EAL

Recommendations Summary

Search Plan and Results

Evidence Analysis Question(s)

Does vitamin D supplementation improve lung function and exacerbation outcomes in adults with COPD?

What associations exist between serum 25(OH)D levels and mortality, lung function and exacerbation outcomes in adults with COPD?

Does vitamin D supplementation improve mortality outcomes in adults with COPD?

Date of Literature Review

December 2017

Inclusion Criteria

Age: Adults 18 years and older.

Setting: All settings, except critical care.

Health Status:

With or without supplemental oxygen

With or without home bilevel positive airway pressure (BiPAP).

Nutrition-Related Problem or Condition:

COPD, COPD with comorbid conditions (Studies that include COPD with comorbidities must focus on COPD).

All COPD stages and source of diagnosis.

Study Design Preferences:

Randomized controlled trials (RCT) or Clinical Controlled Studies

Large nonrandomized observational studies

Cohort, case-control studies.

Intervention: Vitamin D supplementation alone or Vitamin D in combination with other vitamins or minerals, as long as serum 25(OH)D levels are reported.

Outcomes: Includes one or more of the following outcomes:

Mortality

Lung function / Respiratory Impairment

Exacerbations

Size of Study Groups: Sample size must equal 10 for each study group (e.g., 10 patients in intervention group and 10 patients in control or comparison group).

Year Range: 2005 to December 31, 2017.

Authorship:

If an author is included on more than one review article or primary research article that is similar in content, the most recent review or article will be accepted and earlier versions will be rejected

If an author is included on more than on review article or primary research article and the content is different, then both reviews may be accepted.

Language: English.

Subjects: Human.

Publication: Published in peer-reviewed journal.

Exclusion Criteria

Age: Young adults up to 18 years of age, infants, children and adolescents.

Setting: Critical care (e.g., intensive care unit).

Health Status: Mechanical ventilation.

Nutrition-Related Problem or Condition:

Fibrosis (without COPD)

Sarcoidosis (without COPD)

Asthma (without COPD)

Asthma-COPD Overlap Syndrome

Chronic Systemic Inflammatory Syndrome (without COPD)

Lung condition that is not COPD

Prevention of COPD in cohort of patients with no COPD

No comorbid conditions excluded. Studies that include COPD with comorbidities that do not focus on COPD are excluded.

Study Designs:

Review article; meta-analysis (Relevant review articles will be hand searched.)

Not a research study: Poster session, commentary, letter to editor, “grey” literature: technical reports from government agencies or scientific research groups, working papers from research groups or committees, white papers, position papers, abstracts, conference reports or pre-prints.

Intervention:

Vitamin D in combination with other vitamins or minerals, without serum 25(OH)D levels reported

Vitamin D-binding protein.

Outcomes: Does not report on at least one of the three outcomes of interest.

Size of Study Groups:

Less than 10 subjects for each study group

Subject number is unclear or not reported.

Year Range: Published prior to 2005.

Authorship: Studies by same author similar in content.

Language: Not in English.

Subjects: Animal studies.

Publication: Not published in peer-reviewed journal.

Search Terms: Search Vocabulary

Condition: COPD

Population: Adults

Intervention/treatment:

Vitamin D

Ergocalciferols; cholecalciferol; calciferol; colecalciferol; ergocalciferol; dihydrotachysterol; hydroxycholecalciferol; dihydrotachysterol

25 OHD; 25 hydroxyvitamin D; 1, 25-dihydroxyvitamin D

Electronic Databases

Medline (ovid) 582 retrieved, 566 unique on 8/17/2017, limited to English, 2005-current

