Vitamin D levels and risk of acute exacerbations of chronic obstructive pulmonary disease: a prospective cohort study

Abstract

Rationale: Low blood levels of 25-hydroxyvitamin D (25[OH]D) have been associated with a higher risk of respiratory infections in general populations and higher risk of exacerbations of lung disease in people with asthma. We hypothesized that low blood levels of 25(OH)D in patients with chronic obstructive pulmonary disease (COPD) would be associated with an increased risk of acute exacerbations of COPD (AECOPD).

Objectives: To determine if baseline 25(OH)D levels relate to subsequent AECOPD in a cohort of patients at high risk for AECOPD.

Methods: Plasma 25(OH)D was measured at baseline in 973 participants on entry to a 1-year study designed to determine if daily azithromycin decreased the incidence of AECOPD. Relationships between baseline 25(OH)D and AECOPD over 1 year were analyzed with time to first AECOPD as the primary outcome and exacerbation rate as the secondary outcome.

Measurements and main results: In this largely white (85%) sample of North American patients with severe COPD (mean FEV(1) 1.12L; 40% of predicted), mean 25(OH)D was 25.7 ± 12.8 ng/ml. A total of 33.1% of participants were vitamin D insufficient (≥20 ng/ml but <30 ng/ml); 32% were vitamin D deficient (<20 ng/ml); and 8.4% had severe vitamin D deficiency (<10 ng/ml). Baseline 25(OH)D levels had no relationship to time to first AECOPD or AECOPD rates.

Conclusions: In patients with severe COPD, baseline 25(OH)D levels are not predictive of subsequent AECOPD. Clinical trial registered with www.clinicaltrials.gov (NCT00119860).

Figure 1.

Distribution of vitamin D levels by season and ethnicity (upper panel ) and clinical center (lower panel). 25(OH)D = 25 hydroxyvitamin D; A. Arbor = Ann Arbor, MI; Balt = Baltimore, MD; Birm = Birmingham, AL; Bost = Boston, MA; Denv = Denver, CO; Minn = Minnesota; Phil = Philadelphia, PA; Pitt = Pittsburgh, PA; UCLA = University of California, Los Angeles; UCSF = University of California, San Francisco.