Chronic Obstructive Pulmonary Disease

COPD: Micronutrients (2019)

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

  • Conclusion

    Evidence from adults with COPD with baseline serum 25(OH)D levels ≤10ng per ml, showed a decrease in exacerbations with vitamin D supplementation. The evidence related to the effect of supplementation on lung function and exacerbation outcomes for COPD patients with higher serum 25(OH)D levels was inconclusive due to mixed findings. Synthesis of the results was challenging due to lack of consistency in vitamin D dosing, dosing frequency and delivery routes, length of intervention and baseline serum 25(OH)D levels.

  • Grade: II
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: Does vitamin D supplementation improve lung function and exacerbation outcomes in adults with COPD?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Khan D, Ullah A, Randhawa F, Iqtadar S, Butt N, Waheed K. Role of Vitamin D in reducing number of acute exacerbations in Chronic Obstructive Pulmonary Disease (COPD) patients. Pakistan Journal of Medical Sciences 2017; 33:610-614
      • Lehouck A, Mathieu C, Carremans C, Baeke F, Verhaegen J, Van Eldere J, Decallonne B, Bouillon R, Decramer M, Janssens W. High doses of vitamin D to reduce exacerbations in chronic obstructive pulmonary disease: a randomized trial. Annals of Internal Medicine 2012; 156:105-14
      • Martineau A, James W, Hooper R, Barnes N, Jolliffe D, Greiller C, Islam K, McLaughlin D, Bhowmik A, Timms P, Rajakulasingam R, Rowe M, Venton T, Choudhury A, Simcock D, Wilks M, Degun A, Sadique Z, Monteiro W, Corrigan C, Hawrylowicz C, Griffiths C. Vitamin D3 supplementation in patients with chronic obstructive pulmonary disease (ViDiCO): a multicentre, double-blind, randomised controlled trial. The Lancet. Respiratory Medicine 2015; 3:120-130
      • Rafiq R, Prins H, Boersma W, Daniels J, den Heijer M, Lips P, de Jongh R. Effects of daily vitamin D supplementation on respiratory muscle strength and physical performance in vitamin D-deficient COPD patients: a pilot trial. International Journal of Chronic Obstructive Pulmonary Disease 2017; 12:2583-2592
      • Rezk NA, Yehia AA, Hewidy, AA. Effect of vitamin D replacement in chronic obstructive pulmonary disease patients with vitamin D deficiency. Egyptian Journal of Chest Diseases and Tuberculosos 2015; 64:353-357
      • Said AF and Abd-Elnaeem EA. Vitamin D and chronic obstructive pulmonary disease. Egyptian Journal of Chest Diseases and Tuberculosis 2015; 64:67-73
      • Sanjari M, Soltani A, Habibi Khorasani A, Zareinejad M. The effect of vitamin D on COPD exacerbation: a double blind randomized placebo-controlled parallel clinical trial. Journal of Diabetes and Metabolic Disorders 2016; 15:33
      • Zendedel A, Gholami M, Anbari K, Ghanadi K, Bachari E, Azargon A. Effects of Vitamin D Intake on FEV1 and COPD Exacerbation: A Randomized Clinical Trial Study. Global Journal of Health Science 2015; 7:243-8
  • Search Plan and Results: COPD: Vitamin D 2017
     
  Does vitamin D supplementation improve mortality outcomes in adults with COPD?

  • Conclusion

    A single study examining vitamin D supplementation and mortality as a secondary outcome found no significant difference in mortality rate in adults with COPD.

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: Does vitamin D supplementation improve mortality outcomes in adults with COPD?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Lehouck A, Mathieu C, Carremans C, Baeke F, Verhaegen J, Van Eldere J, Decallonne B, Bouillon R, Decramer M, Janssens W. High doses of vitamin D to reduce exacerbations in chronic obstructive pulmonary disease: a randomized trial. Annals of Internal Medicine 2012; 156:105-14
  • Search Plan and Results: COPD: Vitamin D 2017
     
  What associations exist between serum 25(OH)D levels and mortality, lung function and exacerbation outcomes in adults with COPD?

