Taken from the Lancet

With all the talk about vitamins on here recently this seems appropriate.

The Lancet Home

Vitamin D and COPD: who benefits from supplementation?

Much attention has been focused on the potential role of vitamin D deficiency on both the development and exacerbations of obstructive lung diseases. Vitamin D has immunomodulatory functions and anti-inflammatory properties, reduces oxidative stress, and acts as an epigenetic regulator of genes associated with lung disease.1 Research into the link between vitamin D and asthma, including a large multicentre randomised trial, has been focused mainly on the potential for vitamin D supplementation to improve the effectiveness of inhaled corticosteroids by enhancing their anti-inflammatory effects and reversing steroid resistance.2 By contrast, research into the link between vitamin D and chronic obstructive pulmonary disease (COPD) has been focused largely on the antimicrobial and anti-inflammatory effects of vitamin D and its ability to stimulate the innate immune response and ward off upper respiratory infections, thereby reducing the frequency of COPD exacerbations.3

In The Lancet Respiratory Medicine, Adrian Martineau and colleagues present the results of a double-blind, multicentre placebo-controlled trial of the effect of vitamin D3 (colecalciferol) supplementation on exacerbations and upper respiratory tract infections in adults with COPD in London, UK.4 240 participants with COPD (aged ≥40 years) were followed up every 2 months, by telephone or in person, over 1 year. Individuals in the intervention group were given an oral bolus dose of 3 mg (120 000 IU) of vitamin D3 every 2 months. Martineau and colleagues enrolled participants with a broad range of 25-hydroxyvitamin D serum levels. Overall, they found that supplementation did not affect the time to a moderate-to-severe exacerbation or time to first upper respiratory tract infection. However, the investigators noted that supplementation with vitamin D3 led to a lower incidence of moderate-to-severe exacerbations in participants with baseline serum 25-hydroxyvitamin D level of less than 50 nmol/L, which, though not universally accepted, is the current standard cutoff for vitamin D deficiency. Additionally, Martineau and colleagues found that the intervention reduced mean peak symptom score for exacerbation, suggesting that supplementation might ameliorate exacerbation symptoms. They concluded that supplementation should be provided to individuals with COPD and 25-hydroxyvitamin D levels of less than 50 nmol/L.

This study is the first multicentre trial to assess the effect of vitamin D supplementation on COPD outcomes. The finding that vitamin D supplementation increased the time to first exacerbation in participants who had vitamin D deficiency (25-hydroxyvitamin D levels < 50 nmol/L) could have important implications, especially because of the high prevalence of this in individuals with COPD.5 However, the results of the subgroup analysis should not be taken as conclusive evidence for the effectiveness of supplementation in patients with deficiency, although supplementation should be assessed on an individual basis for people with deficiency irrespective of the direct effect on COPD outcomes. The results should instead be regarded as exploratory and hypothesis-generating because of the small size of the subgroup (n=148). Also, the benefits of randomisation are lost in subgroup analyses, thereby precluding the ability to ascertain causality. The investigators point out that the results from another small, randomised controlled trial also showed a benefit of vitamin D3 supplementation on time to exacerbation in participants with COPD and severe deficiency (ie, <25 nmol/L).6 However, this trial had similar limitations to the current trial. Although the results of subgroup analyses in these trials are promising, additional randomised trials are needed in which only individuals with COPD and 25-hydroxyvitamin D levels of less than 50 nmol/L, or perhaps less than 75 nmol/L, the current accepted definition of vitamin D insufficiency, are enrolled.

Martineau and colleagues also noted that one potential reason for the absence of an effect on COPD outcomes could be related to the intermittent bolus dosing regimen in this trial. Improved studies are needed to assess the differences in daily versus intermittent dosing regimens because dose frequency could affect the physiological effects and therapeutic benefits of vitamin D supplementation on COPD. Because of the important relation between COPD and obesity and the anti-inflammatory effects of vitamin D,7 the interaction between vitamin D supplementation and obesity should be studied.

