High Doses of Vitamin D to Reduce Exacerbations in Chronic Obstructive Pulmonary Disease

作者：Lehouck, An; Mathieu, Chantal; Carremans, Claudia; Baeke, Femke; Verhaegen, Jan; Van Eldere, Johan; Decallonne, Brigitte; Bouillon, Roger; Decramer, Marc; Janssens, Wim^*

来源：Annals of Internal Medicine, 2012, 156(2): 105-W20.

DOI：10.7326/0003-4819-156-2-201201170-00004

• NUTRITION EXAMINATION SURVEY
• RANDOMIZED CONTROLLED-TRIAL
• PLACEBO-CONTROLLED TRIAL
• LUNG-FUNCTION DECLINE
• 3RD NATIONAL-HEALTH
• D SUPPLEMENTATION
• D DEFICIENCY
• DOUBLE-BLIND
• TUBERCULOSIS
• STANDARDIZATION

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. (ClinicalTrials.gov registration number: NCT00666367) 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.

• 出版日期2012-1-17