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COPD helped by weekly 50,000 IU Vitamin D – several trials

Did you know?
  • COPD = Chronic Obstructive Pulmonary Disease
  • COPD has dramatically risen to become the 3rd leading cause of death
  • COPD is 2 times as likely if you have low vitamin D
  • COPD attack is 30 times more likely if low vitamin D
  • COPD can be effectively treated by Vitamin D
       using 50,000 IU weekly or 100,000 IU monthly
          (More COPD info below)

Learn how Vitamin D is essential for good health
  Watch a 5 minute video "Does Less Sun Mean more Disease?"
  Browse for other Health Problems and D in left column or here
  see also Supplementing for D and More in the menu at the top of very page

50,000 IU weekly - 6X more likely to improve breathing - 2014

Efficiency of supplemental vitamin D in patients with chronic obstructive pulmonary disease.
British Journal of Medicine and Medical Research 2014 Vol. 4 No. 16 pp. 3031-3041
IHeidari, B.; Monadi, M.; Asgharpour, M.; Firouzjahi, A.; Tilaki, K. H.; Monadi, M.

Aims: To investigate the impact of supplemental vitamin D on pulmonary function in patients with stable chronic obstructive pulmonary disease (COPD).

Study Design: Case-control study Place and Duration of Study: Department internal medicine, Rouhani hospital, Babol university of medical sciences, Babol, Iran.
Over six months from September 2011 through February 2012

Methodology: Patients with COPD allocated to the treatment or control group intermittently. Thirty patients in the treatment group received 50.000 IU oral cholecalciferol weekly for two months plus routine treatment and 28 patients who served as controls received only their usual medications. The serum 25-hydroxyvitamin D (25-OHD) and FEV1% was measured at baseline and two months later. The primary objective was to determine treatment response defined as 5% or greater increase from baseline in FEV1% and the secondary objective was to determine the association between vitamin D supplementation and treatment response. In statistical analysis Spearman's correlation coefficient was used to determine correlation and logistic regression analysis with calculation of odds ratio (OR) was used to determine association.

Results: Mean age of the patients and controls was 67.1±10.5 years and 66.±12.2 years respectively (P=0.83).
Thirteen patients (43.3%) versus 3 (10.7%) controls responded to treatment (P=0.009).
Treatment response was positively correlated with mean serum 25-OHD changes from baseline (Spearman's correlation coefficient=0.358, P=0.026).
Mean 25-OHD change from baseline in the responders was significantly higher than in no responders (P=0.031).
Mean 25-OHD changes were positively correlated with FEV1% (P=0.013).
Vitamin D supplementation increased the treatment response by OR=6.37 (95% CI, 1.57-25.8).

After adjustment for inhaled bronchodilator, corticosteroid therapy, age, weight, smoking, ESR and CRP the odds of treatment response in vitamin D group increased to 17.1 (95%CI, 2.39-122, P=0.005).

Conclusion: The findings of this study indicate that, two months vitamin D supplement to the drug regimen of COPD confers small pulmonary function improvement as compared with controls and justify serum 25-OHD measurement in COPD. Raising serum 25-OHD to sufficient levels with longer duration of treatment may exert further benefits

50,000 IU helped COPD in many ways - Jan 2015

Effect of vitamin D replacement in chronic obstructive pulmonary disease patients with vitamin D deficiency
Egyptian Journal of Chest Diseases and Tuberculosis, doi:10.1016/j.ejcdt.2015.01.002
Nasef Abdel Salam A. Rezka, , Nasser Yehia A. Alyb, Asem Abdel Hamid Hewidya

Vitamin D deficiency is prevalent among patients with chronic obstructive pulmonary disease (COPD) and comes to be more frequent with increased disease severity. We aimed to assess the role of vitamin D supplementation in patients with severe COPD.

Patients and methods
We studied 30 patients with severe COPD and vitamin D deficiency. All patients received oral vitamin D3 50,000 IU once weekly for 8 weeks, followed by a daily dose of 800 IU thereafter.

  • Pulmonary function tests,
  • six minute walk test (6MWT),
  • maximum inspiratory pressure (MIP),
  • maximum expiratory pressure (MEP),
  • C-reactive protein (CRP), and
  • serum vitamin D level

were assessed at the start of the study and 1 year later.
The frequency of exacerbations was recorded a year before and a year after vitamin D supplementation.

The mean serum vitamin D level was 11.80 ± 2.40 ng/dl and reached 55.30 ± 5.65 ng/dl a year after vitamin D intake (p < 0.001).
We found a significant improvement in

  • dyspnea scale (p < 0.003),
  • 6MWT (p < 0.001) (six minute walk test )
  • MVV (p < 0.001),
  • MIP (p = 0.006) (maximum inspiratory pressure )
  • MEP (p < 0.001), (maximum expiratory pressure ) coupled with a
  • decrease in disease exacerbations (p < 0.001) and
  • (decrease) CRP (p < 0.001)

a year after vitamin D replacement. However, the FEV1 and FVC did not differ significantly.