Similar to the findings reported by Martineau and colleagues,4 the Vitamin D Add-on Therapy Enhances Corticosteroid Responsiveness in Asthma (VIDA) investigators reported that vitamin D3 supplementation in adult individuals with asthma did not reduce the rate of first treatment failure compared with placebo. However, in a subgroup of VIDA participants who responded to supplementation, each 10 ng/mL (25 nmol/L) increase in serum concentrations of vitamin D3 was associated with a significant reduction in the rate of treatment failures and exacerbations,2 which suggests that there might be a dose-response relation between vitamin D and outcomes in patients with asthma and COPD. 85% of circulating levels of vitamin D metabolites are bound to vitamin D binding protein and 15% to albumin (the bioavailable fraction), with less than 1% in the free or unbound form.8 Polymorphisms in GC, the gene that codes for vitamin D binding protein, might contribute to the variability in levels of vitamin D binding protein between individuals.9, 10 Because of the variability in vitamin D binding protein concentrations, the use of total levels of vitamin D as a biomarker of vitamin D insufficiency has been recently questioned in favour of quantifying bioavailable or free vitamin D concentrations, which are unaffected by differences in vitamin D binding protein concentrations.11, 12, 13 Therefore, future studies of vitamin D levels as a biomarker of disease should include the measurement of vitamin D binding protein and estimation of bioavailable or free concentrations.

coughalot x

18 Replies

  • I'll have to come back and read this properly...

  • medicalupdateonline.com/201...,,, hiya vashti theres another link as well, theres no harm in addin another as well as coughs link,

  • Thanks my link is a bit technical! x

  • Hunter gatherers living around the African equator (where humans evolved) have average vitamin D levels of 115 nmol/L (46 ng/ml).

  • Thank you Coughalot and ItsBAme for the Vit D deficiency links. Just had blood tests and it came back so deficient it didn't register! Big dose now. Fighting to get over flare up, so breathless, so this explanation has really given me hope. Reckon my dr read this article recently! All the best, a breathless Honey7474

  • mdpi.com/2072-6643/5/12/5127


    '. . . Minimum effective serum 25-OHD levels are lower for skeletal disease, e.g., rickets (25 nmol/L), osteoporosis and fractures (50 nmol/L), than for premature mortality (75 nmol/L) or non-skeletal diseases, e.g., depression (75 nmol/L), diabetes and cardiovascular disease (80 nmol/L), falls and respiratory infections (95 nmol/L) and cancer (100 nmol/L). . . .'

  • I take a vit D supplement because I have Lupus I need to ware a factor 20 sunscreen all year round so get no sun. Glad its helping with my copd

  • Dear Coughalot,

    I have been taking Vitamin D3 now for 3 years with I think good effect, I am very severe and since adding this supplement to my regime am now certainly experiencing less exacerbations than I was in 2010 when my Doctors said to me you know you are very very ill and it would be a good thing now to put your affairs in order!

    Best Regards,


  • I am glad it is helping you halsa. It sounds like you are beating the odds so well done. x

  • Blimey Robert ! , that was a very encouraging thing to say to you - about " Put your affairs in order" ! - thats as bad as the comment I received recently about my Lung condition and a forthcoming operation on my enlarged Prostrate = " Well, you might die on the operating table, but I'll have a go at it " - CHARMING ! - what is it with these Doctors ? , they may be brilliant at their Job, but know very little about the so called " Bedside manner " -- more like GRAVESIDE MANNER ...,..........

  • i faced the same four years ago,they started of by saying they could not put me under and after a meeting said they could do it if i had a jab in the spine,well it went okey,but you are right,they said i could die,i said what have i got to loose,ive seen end stagers in hospital,being an old army veteran its not my way of popping my clogs

  • I think I need to read this carefully in order to absorb it all. It explains why my GP gave me Vit D3 with Calcium tablets. Unfortunately I felt a bit sick with them and he muttered that it would be the calcium causing this. I had better work harder at taking them!

  • And

  • WOW! - that was a Marathon ! - many thanks - how would you sum it up in a few words Coughalot ? !

  • It's a bit too technical for me vittorio but it sounds like vit D could help us lungies but there is no real proof yet. It wouldn't do any harm to top it up though would it? x

  • im told that if we take vitamins,the body will use them if needed or dump them


  • :) :d x

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