1. exp Vitamin D Deficiency/ or exp Vitamin D/
2. (vitamin adj1 d).ti, ab.
3. ((c adj1 CALCIFEROL*) or CHOLECALCIFEROL* or ERGOCALCIFEROL*).ti, ab.
4. 25 OHD.ti, ab.
5. exp Hydroxycholecalciferols/
6. Hydroxycholecalciferol*.ti, ab.
7. exp Calcifediol/
8. exp Vitamin D Deficiency/
9. "25-OHD".ti, ab.
10. "25 hydroxyvitamin D".ti, ab.
11. colecalciferol*.ti, ab.
12. cholecalciferol/
13. Calcifediol.ti, ab.
14. exp Dihydroxycholecalciferols/
15. dihydroxycholecalciferol*.ti, ab.
16. exp Calcitriol/
17. Calcitriol*.ti, ab.
18. exp 24, 25-Dihydroxyvitamin D 3/
19. "24, 25-OH2 D3".ti, ab.
20. "OH2 D3".ti, ab.
21. exp Ergocalciferols/
22. ergocalciferol*.ti, ab.
23. exp Dihydrotachysterol/
24. dihydrotachysterol*.ti, ab.
25. exp 25-Hydroxyvitamin D 2/
26. "25- OHD2".ti, ab.
27. "1, 25-dihydroxyvitamin d".ti, ab.
28. "1, 25-OH2 D".ti, ab.
29. "1, 25- dihydroxyvitamin d2".ti, ab.
30. "1, 25-dihydroxyergocalciferol".ti, ab.
31. "1, 25-OH2 D2".ti, ab.
32. "1, 25-dihydroxyvitamin d3".ti, ab.
33. "1, 25-OH2 D3".ti, ab.
34. ((vitamin* or hydroxyvitamin* or dihydroxyvitamin*) adj1 (d or d3 or d2)).ti, ab.
35. or/1-34
36. exp Pulmonary Disease, Chronic Obstructive/
37. (Chronic Obstructive pulmonary or copd).ti, ab.
38. Obstructive lung disease*.ti, ab.
39. exp Lung Diseases, Obstructive/
40. or/36-39
41. 35 and 40
42. animal/ not human/
43. 41 not 42
44. limit 43 to yr="2005 -Current"
45. limit 44 to english language

63 new retrieved; 63 unique
(((("Vitamin D"[Mesh] OR "Vitamin D Deficiency"[Mesh] OR (vitamin d))) AND ("Pulmonary Disease, Chronic Obstructive"[Mesh] OR "COPD, Severe Early-Onset" [Supplementary Concept] OR (COPD or chronic obstructive pulmonary))) AND ("2017/08/01"[PDat] : "2017/12/31"[PDat] ) AND English[lang])

Updated Medline search Aug 18 2017- Dec 31 2017- 12 retrieved; 12 unique
Updated Pubmed Aug 18 2017- Dec 31 2017- 13 retrieved; 13 unique

CINAHL 1/1/2005-12/31/2017, 86 retrieved, 36 unique

( (MH "Vitamin D+") OR (MH "Vitamin D Deficiency+") OR (MH "Ergocalciferols") OR (MH "Cholecalciferol") ) OR TI ( (vitamin n1 d) or ((c n1 CALCIFEROL*) or CHOLECALCIFEROL* or ERGOCALCIFEROL*) or "25 OHD" or Hydroxycholecalciferol* or "25 hydroxyvitamin D" or colecalciferol* or Calcifediol or dihydroxycholecalciferol* or Calcitriol* or "24, 25-OH2 D3" or "OH2 D3" or ergocalciferol* or dihydrotachysterol* or "25- OHD2" or "1, 25-dihydroxyvitamin d" or "1, 25-OH2 D" or "1, 25- dihydroxyvitamin d2" or "1, 25-dihydroxyergocalciferol" or "1, 25-OH2 D2" or "1, 25-dihydroxyvitamin d3" or "1, 25-OH2 D3 or ((vitamin* or hydroxyvitamin* or dihydroxyvitamin*) n1 (d or d3 or d2)) ) OR AB ( (vitamin n1 d) or ((c n1 CALCIFEROL*) or CHOLECALCIFEROL* or ERGOCALCIFEROL*) or "25 OHD" or Hydroxycholecalciferol* or "25 hydroxyvitamin D" or colecalciferol* or Calcifediol or dihydroxycholecalciferol* or Calcitriol* or "24, 25-OH2 D3" or "OH2 D3" or ergocalciferol* or dihydrotachysterol* or "25- OHD2" or "1, 25-dihydroxyvitamin d" or "1, 25-OH2 D" or "1, 25- dihydroxyvitamin d2" or "1, 25-dihydroxyergocalciferol" or "1, 25-OH2 D2" or "1, 25-dihydroxyvitamin d3" or "1, 25-OH2 D3 or ((vitamin* or hydroxyvitamin* or dihydroxyvitamin*) n1 (d or d3 or d2)) )

AND
(MH "Pulmonary Disease, Chronic Obstructive+") OR TI (copd or chronic obstructive pulmonary disease or chronic obstructive airway disease or chronic obstructive lung disease ) OR AB ( copd or chronic obstructive pulmonary disease or chronic obstructive airway disease or chronic obstructive lung disease)

