Vitamin D Deficiency and Reduced Lung Function in Connective Tissue-Associated Interstitial Lung Diseases

Hagaman, Jared T.; Panos, Ralph J.; McCormack, Francis X.; Thakar, Charuhas V.; Wikenheiser-Brokamp, Kathryn A.; Shipley, Ralph; Kinder, Brent W.

doi:10.1378/chest.10-0968

Cited by 38 publications

(27 citation statements)

References 42 publications

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“…Despite a rapidly growing body of scientific literature, the mechanisms underlying the potential benefit of high-dose vitamin D therapy remain uncertain. Several epidemiologic studies have shown an association between vitamin D deficiency and increased risk of respiratory infections [32] , [33] as well as an direct relationship between vitamin D and decreased lung function in patients with chronic obstructive pulmonary disease and interstitial lung disease [34] , [35] , [36] , [37] . Therapeutically, administration of 25(OH)D was associated with an increase in lung function for adult patients with asthma [38] and with improved one year survival in patients with cystic fibrosis [39] .…”

Section: Discussionmentioning

confidence: 99%

High dose vitamin D administration in ventilated intensive care unit patients: A pilot double blind randomized controlled trial

Han

Jones

Tangpricha

et al. 2016

Journal of Clinical & Translational Endocrinology

153

203

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Background There is a high prevalence of vitamin D deficiency in the critically ill patient population. Several intensive care unit studies have demonstrated an association between vitamin D deficiency [25-hydroxyvitamin D (25(OH)D) < 20 ng/mL] and increased hospital length of stay (LOS), readmission rate, sepsis and mortality. Material and Methods Pilot, double blind randomized control trial conducted on mechanically ventilated adult ICU patients. Subjects were administered either placebo, 50,000 IU vitamin D3 or 100,000 IU vitamin D3 daily for 5 consecutive days enterally (total vitamin D3 dose = 250,000 IU or 500,000 IU, respectively). The primary outcome was plasma 25(OH)D concentration 7 days after oral administration of study drug. Secondary outcomes were plasma levels of the antimicrobial peptide cathelicidin (LL37), hospital LOS, SOFA score, duration of mechanical ventilation, hospital mortality, mortality at 12 weeks, and hospital acquired infection. Results A total of 31 subjects were enrolled with 13 (43%) being vitamin D deficient at entry (25(OH)D levels < 20 ng/mL). The 250,000 IU and 500,000 IU vitamin D3 regimens each resulted in a significant increase in mean plasma 25(OH)D concentrations from baseline to day 7; values rose to 45.7±19.6 ng/mL and 55.2 ± 14.4 ng/mL, respectively, compared to essentially no change in the placebo group (21±11.2 ng/mL), p<0.001. There was a significant decrease in hospital length of stay over time in the 250,000 IU and the 500,000 IU vitamin D3 group, compared to the placebo group (25 ± 14 and 18 ± 11 days compared to 36 ± 19 days, respectively; p=0.03). There was no statically significant change in plasma LL-37 concentrations or other clinical outcomes by group over time. Conclusions In this pilot study, high-dose vitamin D3 safely increased plasma 25(OH)D concentrations into the sufficient range and was associated with decreased hospital length of stay without altering other clinical outcomes. Clinical Trial Registration www.clinicaltrials.gov (NCT01372995)

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Section: Discussionmentioning

confidence: 99%

High dose vitamin D administration in ventilated intensive care unit patients: A pilot double blind randomized controlled trial

Han

Jones

Tangpricha

et al. 2016

Journal of Clinical & Translational Endocrinology

153

203

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“…A study on 118 patients with interstitial lung disease, including 67 patients with connective tissue disorders, revealed significantly low vitamin D levels (35). In patients with connective tissue disorders, correlations between vitamin D level and forced vital capacity and DLCO were identified.…”

