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

Abstract

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.

Vitamin D to prevent exacerbations of COPD: systematic review and meta-analysis of individual participant data from randomised controlled trials

“…Since acute respiratory infections commonly precipitate exacerbations of both asthma and COPD, and it may be that protective effects of vitamin D against these outcomes are mediated by a common mechanism, namely induction of antiviral and antimicrobial responses. The protective effects demonstrated in this meta-analysis of intervention studies are consistent with results of some observational studies9 but at variance with others10: failure to demonstrate an association between vitamin D deficiency and increased exacerbation risk in some observational studies may relate to the low prevalence of participants with baseline 25(OH)D levels <25 nmol/L 23…”

Vitamin D status is associated with muscle strength and quality of life in patients with COPD: a seasonal prospective observation study

“…Vitamin D deficiency, in turn, has been associated with increased rates of exacerbations and hospitalization in COPD patients 8,9. Recent meta-analyses have concluded that vitamin D deficiency is directly associated with COPD disease severity and vitamin D supplementation may prevent exacerbations 10–12.…”

Vitamin D and Diagnosis of COPD in a Working Population

“…An association between vitamin D deficiency and decreased pulmonary functions as well as airflow limitation in asthma patients has been suggested [6]. There have been some reports of the possible association of acute exacerbation of COPD with vitamin D deficiency although there have also been other reports that no association exists [7,8]. Martineau et al [9] reported that vitamin D 3 supplementation protected against moderate or severe exacerbation in subjects with COPD with low 25-hydroxyvitamin D [25(OH)D] level.…”