Embase search 865 retrieved; 113 unique, 2005-12/31/2017
1. exp Vitamin D Deficiency/ or exp Vitamin D/
2. (vitamin adj1 d).ti, ab.
3. ((c adj1 CALCIFEROL*) or CHOLECALCIFEROL* or ERGOCALCIFEROL*).ti, ab.
4. 25 OHD.ti, ab.
5. exp Hydroxycholecalciferols/
6. Hydroxycholecalciferol*.ti, ab.
7. exp Calcifediol/
8. exp Vitamin D Deficiency/
9. "25-OHD".ti, ab.
10. "25 hydroxyvitamin D".ti, ab.
11. colecalciferol*.ti, ab.
12. cholecalciferol/
13. Calcifediol.ti, ab.
14. exp Dihydroxycholecalciferols/
15. dihydroxycholecalciferol*.ti, ab.
16. exp Calcitriol/
17. Calcitriol*.ti, ab.
18. exp 24, 25-Dihydroxyvitamin D 3/
19. "24, 25-OH2 D3".ti, ab.
20. "OH2 D3".ti, ab.
21. exp Ergocalciferols/
22. ergocalciferol*.ti, ab.
23. exp Dihydrotachysterol/
24. dihydrotachysterol*.ti, ab.
25. exp 25-Hydroxyvitamin D 2/
26. "25- OHD2".ti, ab.
27. "1, 25-dihydroxyvitamin d".ti, ab.
28. "1, 25-OH2 D".ti, ab.
29. "1, 25- dihydroxyvitamin d2".ti, ab.
30. "1, 25-dihydroxyergocalciferol".ti, ab.
31. "1, 25-OH2 D2".ti, ab.
32. "1, 25-dihydroxyvitamin d3".ti, ab.
33. "or 1, 25-OH2 D3".ti, a
34. ((vitamin* or hydroxyvitamin* or dihydroxyvitamin*) adj1 (d or d3 or d2)).ti, ab.
35. or/1-34
36. exp Pulmonary Disease, Chronic Obstructive/
37. (Chronic Obstructive pulmonary or copd).ti, ab.
38. or/36-37
39. 35 and 38
40. animal/ not human/
41. 39 not 40
42. limit 41 to (english language and yr="2005 - 2017")
43. limit 42 to exclude medline journals

List of Included Articles

A-L

Azargoon AR, Moghadam PK, et al. Relationship Between FEV1 and 25-hydroxy Vitamin D in Patients with Chronic Obstructive Pulmonary Disease. Trends in Medical Research 2011; 6:184-190. doi: 10.3923/tmr.2011.184.190
Berg I, Hanson C, Sayles H, et al. Vitamin D, vitamin D binding protein, lung function and structure in COPD. Respir Med. 2013 Oct;107(10):1578-88. doi: 10.1016/j.rmed.2013.05.010. Epub 2013 Jul 1.PMID: 23809536
El-Shafey BI, El-Srougy, HA. Does serum 25 hydroxy vitamin D level play a role in COPD? Egypt J Chest Dis Tuberc 2014; 63(1):43-47
Gouda E, Zidan M, et al. Pattern of vitamin D in patients with chronic obstructive pulmonary diseases and in patients with bronchial asthma. Egypt J Chest Dis Tuberc 2016; 65(2):389-396, ISSN 0422-7638, https://doi.org/10.1016/j.ejcdt.2016.02.005
Hashim AHS, Nielsen LP, et al. Serum magnesium and not vitamin D is associated with better QoL in COPD: A cross-sectional study. Respir Med. 2015 Jun;109(6):727-33. doi: 10.1016/j.rmed.2015.03.005. Epub 2015 Mar 27. PMID: 25892292
Holmgaard DB, Mygind LH, et al. Serum vitamin D in patients with chronic obstructive lung disease does not correlate with mortality--results from a 10-year prospective cohort study. PLoS One 2013;8(1):e53670. doi: 10.1371/journal.pone.0053670. Epub 2013 Jan 14. PMID: 23341971
Janssens W, Bouillon R, et al. Vitamin D deficiency is highly prevalent in COPD and correlates with variants in the vitamin D-binding gene. Thorax. 2010 Mar;65(3):215-20. doi: 10.1136/thx.2009.120659. Epub 2009 Dec 8. PMID: 19996341
Jolliffe DA, James WY, et al. Prevalence, determinants and clinical correlates of vitamin D deficiency in patients with Chronic Obstructive Pulmonary Disease in London, UK. J Steroid Biochem Mol Biol. 2017 Feb 1. pii: S0960-0760(17)30019-5. doi: 10.1016/j.jsbmb.2017.01.019. [Epub ahead of print] PMID: 28161533
Jung JY, Kim YS, et al. KOLD Study. Relationship of vitamin D status with lung function and exercise capacity in COPD. Respirology. 2015 Jul;20(5):782-9. doi: 10.1111/resp.12538. Epub 2015 Apr 13. PMID: 25868752
Khan DM, Ullah A, et al. Role of Vitamin D in reducing number of acute exacerbations in Chronic Obstructive Pulmonary Disease (COPD) patients. Pak J Med Sci. 2017 May-Jun;33(3):610-614. doi: 10.12669/pjms.333.12397. PMID: 28811780
Kunisaki KM, Niewoehner DE, et al. COPD Clinical Research Network. Vitamin D levels and risk of acute exacerbations of chronic obstructive pulmonary disease: a prospective cohort study. Am J Respir Crit Care Med. 2012 Feb 1;185(3):286-90. doi: 10.1164/rccm.201109-1644OC. Epub 2011 Nov 10. PMID: 22077070
Kunisaki KM, Niewoehner DE, et al. Vitamin D status and longitudinal lung function decline in the Lung Health Study. Eur Respir J. 2011 Feb;37(2):238-43. doi: 10.1183/09031936.00146509. Epub 2010 Jul 1. PMID: 20595151
Lee HM, Liu M, et al. Does low vitamin D amplify the association of COPD with total and cardiovascular disease mortality? Clin Cardiol. 2014 Aug;37(8):473-8. doi: 10.1002/clc.22284. Epub 2014 Apr 9. PMID: 24719373
Lehouck A, Mathieu C, et al. High doses of vitamin D to reduce exacerbations in chronic obstructive pulmonary disease: a randomized trial. Ann Intern Med. 2012 Jan 17;156(2):105-14. doi: 10.7326/0003-4819-156-2-201201170-00004. PMID: 22250141. Accession Number: CN-00831135.

