https://immattersacp.org/weekly/archives/2012/01/24/4.htm

High-dose vitamin D does not reduce COPD exacerbations, study finds

Supplementation with high doses of vitamin D did not reduce exacerbations of chronic obstructive pulmonary disease (COPD) in most patients in a small new study.


Supplementation with high doses of vitamin D did not reduce exacerbations of chronic obstructive pulmonary disease (COPD) in most patients in a small new study.

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Researchers in Belgium performed a randomized, single-center, double-blind, placebo-controlled trial to determine whether high-dose vitamin D supplementation would help reduce exacerbations in patients with COPD.

Patients were screened over 1.5 years from 2008 to 2009 and were eligible for the study if they smoked or had smoked, were over 50, had been diagnosed with COPD according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria, and had an FEV1 less than 80% of predicted. Those with a history of hypercalcemia, sarcoidosis or active cancer were excluded, as were patients who had been treated with vitamin D supplements for other conditions and patients who had received long-term azithromycin treatment.

One hundred eighty-two patients were randomly assigned to receive a monthly oral vitamin D dose of 100,000 IU (n=91) or placebo (n=91) for one year in addition to their usual treatment. Most of the patients (79.6% overall) were men, and the mean age in both the vitamin D and placebo groups was 68 years. The study's primary outcome was time to first COPD exacerbation; secondary outcomes were exacerbation rate, time to second exacerbation, time to first hospitalization, quality of life, FEV1, and death. Results appear in the Jan. 17 Annals of Internal Medicine.

Although patients in the vitamin D group experienced a significant increase in mean serum 25-hydroxyvitamin D (25-[OH]D) levels compared with the placebo group (mean between-group difference, 30 ng/mL; P<0.001), median time to first COPD exacerbation, exacerbation rates, FEV1, time to first hospitalization, quality of life, and death did not differ significantly between groups. The authors found in a post hoc analysis, however, that COPD exacerbations did significantly decrease (rate ratio, 0.57; P=0.042) in patients in the vitamin D group who had had severe vitamin D deficiency at baseline (serum 25-[OH]D level <10 ng/mL).

The authors acknowledged that their study involved only one center and had a small sample size. However, they concluded that high-dose vitamin D supplementation in patients with COPD did not reduce exacerbation incidence, although it may have helped in patients with severe vitamin D deficiency at baseline.

“Although our results demonstrate that supplementation beyond what is recommended for bone health does not reduce exacerbations in patients with moderate to very severe COPD, they corroborate the suggestion that vitamin D deficiency is a potential risk in some patients,” the authors wrote.

They called for further studies to examine the necessity and safety of recommending high-dose vitamin D to treat chronic disease, especially in patients with immune-related diseases who are vitamin-D deficient.