Section: Methodsmentioning

confidence: 99%

Low vitamin D status in systemic sclerosis and the impact on disease phenotype

et al. 2016

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Objective: Vitamin D has pleiotropic effects including immunomodulatory, cardioprotective, and antifibrotic properties and is thus able to modulate the three main links in scleroderma pathogenesis. The aim of the study was to evaluate the level of vitamin D in patients with systemic sclerosis and to analyze the associations between the concentration of vitamin D and the features of systemic sclerosis.Material and Methods: Fifty-one consecutive patients were evaluated for visceral involvement, immunological profile, activity, severity scores, and quality of life. The vitamin D status was evaluated by measuring the 25hydroxy-hydroxyvitamin D serum levels. Results:The mean vitamin D level was 17.06±9.13 ng/dL. Only 9.8% of the patients had optimal vitamin D levels; 66.66% of them had insufficient 25(OH)D levels, while 23.52% had deficient levels. No correlation was found between vitamin D concentration and age, sex, autoantibody profile, extent of skin involvement, or vitamin D supplementation. Vitamin D levels were correlated with the diffusing capacity of the lung for carbon monoxide (p=0.019, r=0.353), diastolic dysfunction (p=0.033, r=−0.318), digital contractures (p=0.036, r=−0.298), and muscle weakness (p=0.015, r=−0.377) and had a trend for negative correlation with pulmonary hypertension (p=0.053, r=−0.29).Conclusion: Low levels of vitamin D are very common in systemic sclerosis. Poor vitamin status seems to be related with a more aggressive disease with multivisceral and severe organ involvement, especially pulmonary and cardiac involvement.

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“…13 Vitamin D concentration has been shown to be directly correlated with spirometry and gas exchange in subjects with interstitial lung disease. 14 Subjects with COPD who had mild vitamin D insufficiency 15 and who engaged in rehabilitation demonstrated higher functional gains when vitamin D supplementation was added to their rehabilitation regimen. 16 Furthermore, COPD subjects with severe vitamin D deficiency (< 10 ng/mL) had a significantly lower rate of COPD exacerbations with supplementation compared with those without.…”

Section: Introductionmentioning

confidence: 99%

Association Between Vitamin D Status and Weaning From Prolonged Mechanical Ventilation in Survivors of Critical Illness

Verceles¹,

Weiler²,

Koldobskiy

et al. 2015

Respir Care

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BACKGROUND In this study, we examined the association between 25-hydroxyvitamin D (25(OH)D) concentration and successful weaning from mechanical ventilation in a cohort of ICU survivors requiring prolonged mechanical ventilation. METHODS This was a retrospective cohort study of ICU survivors admitted to a long-term acute care hospital. Demographic data were extracted from medical records, including 25(OH)D concentrations drawn on admission. Subjects were divided into 2 groups based on their 25(OH)D concentrations (deficient, < 20 ng/mL; not deficient, ≥ 20 ng/mL), and associations between 25(OH)D concentration and successful weaning were calculated. RESULTS A total of 183 subjects were studied. A high prevalence of 25(OH)D deficiency was found (61%, 111/183). No association was found between 25(OH)D concentration and weaning from mechanical ventilation. Increased comorbidity burden (Charlson comorbidity index) was associated with decreased odds of weaning (odds ratio of 0.50, 95% CI 0.25– 0.99, P = .05). CONCLUSIONS Vitamin D deficiency is common in ICU survivors requiring prolonged mechanical ventilation. Surprisingly, there was no significant relationship between 25(OH)D concentration and successful weaning. This finding may be due to the low 25(OH)D concentrations seen in our subjects. Given what is known about vitamin D and lung function and given the low vitamin D concentrations seen in patients requiring long-term ventilatory support, interventional studies assessing the effects of 25(OH)D supplementation in these patients are needed.

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Vitamin D Deficiency and Reduced Lung Function in Connective Tissue-Associated Interstitial Lung Diseases

Abstract: There is a high prevalence of vitamin D deficiency in patients with ILD, particularly those with CTD-ILD, and it is associated with reduced lung function. Vitamin D may have a role in the pathogenesis of CTD-ILD.

Cited by 38 publications

References 42 publications

High dose vitamin D administration in ventilated intensive care unit patients: A pilot double blind randomized controlled trial

High dose vitamin D administration in ventilated intensive care unit patients: A pilot double blind randomized controlled trial

Low vitamin D status in systemic sclerosis and the impact on disease phenotype

Association Between Vitamin D Status and Weaning From Prolonged Mechanical Ventilation in Survivors of Critical Illness

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