M-Z

Mahlin C, von Sydow H, et al. Vitamin D status and dietary intake in a Swedish COPD population. Clin Respir J. 2014;8(1):24-32. PMID: 23711108 doi: 10.1111/crj.12030.
Malinovschi A, Masoero M, et al. Severe vitamin D deficiency is associated with frequent exacerbations and hospitalization in COPD patients. Respir Res. 2014 Dec 13;15:131. doi: 10.1186/s12931-014-0131-0. PMID: 25496239
Martineau AR, James WY, et al. CJ. Vitamin D3 supplementation in patients with chronic obstructive pulmonary disease (ViDiCO): a multicentre, double-blind, randomised controlled trial. Lancet Respir Med. 2015 Feb;3(2):120-130. doi: 10.1016/S2213-2600(14)70255-3. Epub 2014 Dec 2.PMID: 25476069
Mekov E, Slavova Y, Tsakova A, et al. One-year mortality after severe COPD exacerbation in Bulgaria. Peer J. 2016 Dec 13;4:e2788. eCollection 2016. PMID: 27994981
Mekov E, Slavova Y, et al. Vitamin D Deficiency and Insufficiency in Hospitalized COPD Patients. PLoS One. 2015 Jun 5;10(6):e0129080. doi: 10.1371/journal.pone.0129080. eCollection 2015. PMID: 26047485
Moberg M, Vestbo J, et al. Prognostic value of C-reactive protein, leukocytes, and vitamin d in severe chronic obstructive pulmonary disease. ScientificWorldJournal. 2014 Jan 21;2014:140736. doi: 10.1155/2014/140736. eCollection 2014. PMID: 24587707
Monadi M, Heidari B, et al. Relationship between serum vitamin D and forced expiratory volume in patients with chronic obstructive pulmonary disease (COPD). Caspian J Intern Med. 2012 Summer;3(3):451-5. PMID: 24009913
Park JH, Park HK, et al. Parathyroid Hormone as a Novel Biomarker for Chronic Obstructive Pulmonary Disease: Korean National Health and Nutrition Examination Survey. PLoS One. 2015 Sep 23;10(9):e0138482. doi: 10.1371/journal.pone.0138482. eCollection 2015.PMID: 26398210
Park Y, Kim YS, et al. Relationship between vitamin D-binding protein polymorphisms and blood vitamin D level in Korean patients with COPD. Int J Chron Obstruct Pulmon Dis. 2016 Apr 7;11:731-8. doi: 10.2147/COPD.S96985. eCollection 2016.PMID: 27103796
Persson LJ, Aanerud M, et al. Chronic obstructive pulmonary disease is associated with low levels of vitamin D. PLoS One. 2012;7(6):e38934. doi: 10.1371/journal.pone.0038934. Epub 2012 Jun 21. PMID: 22737223
Persson LJ, Aanerud M, et al. Vitamin D, vitamin D binding protein, and longitudinal outcomes in COPD. PLoS One. 2015 Mar 24;10(3):e0121622. doi: 10.1371/journal.pone.0121622. eCollection 2015. PMID: 25803709
Puhan MA, Siebeling L, et al. No association of 25-hydroxyvitamin D with exacerbations in primary care patients with COPD. Chest. 2014 Jan;145(1):37-43. doi: 10.1378/chest.13-1296. PMID: 24008868
Quint JK, Donaldson GC, et al. 25-hydroxyvitamin D deficiency, exacerbation frequency and human rhinovirus exacerbations in chronic obstructive pulmonary disease. BMC Pulm Med. 2012 Jun 22;12:28. doi: 10.1186/1471-2466-12-28.PMID: 22726649