  • Conclusion

    The evidence for the relationship between serum 25(OH)D levels and lung function and exacerbation outcomes in adults with COPD yielded mixed findings. Sixty percent of studies examining serum 25(OH)D and lung function outcomes found a positive association; 36% of studies examining exacerbation outcomes found a positive association. No studies examining serum 25(OH)D and mortality found an association.

  • Grade: II
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What associations exist between serum 25(OH)D levels and mortality, lung function and exacerbation outcomes in adults with COPD?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Azargoon AR, Moghadam PK, Shokrollahi S, Ebrahimzadeh F, Pournia Y. . Relationship between FEV1 and 25-hydroxy Vitamin D in patients with chronic obstructive pulmonary disease. Trends in Medical Research 2011; 6:184-190
      • Berg I, Hanson C, Sayles H, Romberger D, Nelson A, Meza J, Miller B, Wouters E, Macnee W, Rutten E ,Romme E, Vestbo J, Edwards L, Rennard S. Vitamin D, vitamin D binding protein, lung function and structure in COPD. Respiratory Medicine 2013; 107:1578-88
      • Basem I. El-Shafey and Hesham A. El-Srougy B. Does serum 25 hydroxy vitamin D level play a role in COPD?. Egyptian Journal of Chest Diseases and Tuberculosis 2014; 63:43-47
      • Essam Gouda, Mohamed Zidan, Gharraf Heba, Doreene Nazeih Younan, Samar Mohamed. Pattern of vitamin D in patients with chronic obstructive pulmonary diseases and in patients with bronchial asthma. Egyptian Journal of Chest Diseases and Tuberculosis 2016; 65:389-396
      • Hashim Ali Hussein S, Nielsen L, Konow Bøgebjerg Dolberg M, Dahl R. Serum magnesium and not vitamin D is associated with better QoL in COPD: A cross-sectional study. Respiratory Medicine 2015; 109:727-33
      • Holmgaard D, Mygind L, Titlestad I, Madsen H, Fruekilde P, Pedersen S, Pedersen C. 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:e53670
      • Janssens W, Bouillon R, Claes B, Carremans C, Lehouck A, Buysschaert I, Coolen J, Mathieu C, Decramer M, Lambrechts D. Vitamin D deficiency is highly prevalent in COPD and correlates with variants in the vitamin D-binding gene. Thorax 2010; 65:215-20
      • Jolliffe D, James W, Hooper R, Barnes N, Greiller C, Islam K, Bhowmik A, Timms P, Rajakulasingam R, Choudhury A, Simcock D, Hyppönen E, Walton R, Corrigan C, Griffiths C, Martineau A. Prevalence, determinants and clinical correlates of vitamin D deficiency in patients with Chronic Obstructive Pulmonary Disease in London, UK. The Journal of Steroid Biochemistry and Molecular Biology 2018; 175:138-145
      • Jung J, Kim Y, Kim S, Kim H, Oh Y, Lee S, Seo J, Lee S. Relationship of vitamin D status with lung function and exercise capacity in COPD. Respirology (Carlton, Vic.) 2015; 20:782-9
      • Kunisaki K, Niewoehner D, Singh R, Connett J. Vitamin D status and longitudinal lung function decline in the Lung Health Study. The European Respiratory Journal 2011; 37:238-43
      • Kunisaki K, Niewoehner D, Connett J. Vitamin D levels and risk of acute exacerbations of chronic obstructive pulmonary disease: a prospective cohort study. American Journal of Respiratory and Critical Care Medicine 2012; 185:286-90
      • Måhlin C, von Sydow H, Osmancevic A, Emtner M, Grönberg A, Larsson S, Slinde F. Vitamin D status and dietary intake in a Swedish COPD population. The Clinical Respiratory Journal 2014; 8:24-32
      • Malinovschi A, Masoero M, Bellocchia M, Ciuffreda A, Solidoro P, Mattei A, Mercante L, Heffler E, Rolla G, Bucca C. Severe vitamin D deficiency is associated with frequent exacerbations and hospitalization in COPD patients. Respiratory Research 2014; 15:131
