Vitamin D and COPD: What’s the connection?

When you think about vitamin D, the first thought that often comes to mind is the importance of this vitamin with bone health. Deficiency of vitamin D can lead to weakened bones and osteoporosis. Besides this role, did you know there are many other functions in the body that are impacted by vitamin D?  Recently published guidelines highlight the relationship of vitamin D with chronic obstructive pulmonary disease (COPD) and the chronic inflammation present with this condition. Let’s take a closer look.

What is COPD?^1-3

Approximately 16 million Americans suffer from COPD, a progressive and chronic pulmonary disorder.  This lung disease results in an obstruction of normal air flow, and typical symptoms include shortness of breath, a productive cough, wheezing, increased weakness, and generalized fatigue with lack of energy. With more advanced disease, pulmonary cachexia and malnutrition are a concern and nutrition status can be compromised.  Smoking is recognized as the biggest contributor to COPD. Smoking cessation is recommended as part of a treatment plan in addition to medications, pulmonary rehabilitation, and in some cases, oxygen therapy.

Role of Vitamin D with COPD^4,5

Newer research has found vitamin D may play a role with inflammation and lung function. With COPD, serum vitamin D is often low. Severe deficiency is more common with disease progression. This decrease in vitamin D occurs due to the inflammatory impact of COPD. It causes an elevation in signaling pathways of inflammatory cytokines and a reduction in pulmonary nuclear vitamin D receptors.

The American Society of Parenteral and Enteral Nutrition (ASPEN) recognizes normal serum vitamin D levels as:

• Sufficient: > 30 ng/mL
• Insufficient: >20 ng/mL to ≤ 30 ng/mL
• Deficient: ≤ 20 ng/mL

In patients with COPD, vitamin D levels often fall into the insufficient or deficient categories. Supplementation and correction of vitamin D should be considered with the goal of decreasing inflammation. While more specific research is needed, some early trials have shown beneficial results of supplementation with improved lung function and a decrease in exacerbations in those with severe vitamin D deficiency (≤10 ng/mL).

What do the guidelines recommend?⁵

In 2021, the Academy of Nutrition and Dietetics Evidence Analysis Center published an update to COPD Practice Guidelines. Recognizing the relationship between vitamin D and lung function, recommendations for assessment, supplementation, monitoring and evaluation of this nutrient were included. Putting this into practice, registered dietitian nutritionists (RDNs) should consider evaluating serum 25(OH)D levels as part of a routine nutrition assessment. Noting the increased risk for deficiency with disease progression, RDNs should check serum 25 (OH)D levels in individuals who have had two or more COPD exacerbations within a year.

The vitamin D lab results can be used by the RDN to determine the need for supplementation as well as monitoring and evaluating outcomes with this supplementation.

• If serum 25(OH)D ≤ 10 ng/mL, the RDN should advise supplementation to optimize levels to decrease risk of COPD exacerbations.
• If serum 25(OH)D is between 11 to 29 ng/mL, the RDN should consider Research found mixed results with supplementation that may or may not result in pulmonary benefits with this group of patients and therefore, clinical judgement should be used.

Nutrition application^1,4

The recommended daily amount of vitamin D ranges from 600 to 800 IU in individuals aged 19 and older.  Supplementation of vitamin D in increased amounts is needed to correct severe deficiency.  Although the studies included in the COPD guidelines used different amounts of vitamin D supplementation, ASPEN recommends initial supplementation of 50,000 IU vitamin D₃ once per week for 8 weeks. Once this high level of supplementation is completed, vitamin D levels should be rechecked.  On average, if serum levels are within a normal range, 1,000 IU per day of vitamin D₃ can help to maintain this repleted level.

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References

National Institutes of Health: Office of Dietary Supplements. Vitamin D: Fact Sheet for Consumers. Available at https://ods.od.nih.gov/factsheets/VitaminD-Consumer/. Accessed August 28, 2021.

Mayo Clinic. COPD. Available at https://www.mayoclinic.org/diseases-conditions/copd/symptoms-causes/syc-20353679. Accessed August 28, 2021.

Centers for Disease Control and Prevention. Chronic Obstructive Pulmonary Disease. Available at https://www.cdc.gov/copd/index.html. Accessed August 28, 2021.

McKeever L. Vitamins and Trace Elements. In: The A.S.P.E.N. Adult Nutrition Support Core Curriculum. 3rd edition. United States: American Society for Parenteral and Enteral Nutrition; 2017:146.

Hanson C, Bowser E, Frankenfield D, Piemonte T. Chronic obstructive pulmonary disease: A 2019 evidence analysis center evidence-based practice guideline. J Acad Nutr Diet. 2021;121(1):139-165.