B Chronic Obstructive Pulmonary Disease
Chronic obstructive pulmonary disease is characterized by airflow limitation that is not fully reversible. The airflow limitation is progressive and associated with an abnormal inflammatory response of the lungs to noxious stimulus or gases, like cigarette smoke. In addition to slow progressive loss of lung function, patients with COPD can have acute exacerbations that lead to a faster decline in FEV1. Exacerbations are most often triggered by viral or bacterial infection. . Vitamin D deficiency is highly prevalent in COPD and correlates with the severity of COPD . In line with new insights into the immunomodulatory effects of vitamin D, including anti-inflammatory and possibly anti-microbial effects, it has been postulated that vitamin D may affect the pathogenesis of COPD . Epidemiological studies in healthy subjects and patients with COPD have suggested a dose dependant association between serum 25D levels and lung function . It is unclear at this time how vitamin D may affect lung function but variants in the vitamin D-binding gene have been linked to vitamin D deficiency and COPD risk . These population based studies do not prove that there is an association between vitamin D deficiency and lung function but they do provide preliminary data and justification for randomized controlled trials of vitamin D supplementation in COPD. A randomized, multi-centre, double-blind, placebo-controlled trial of vitamin D supplementation in COPD is currently underway .
Cellular And Intercellular Effects Of Vitamin D Deficiency
|No association between serum 25D and lung function|
|Wood et al||Cross sectional study of 471 subjects with Î±1-antitrypsin deficiency, 140 subjects with COPD, and 480 control subjects||Serum 25D levels, DBP levels, and single nucleotide polymorphisms in the DBP gene||Phenotypical characteristics and alveolar macrophage activation||25D levels related positively to FEV1 DBP levels related inversely to FEV1|
|Lange et al||626 men from the Normative Aging Study had 25D levels measured at 3 different time points between 1984 and 2003 with concurrent spirometry||Serum 25D levels||Lung function and decline in lung function over time||A significant difference was found with a greater effect of pack-years of smoking on FEV1 decline in those with vitamin D deficiency|
2.5.3 Skeletal muscle weakness in COPD
Vitamin D in the elderly is associated with reductions in not only bone mineral density but in type 2 muscle fibers. Observational studies report an association between vitamin D, muscle function and physical performance in the elderly. In a study conducted in Longitudinal Aging Study Amsterdam, subjects were asked if they have any difficulty in daily life physically and in the older patients, vitamin D deficiency was found to be associated with an increase in limitations at 3 years. Korean National Health and Nutrition Examination Survey included 2258 men and 3005 women over 50 years showed an inverse association with vitamin D level and sarcopenia in women.
What Is Vitamin D
Vitamin D is a nutrient and building block your body needs to create and maintain healthy bones. Vitamin D helps the body absorb nutrients and amino acids like calcium, magnesium, and phosphate. It is crucial to bone health because the human body can only absorb calcium when vitamin D is present.2
Vitamin D also has anti-inflammatory and antioxidant properties that help many functions in the body. It can help boost the immune system, muscle function, and brain cell activity.2
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Effects Of Vitamin D On Innate And Adaptive Immune Responses
Diseases such as COPD and asthma are characterized by chronic inflammation, a low-grade and prolonged inflammation that may result in destruction and aberrant repair of surrounding tissue by growth factors, proteases and cytokines that are released at the site of inflammation . Cumulative data suggest that vitamin D exerts anti-inflammatory effects via its actions on both innate and adaptive immune responses. Upon viral infection or exposure of pro-inflammatory stimuli such as Poly or PM, 1,252D attenuates induced expression of cytokines and chemokines e.g., via inhibition of nuclear factor -B or oxidative stress, respectively, in epithelial cells . Furthermore, 1,252D increases expression of the soluble decoy receptor for IL-33 by airway epithelial cells, which in turn inhibits the actions of the type 2 alarmin IL-33 . Further effects of 1,252D on local innate and adaptive immune responses in the epithelial mucosa are mediated through its actions on immune and structural cells and have been reviewed by Heulens et al. Vanherwegen et al. , and Pfeffer et al. .
Testing Supplements In Copd
For the study, researchers enrolled 50 COPD patients whose symptoms, including shortness of breath and coughing and phlegm, had been getting worse.
All the patients participated in a three-month pulmonary rehabilitation program. Half were randomly selected to receive once-monthly, high-dose vitamin D supplements the other half were given a placebo pill.
At the beginning of the study, and again at the end, researchers tested muscle strength in the lungs and the legs, vitamin D levels, and exercise capacity, which is a measure of how long and how intensely a person can exercise. Researchers also asked about improvements in quality of life before and after the study.
Despite the fact that they could move and breathe better, however, study participants taking vitamin D didnât report any improvements in quality of life. Researchers think that may be because the study was relatively short.
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The Efficacy Of Vitamin D Therapy For Patients With Copd: A Meta
Xiaoyan Li, Jie He, Mi Yu, Jian Sun
Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chengdu Medical College , , China
Contributions: Conception and design: X Li Administrative support: J Sun Provision of study materials or patients: M Yu Collection and assembly of data: J He Data analysis and interpretation: X Li Manuscript writing: All authors Final approval of manuscript: All authors.
