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Does high dose vitamin D therapy reduce exacerbations in COPD?
DOI:10.1038/bonekey.2012.44
Approximately 60–75% of patients with severe chronic obstructive pulmonary disease (COPD) have low serum 25-hydroxyvitamin D (25[OH]D) levels and impaired FEV1. A study by Lehouck et al investigated the use of high-dose vitamin D supplements in patients with moderate to severe COPD to establish whether this could lower their incidence of infectious exacerbations.
A group of 182 COPD patients prone to exacerbations was randomized into two groups and received either 100,000 IU of vitamin D, or a placebo, every month for a year. The times to first exacerbation (primary outcome) and other secondary outcomes were determined. Although COPD patients given high-dose vitamin D achieved mean 25(OH)D levels that were, on average, 30 ng/mL (p<0.001) higher than the placebo group, times to first exacerbation were not significantly different between the groups.
Post hoc analysis highlighted a subgroup of treated patients, those with the worst vitamin D deficiency, who did show a significant increase in the time to their first exacerbation (p = 0.042).
Editor's comment: Although innumerable epidemiological studies suggest that vitamin D exerts pleiotropic effects, randomized controlled trials demonstrating its efficacy beyond fracture reduction are still limited. This RCT shows that taking 100,000 IU of vitamin D monthly reduces the number of exacerbations in patients with COPD, but only among those whose 25(OH)D levels were deficient at baseline (<10 ng/mL) and then reached 25(OH)D levels of approx 50 ng/mL.
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