Hong Kong Respiratory Medicine

Background:
Low serum 25-hydroxyvitamin D (25-[OH]D) levels have been associated with lower FEV₁, impaired immunologic control, and increased airway inflammation. Because many patients with chronic obstructive pulmonary disease (COPD) have vitamin D deficiency, effects of vitamin D supplementation may extend beyond preventing osteoporosis.

Objective:
To explore whether supplementation with high doses of vitamin D could reduce the incidence of COPD exacerbations.

 

Design:
Randomized, single-center, double-blind, placebo-controlled trial.

Setting:
University Hospitals Leuven, Leuven, Belgium.

Patients:
182 patients with moderate to very severe COPD and a history of recent exacerbations.

Intervention:
100 000 IU of vitamin D supplementation or placebo every 4 weeks for 1 year.

Measurements:
The primary outcome was time to first exacerbation. Secondary outcomes were exacerbation rate, time to first hospitalization, time to second exacerbation, FEV₁, quality of life, and death.

Results:
Mean serum 25-(OH)D levels increased significantly in the vitamin D group compared with the placebo group (mean between-group difference, 30 ng/mL [95% CI, 27 to 33 ng/mL]; P < 0.001). The median time to first exacerbation did not significantly differ between the groups (hazard ratio, 1.1 [CI, 0.82 to 1.56]; P = 0.41), nor did exacerbation rates, FEV₁, hospitalization, quality of life, and death. However, a post hoc analysis in 30 participants with severe vitamin D deficiency (serum 25-[OH]D levels <10 ng/mL) at baseline showed a significant reduction in exacerbations in the vitamin D group (rate ratio, 0.57 [CI, 0.33 to 0.98]; P = 0.042).

Limitation:
This was a single-center study with a small sample size.

Conclusion:
High-dose vitamin D supplementation in a sample of patients with COPD did not reduce the incidence of exacerbations. In participants with severe vitamin D deficiency at baseline, supplementation may reduce exacerbations.

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