Background: Many studies have demonstrated that vitamin D has clinical benefits when used to treat patients with chronic obstructive pulmonary disease . However, most of these studies have insufficient samples or inconsistent results. The aim of this meta-analysis was to evaluate the effects of vitamin D therapy in patients with COPD.
Methods: We performed an electronic literature search of the databases PubMed, China National Knowledge Internet , Embase, Web of Science and Wanfang Data. Meta-analysis was carried out by Review Manager Version 5.3 , and standardized mean difference and mean difference were used to assess the efficacy of vitamin D therapy in patients with COPD.
Results: A total of 25 articles involving 2,670 participants were included in this study. The overall results showed a statistical significance of vitamin D therapy in patients with COPD on forced expiratory volume in 1 second , FEV1/FVC , Exacerbations , Sputum volume , 6-minute walk distance and COPD assessment test score .
How To Get More Vitamin D
Some people think an easy way to get more vitamin D is to get more sunlight. While it’s true that sun exposure creates vitamin D, be careful. Too much can cause skin cancer and other types of skin damage.
Some foods rich in vitamin D, such as salmon, tuna, sardines, and fortified milk and orange juice, can help. It may make sense to add them to your diet, but it can be hard to reach healthy levels through diet alone.
Another way to get more vitamin D is to quit smoking and avoid secondhand smoke. Cigarette smoke makes it harder for your body to absorb vitamin D.
If your levels are too low, your doctor will probably prescribe supplements to get them where they need to be. There are several kinds. Your doctor can recommend the dose and type that are most likely to help with your COPD and your overall health.
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What Did It Find
- When pooling individual-level data for people with low vitamin D at the start of the trial , those taking a vitamin D supplement experienced on average 1.2 moderate or severe exacerbations of COPD in a year , compared to 2.1 exacerbations in the placebo group .
- There was no significant effect of vitamin D supplementation for those with adequate baseline vitamin D levels .
- When all those who had vitamin D supplementation were compared with all those who had a placebo, there was no difference in exacerbation rates .
- Vitamin D did not cause any increase in the proportion of participants experiencing a serious adverse event.
Respiratory Symptoms Functional Status And Exacerbations
Vitamin D deficiency was associated with worse quality of life based on higher SGRQ total score and greater dyspnea based on higher MMRC score at baseline . The effect on SGRQ score persisted in multivariable linear regression analysis, corresponding to a one-point decrease in SGRQ score for 5ng/mL increase in 25 D serum concentration. In addition, the effect on SGRQ score persisted in a subset of the study cohort of only subjects with COPD . While vitamin D deficiency was not associated with reduced BODE index, vitamin D deficiency was associated with reduced exercise capacity on 6-min walk test . While the effect of vitamin D deficiency did not persist in multivariable regression, the 6MWD was increased by 2.25ft per unit increase in serum 25 D concentration . There was no association with vitamin D levels and change in FEV1 over 5years.
Table 2 Respiratory symptoms, functional status, and exacerbationsFig. 2
Time to exacerbation Kaplan-Meier curves demonstrating the time to exacerbation in the vitamin D sufficient group and the vitamin D deficient group . There was no significant difference between to two groups
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Risk Factors For Vitamin D Deficiency
Vitamin D deficiency is mostly caused by inadequate exposure to sunlight and inadequate dietary intake. Natural nutritional sources are mainly limited to fatty fish, so regular sunlight exposure is still the best way to prevent and resolve vitamin D deficiency. To have appropriate vitamin D3 production, direct sunlight exposure needs to be maintained for only 15 minutes twice a week . Since there is a seasonal variation in sunlight, there is also a seasonal variation in serum vitamin D level which shows the highest level in summer and the lowest level in winter in the northern hemisphere.- Even during the summer, early morning and late afternoon UV-B is not sufficient to activate vitamin D production in the skin. Hence, people who live in higher latitude have a higher risk of vitamin D deficiency. Premenopausal women have been shown to have 6 nmol/L higher serum levels compared to postmenopausal women. Apart from sun exposure and skin vitamin D synthesizing ability, premature birth, pigmented skin, obesity, malabsorption, glucocorticoid usage, smoking, advanced age, and reduced physical activity are also risk factors for vitamin D deficiency which most of them are also risk factors for COPD., , –
When You Should Take Vitamin D
How do you know if you need vitamin D?
Hill explained that without medical testing and a doctors assessment, its difficult to determine signs or symptoms of vitamin D deficiency, such as fatigue, muscle and back pain, and increased infections.
You need to be tested, said John Linnell, who has stage 4 COPD. Hes a patient advocate and the COPD Foundations state captain for Wisconsin.
Linnell shared his concerns about people with COPD seeing headlines about the study and rushing out to get vitamin D without understanding the full picture that taking it wont help if you dont have a deficiency.
