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Treat vitamin D deficiency to prevent COPD exacerbations

Vitamin D supplementation safely and substantially reduced the rate of moderate/severe COPD exacerbations in patients with baseline 25-hydroxyvitamin D levels <25 nmol/L but not in those with higher levels, according to a new review of the evidence.

Clinical trials investigating effects of vitamin D supplementation on COPD have shown conflicting results. This new study pooled individual patient data for 469 participants in 3 randomised controlled trials, which were identified through a search for relevant studies published on PubMed, Embase, the Cochrane Central Register of Controlled Trials and Web of Science up to and including 5 October 2017.

The research, led by Queen Mary University of London, found that vitamin D supplementation did not influence the overall rate of moderate/severe COPD exacerbations (adjusted incidence rate ratio [aIRR], 0.94; 95% CI, 0.78-1.13). Vitamin D did not influence the proportion of participants experiencing at least one serious adverse event (adjusted OR, 1.16; 95% CI, 0.76-1.75).

However, prespecified subgroup analysis revealed that protective effects were seen in participants with baseline 25-hydroxyvitamin D levels <25 nmol/L (aIRR, 0.55; 95% CI, 0.36-0.84) but not in those with baseline levels ≥25 nmol/L (aIRR, 1.04; 95% CI, 0.85-1.27; Pinteraction=.015).

Commenting on the findings, lead researcher, Professor Adrian Martineau, said: "Vitamin D supplementation is safe, and it costs just a few pence to supplement a person for a year - so this is a potentially highly cost-effective treatment that could be targeted at those who have low vitamin D levels following routine testing.

"Around a fifth of COPD patients in the United Kingdom - about 240,000 people - have low levels of vitamin D. Reducing risk of attacks in such a large group would have major benefits for patients and for the NHS, since many attacks require costly hospital admission," Professor Martineau said.


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