Rafiq R, Prins HJ, et al. Effects of daily vitamin D supplementation on respiratory muscle strength and physical performance in vitamin D-deficient COPD patients: a pilot trial. Int J Chron Obstruct Pulmon Dis. 2017 Aug 28;12:2583-2592. doi: 10.2147/COPD.S132117. eCollection 2017. PMID: 28894361
Rezk NASA, Nasser YAA.; Hewidy AAH. Effect of vitamin D replacement in chronic obstructive pulmonary disease patients with vitamin D deficiency, Egypt J Chest Dis Tuberc, 2015; 64(2):353-357 ISSN 0422-7638, https://doi.org/10.1016/j.ejcdt.2015.01.002.
Romme EA, Rutten EP, et al. Vitamin D status is associated with bone mineral density and functional exercise capacity in patients with chronic obstructive pulmonary disease. Ann Med. 2013 Feb;45(1):91-6. doi: 10.3109/07853890.2012.671536. Epub 2012 Apr 2. PMID: 22462562
Said AF, Abd-Elnaeem EA. Vitamin D and chronic obstructive pulmonary disease. Egypt J Chest Dis Tuberc. 2015;64:67–73.
Sanjari M, Soltani A, et al. The effect of vitamin D on COPD exacerbation: a double blind randomized placebo-controlled parallel clinical trial. J Diabetes Metab Disord. 2016 Aug 26;15(1):33. doi: 10.1186/s40200-016-0257-3. eCollection 2015. PMID: 27570748
Shaheen SO, Jameson KA, et al. Relationship of vitamin D status to adult lung function and COPD. Thorax. 2011 Aug;66(8):692-8. doi: 10.1136/thx.2010.155234. Epub 2011 Jun 8. PMID: 21653927
Yang YM, Guo YF, et al. Antimicrobial peptide LL-37 circulating levels in chronic obstructive pulmonary disease patients with high risk of frequent exacerbations. J Thorac Dis. 2015 Apr;7(4):740-5. doi: 10.3978/j.issn.2072-1439.2015.04.33. PMID: 25973241
Yumrutepe T, Aytemur ZA, et al. Relationship between vitamin D and lung function, physical performance and balance on patients with stage I-III chronic obstructive pulmonary disease. Rev Assoc Med Bras (1992). 2015 Mar-Apr;61(2):132-8. doi: 10.1590/1806-9282.61.02.132. PMID: 26107362
Zendedel A, Gholami M, et al. Effects of Vitamin D Intake on FEV1 and COPD Exacerbation: A Randomized Clinical Trial Study. Glob J Health Sci. 2015 Jan 14;7(4):243-8. doi: 10.5539/gjhs.v7n4p243.PMID: 25946929

Articles Considered, but Excluded

List of Excluded Articles with Reason

The Vitamin D topic consists of 53 excluded articles. Download the entire list of articles and reason for exclusion.

Search Methods and Results

Identification

Articles Identified Through Database Searching: 1621
Additional Articles Identified Through Other Sources: 6

Screening

Articles Screened After Removing Duplicates: 591
Articles Excluded During the Screening Process: 500

Eligibility

Full-text Articles Assessed for Eligibility: 89
Full-text Articles Excluded: 53

Included

Articles Included in Qualitative Synthesis: 36
Articles Included in Quantitative Synthesis (Meta-analysis): 0