Its true that probably 25 percent of people with COPD are low in vitamin D, Linnell told Healthline.
If you live in a northern climate, youre more apt to be low because youre not getting as much sunshine. If you usually stay indoors or are housebound, youre not getting sunlight and youre more apt to be low in vitamin D, he said. If youre obese, you tend to be lower in vitamin D because it stores in fat and doesnt circulate throughout your body.
For Linnell, supplementation without a deficiency is, simply put, doing nothing more than creating expensive urine.
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Maintain A Healthy Weight
People with COPD who are underweight have a of mortality than people with COPD who are overweight. Researchers are still investigating the impact of obesity on COPD outlook.
People with COPD who are underweight are more likely to experience:
- weakness in the breathing muscles
- reduced ability to exercise
- reduced lung capacity
According to a recent review, a balanced diet can help people with COPD by improving lung function. A balanced diet also has metabolic and heart benefits. People who are underweight may especially benefit from a nutritional diet high in calories, protein, and unsaturated fats.
This type of diet increases a persons energy and helps build muscle when combined with exercise. However, more large-scale studies are needed before researchers understand the benefits of this diet for people with COPD.
Risk Factors Of Too Much Vitamin D
Vitamin D has many benefits for a number of health conditions, but there are some risk factors from overdoing it.
Vitamin D toxicity is a risk, Yawn said. Serious vitamin D toxicity isnt common, but it can elevate calcium levels and cause negative effects on the bone, muscles, and kidneys, she said. No one should take large doses of vitamin D without medical supervision. If vitamin D is taken, its seldom necessary to take more than 400 to 600 IU daily.
Hill said that vitamin D is relatively harmless. Even if a person has adequate levels, he or she isnt likely to be harmed by taking a vitamin D supplement.
Youd have to go out of your way to overdose on it, he said.
Hill agreed with the studys findings that taking vitamin D when your levels arent low wont be beneficial. People with COPD can reduce this risk by talking to their doctors and coming up with an appropriate treatment approach.
COPD is different for everyone, Linnell said. Some people have more emphysema or chronic bronchitis. Some rarely have flare-ups. Others are hospitalized three or four times a year for attacks. COPD needs to be treated individually, and its important for people to sit down with their doctors to create a personalized action plan.
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Vitamin D Deficiency Prevalent In Chronic Lung Patients
According to a recent study published in Thorax, a leading respiratory medicine journal, vitamin D deficiency is a frequent occurrence in chronic obstructive pulmonary disease patients and has been found to correlate directly to the severity of the disease. With more than half of COPD and emphysema patients developing a vitamin D deficiency during their lifetime, understanding the importance of vitamin D and how to overcome this deficiency is an important step in managing the disease.
The Role of Vitamin D in Chronic Lung Disease
According to the U.S. Department of Health and Human Services, vitamin D is essential for the formation, growth, and repair of bones and for normal calcium absorption and immune function. However, for patients with chronic lung diseases, this important vitamin is thought to play a key role in preventing the loss of lung function over time.
While there are still a lot of studies that need to be done on vitamin D and the lungs, it is thought that in patients with advanced disease the vitamin helps prevent the decline in lung function over time, said Samuel A. Allen, D.O.,pulmonologist, critical care specialist and director of the Pulmonary Hypertension Center at Beaumont Hospital in Troy, Michigan. Vitamin D can also help people recover from infections. So patients with good levels of vitamin D will probably recover from an infection better than those dealing with a deficiency.
The Cause of Vitamin D Deficiency
How Much Vitamin D Should You Take
According to the Vitamin D Council, vitamin D levels above 3040 ng/mL may reduce the risk of COPD. To reach these levels, most people need to take 1,0005,000 international units per day of vitamin D3, an active form of vitamin D that’s produced under the skin. However, they also stress that, because there is considerable variation from person to person, proper dosage should be determined by measuring a patient’s vitamin D blood levels before, and several months after, taking vitamin D3 supplements or increasing UVB exposure.
Before you begin supplementing your diet with vitamin D, it’s best to check with your healthcare provider about which supplement and dose are right for you.
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Does Everyone With Copd Need More Vitamin D
If you already have healthy levels of it, you probably donât need more vitamin D. Studies of people with COPD show that supplements only bring fewer flares to those who don’t get enough vitamin D.
Your doctor can check your levels with a blood test. If yours are too low, they can tell you how much you need and the best way to get it.
Treating Vitamin D Deficiency May Reduce Exacerbations Of Copd
Vitamin D supplements halve the number of exacerbations of chronic obstructive pulmonary disease in people with low levels of the vitamin, from two per year to one per year. The supplements do not affect exacerbations of COPD in people who are not deficient.
This NIHR-funded review is the first to pool individual-level data from randomly controlled trials to see whether taking vitamin D can help reduce exacerbations.
People with moderate to severe COPD may be at risk of low vitamin D levels because their illness reduces their opportunities to get out into the sunlight.
These findings suggest that vitamin D is an effective, safe prevention for those with COPD found to be deficient.
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