CHEST Guidelines-Vitamin-D-Deficiency-in-COPD

Vitamin-D-Deficiency-in-COPD_chest

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This document discusses the role of vitamin D deficiency (VDD) in chronic obstructive pulmonary disease (COPD). It explores whether VDD serves as a biomarker, a treatable trait, or merely a common comorbidity in COPD patients. Stephen Milne, MBBS, PhD, and Don D. Sin, MD, FCCP, present findings by Burkes et al, who analyzed the association between serum vitamin D levels and COPD outcomes using data from the SPIROMICS cohort. They found that VDD, defined as a serum level below 20 ng/mL, is linked to a faster decline in lung function and a higher likelihood of acute exacerbations of COPD (AECOPD).<br /><br />VDD is a prevalent condition, especially among the elderly and African Americans. It plays a crucial role in various physiological processes, including calcium/phosphate homeostasis, hormone regulation, and immune function. Its deficiency has been associated with an increased risk of pulmonary infections.<br /><br />The article addresses whether vitamin D levels can serve as a COPD biomarker; however, it raises concerns about confounding factors like patients taking vitamin D supplements, socioeconomic status, nutritional status, and physical activity, which complicate the use of vitamin D levels as a clear biomarker. Mendelian randomization is suggested as a possible method to evaluate its potential causal impact without such confounding influences.<br /><br />As a treatable trait, the document discusses vitamin D supplementation, especially for those with severe deficiency. While evidence is inconclusive on its effectiveness in altering lung function decline or exacerbation risk, supplementation might be advised for those with levels below 10 ng/mL to potentially reduce respiratory tract infections. Ultimately, treating VDD should be part of a comprehensive COPD management approach, though its impact on long-term outcomes requires further investigation.

Keywords

Vitamin D deficiency

Chronic obstructive pulmonary disease

COPD

Biomarker

Treatable trait

Serum vitamin D levels

Lung function decline

Acute exacerbations

Vitamin D supplementation

Mendelian randomization