      • Mekov E, Slavova Y, Tsakova A, Genova M, Kostadinov D, Minchev D, Marinova D, Tafradjiiska M. Vitamin D Deficiency and Insufficiency in Hospitalized COPD Patients. PloS One 2015; 10:e0129080
      • Mekov E, Slavova Y, Tsakova A, Genova M, Kostadinov D ,Minchev D, Marinova D, Boyanov M. One-year mortality after severe COPD exacerbation in Bulgaria. PeerJ 2016; 4:e2788
      • Moberg M, Vestbo J, Martinez G, Lange P, Ringbaek T. Prognostic value of C-reactive protein, leukocytes, and vitamin d in severe chronic obstructive pulmonary disease. The Scientific World Journal 2014; 2014:140736
      • Monadi M, Heidari B, Asgharpour M, Firouzjahi A, Monadi M, Ghazi Mirsaied M. Relationship between serum vitamin D and forced expiratory volume in patients with chronic obstructive pulmonary disease (COPD). Caspian Journal of Internal Medicine 2012; 3:451-5
      • Park J, Park H, Jung H, Lee S, Koo H. Parathyroid Hormone as a Novel Biomarker for Chronic Obstructive Pulmonary Disease: Korean National Health and Nutrition Examination Survey. PloS One 2015; 10:e0138482
      • Park Y, Kim Y, Kang Y, Shin J, Oh Y, Seo J, Jung J, Lee S. Relationship between vitamin D-binding protein polymorphisms and blood vitamin D level in Korean patients with COPD. International Journal of Chronic Obstructive Pulmonary Disease 2016; 11:731-8
      • Persson L, Aanerud M, Hiemstra P, Hardie J, Bakke P, Eagan T. Chronic obstructive pulmonary disease is associated with low levels of vitamin D. PloS One 2012; 7:e38934
      • Persson L, Aanerud M, Hiemstra P, Michelsen A, Ueland T, Hardie J, Aukrust P, Bakke P, Eagan T. Vitamin D, vitamin D binding protein, and longitudinal outcomes in COPD. PloS One 2015; 10:e0121622
      • Puhan M, Siebeling L, Frei A, Zoller M, Bischoff-Ferrari H, Ter Riet G. No association of 25-hydroxyvitamin D with exacerbations in primary care patients with COPD. Chest 2014; 145:37-43
      • Quint J, Donaldson G, Wassef N, Hurst J, Thomas M, Wedzicha J. 25-hydroxyvitamin D deficiency, exacerbation frequency and human rhinovirus exacerbations in chronic obstructive pulmonary disease. BMC Pulmonary Medicine 2012; 12:28
      • Romme E, Rutten E, Smeenk F, Spruit M, Menheere P, Wouters E. Vitamin D status is associated with bone mineral density and functional exercise capacity in patients with chronic obstructive pulmonary disease. Annals of Medicine 2013; 45:91-6
      • Said AF and Abd-Elnaeem EA. Vitamin D and chronic obstructive pulmonary disease. Egyptian Journal of Chest Diseases and Tuberculosis 2015; 64:67-73
      • Sanjari M, Soltani A, Habibi Khorasani A, Zareinejad M. The effect of vitamin D on COPD exacerbation: a double blind randomized placebo-controlled parallel clinical trial. Journal of Diabetes and Metabolic Disorders 2016; 15:33
      • Shaheen S, Jameson K, Robinson S, Boucher B, Syddall H, Sayer A, Cooper C, Holloway J, Dennison E. Relationship of vitamin D status to adult lung function and COPD. Thorax 2011; 66:692-8
      • Yang Y, Guo Y, Zhang H, Sun T. Antimicrobial peptide LL-37 circulating levels in chronic obstructive pulmonary disease patients with high risk of frequent exacerbations. Journal of Thoracic Disease 2015; 7:740-5
      • Yumrutepe T, Aytemur Z, Baysal O, Taskapan H, Taskapan C, Hacievliyagil S. Relationship between vitamin D and lung function, physical performance and balance on patients with stage I-III chronic obstructive pulmonary disease. Revista da Associacao Medica Brasileira (1992) 2015; 61:132-8
  • Search Plan and Results: COPD: Vitamin D 2017