Chest
Volume 157, Issue 4, April 2020, Pages 856-865
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COPD: Original Research
Associations Among 25-Hydroxyvitamin D Levels, Lung Function, and Exacerbation Outcomes in COPD: An Analysis of the SPIROMICS Cohort

https://doi.org/10.1016/j.chest.2019.11.047Get rights and content

Background

The relationship between 25-hydroxyvitamin D (25-OH-vitamin D) and COPD outcomes remains unclear. Using the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS), we determined associations among baseline 25-OH-vitamin D and cross-sectional and longitudinal lung function and COPD exacerbations.

Methods

Serum 25-OH-vitamin D level was measured in stored samples from 1,609 SPIROMICS participants with COPD. 25-OH-vitamin D levels were modeled continuously and dichotomized as deficient (< 20 ng/mL) vs not deficient (≥ 20 ng/mL). Outcomes of interest included % predicted FEV1 (current and 1-year longitudinal decline) and COPD exacerbations (separately any and severe, occurring in prior year and first year of follow-up).

Results

Vitamin D deficiency was present in 21% of the cohort and was more prevalent in the younger, active smokers, and blacks. Vitamin D deficiency was independently associated with lower % predicted FEV1 (by 4.11%) at enrollment (95% CI, –6.90% to –1.34% predicted FEV1; P = .004), 1.27% predicted greater rate of FEV1 decline after 1 year (95% CI, –2.32% to –0.22% predicted/y; P = .02), and higher odds of any COPD exacerbation in the prior year (OR, 1.32; 95% CI, 1.00-1.74; P = .049). Each 10-ng/mL decrease in 25-OH-vitamin D was associated with lower baseline lung function (–1.04% predicted; 95% CI, –1.96% to –0.12% predicted; P = .03) and increased odds of any exacerbation in the year before enrollment (OR, 1.11; 95% CI, 1.01-1.22; P = .04).

Conclusions

Vitamin D deficiency is associated with worse cross-sectional and longitudinal lung function and increased odds of prior COPD exacerbations. These findings identify 25-OH-vitamin D levels as a potentially useful marker of adverse COPD-related outcomes.

Section snippets

Study Participants

SPIROMICS is a multicenter, observational, prospective, cohort study that includes current or former smokers (≥ 20 pack-years), with or without chronic airflow obstruction, between the ages of 40 and 80 years, and nonsmoking control subjects recruited from 12 clinical centers (n = 2,974).24,25 Participants included in this analysis had spirometry-confirmed COPD (FEV1/FVC < 0.70) and available baseline clinical data (n = 1,609) (Fig 1). Institutional review boards at each center approved

Cohort Characteristics

There were 1,609 participants in the analytical cohort (Table 1). Participants had a mean age of 65 years, 42% were female, and 14% were black. Severe COPD (Global Initiative for Chronic Obstructive Lung Disease [GOLD] stage III-IV) was present in 34% of participants, and 31% reported one or more AECOPD in the year before enrollment. All participants had 25-OH-vitamin D levels above the limit of detection (> 3.7 ng/mL). The median vitamin D level in the cohort was 28.9 ng/mL (quartile

Discussion

This study presents the relationship between 25-OH-vitamin D levels and COPD outcomes among 1,609 participants in the SPIROMICS cohort. VDD was seen in 21% of the study cohort and was associated with black race, younger age, and current smoking. VDD was independently associated with lower FEV1 at baseline, a greater rate of lung function decrement after 1 year, and experiencing AECOPD in the year before study enrollment. These findings demonstrate the association between VDD and COPD outcomes,

Conclusion

We have observed VDD in approximately one of five participants with COPD in a multicenter cohort. Active smokers, blacks, and younger participants were more likely to have VDD. Lower 25-OH-vitamin D levels are independently associated with lower baseline lung function as well as greater odds of an AECOPD in the year before enrollment. VDD was associated with a greater rate of lung function decline over 1 year. These findings describe potential adverse effects of VDD on lung function decline in

Acknowledgments

Author contributions: R. M. B. had access to the data and is the guarantor for the content of the manuscript including data and analysis. R. M. B. and M. B. D. had full access to the data and take responsibility for the integrity of the data and accuracy of analysis presented herein. M. B. D. and R. M. B. contributed substantially to the design of the study, data interpretation, and drafting of the manuscript. A. S. C., M. B. D., and R. M. B. contributed to data analysis. D. C., E. A. H., A. P.

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    FUNDING/SUPPORT: R. M. B. has received support from the National Institutes of Health, National Heart, Lung, and Blood Institute (NIH-NHLBI) [Grant F32HL143867-01] related to this work. M. B. D. has received support from the NIH-NHLBI [Grant R01HL125432-01A1] related to this work. For SPIROMICS funding, see Acknowledgments.

    Collaborators from the SPIROMICS study are listed in the Acknowledgments.

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