0.004) [27]. On the other hand, a matched retrospective cohort study on patients with COPD [17] and an observational cross-sectional study of patients with COPD [16 ▪ ] did not find a relationship between VDD and lung function.…”

“…Another study from 2020 found that 89% of patients with COPD were vitamin D deficient compared with 61% of age-matched controls ( P = 0.015) with significantly lower average serum 25(OH)D 3 levels (15.13 ± 6.02 ng/l compared with 21.89 ± 4.49 ng/l, P = 0.015) [14]. These findings are not limited to North America: recent studies from India found that 50% of COPD patients in an outpatient clinic were vitamin D deficient [16 ▪ ], and that COPD patients were more likely to be vitamin D deficient than age and sex-matched controls [odds ratio (OR) 5.05, 95% confidence interval (CI) 1.4–17.8] [17]. It is possible that the prevalence of VDD in COPD is underestimated: a study completed in 2022 found that only 44% of patients with COPD followed in a specialty clinic were screened for VDD, with screening largely following other indications such as female sex, patients with chronic kidney disease, and osteoporosis [18 ▪ ].…”

“…According to a recent retrospective study, COPD patients with VDD had a higher odds of COPD exacerbation (OR 1.32, P = 0.049) [27]. This may be modified by the severity of VDD: Soeroto et al [16 ▪ ] found that the number of exacerbations was inversely correlated with serum 25(OH)D 3 levels ( r = 0.639, P < 0.001), while Ulucoban et al [15] found that the annual rate of exacerbation was 1.6 per year in severely deficient patients and Lokesh et al [17] found that all patients with severe deficiency [serum 25(OH)D 3 levels <15 ng/ml] experienced more than three exacerbations per year. However, these observations were not confirmed by other recent studies: a retrospective chart review of 117 COPD patients found that patients with severe VDD did not have an increased exacerbation frequency compared with those without VDD [26], and another cross-sectional study found no association between exacerbation frequency and VDD [7].…”

“…Several studies have now demonstrated a difference in symptom scores, based on validated questionnaires, between patients with COPD who have normal vitamin D levels and those who are deficient. Retrospective studies have shown an inverse correlation between COPD Assessment Test scores and serum 25(OH)D 3 levels, even when controlling for other confounders such as age, sex, BMI, comorbidities, and smoking history [16 ▪ ,35 ▪ ,36]. Although these findings may relate to respiratory-driven changes, they may also reflect the impact of vitamin D on the musculoskeletal system and general functional capacity.…”