Conclusion: Vitamin D replacement improved dyspnea, physical performance and decreased the frequency of exacerbation in severe COPD patients with vitamin D deficiency.
 Download the PDF from VitaminDWiki.

50,000 IU weekly helped elderly with COPD tolerate exercise - 2013

High Dose Vitamin D3 Improves Exercise Tolerance in Elderly Patients with Chronic Obstructive Pulmonary Disease
Obstructive Pulmonary Disease. J Gerontol Geriat Res 2: 127. doi:10.4172/2167-7182.1000127
Mehrnaz Asadi Gharabaghi1*, Mehrnoush Asadi Ghrabaghi2, Mohsen Arabi3, Mohammad Reza Zahedpour Anaraki1 and Gholamreza Derakhshan Deilami1
1Department of Pulmonary Medicine, Tehran University of Medical Sciences, Tehran, Iran 'Department of Pharmacy, Maharashtra Institute of Technology, Pune, India 3Department of Medicine, Iran University of Medical Sciences, Tehran, Iran
•Corresponding author: Dr. Mehrnaz Asadi Gharabaghi, Department of Pulmonary Medicine, Imam Khomeini Hospital, Tehran, Iran, Tel: +982161192646; E-mail: asadi_m at tums.ac.ir

Background: In addition to airflow limitation, peripheral muscle dysfunction is a limiting factor in physical performance of patients with chronic obstructive pulmonary disease (COPD).Any measure to improve global muscle function in COPD patients such as vitamin D replacement seems to enhance exercise tolerance of these patients.

Aim: The aim of present study was to study the effect of vitamin D replacement therapy on exercise tolerance of a group of stable COPD patients with vitamin D deficiency or insufficiency.

Methods: It was an experimental, unblended open-label trial. A total number of 25 stable COPD patients were enrolled in the study in the period between March 2012 and OCT 2012 and received 50,000 IU vitamin D weekly for 4-8 weeks in addition to their standard medical therapy as before. They were also subdivided into two subgroups based on serum 25 hydroxy vitamin D,25(OH)D( <10 ng/ml and 10-30 ng/ml).Pulmonary function tests, six-minute walk distance test(6MWD) were measured at baseline and three months after the enrollment.

Results: By the end of study, there was significant improvement in the distance walked during 6-minute walk test. This improvement was documented in both subgroups of patients. However, the perceived dyspnea during test did not differ from baseline value by the end of the study. Also, only patients with serum 25(OH) D, 10 -30 ng/ml showed the significant increase in their mean value of FEV1 by the end of the study.

Conclusion: Vitamin D replacement therapy is an effective measure to improve exercise tolerance of stable COPD patients with vitamin D deficiency or insufficiency

Clipped from Discussion
The present study explored the effect of vitamin D replacement therapy in exercise capacity of COPD patients. Field tests are commonly used to evaluate exercise tolerance of patients with various cardio respiratory diseases. Six-minute walk (6MWT) and shuttle walking tests are commonly used with this aim as they are easy to perform and need minimal equipment. We utilized 6MW test and found that vitamin D supplementation significantly improved distance walked during 6MWT, signifying improvement in the exercise tolerance of COPD patients with vitamin D insufficiency/deficiency. Six minute walk test is a simplified exercise test assessing overall functional capacity of patients. It is influenced by many factors including cardio respiratory function, comorbid disorders, age, BMI, height, nutrition and peripheral muscle strength [10]. Lower limb muscle strength has been reported to have significant and positive relationship with the distance walked during 6MWT [21]. Peripheral muscle dysfunction is a well-known complication in COPD patients and vitamin D insufficiency that is common in COPD, contributes to its development. Therefore, it is prudent to assume that insufficient vitamin D store in COPD patients reduces their maximum distance walked during 6MWT .As a supportive evidence, Ringbaek et al., [9]. showed that COPD patients with vitamin D deficiency who undergo PR have poorer outcome in training programs compared with patients with enough vitamin D reservoir [9]. There is also a strong document stating vitamin D supplementation improves exercise capacity of COPD patients receiving pulmonary rehabilitation [22]. Vitamin D receptors exist on various organs including skeletal muscles. Vitamin D affects muscle metabolism in different pathways. For instance, after binding to its receptor, 1, 25(OH) D3 causes both voltage-dependent calcium channels and calcium-release-activated channels to be opened and facilitates calcium entry to the cells to initiate myosin and actin interaction and finally muscle contraction. Therefore, it is not surprising that vitamin D insufficiency causes proximal muscle weakness even in the presence of normocalcemia [23]. The exact mechanisms that vitamin D improves exercise tolerance in COPD patients are not known. Improvement in oxidative capacity of musculoskeletal tissues, reducing anaerobic threshold are areas of uncertainty that need to be addressed in future studies [18].

Yet, there are controversies about contribution of vitamin D deficiency to muscle dysfunction in COPD patients. Jackson et al. studied the correlation between vitamin D status , muscle strength and quadriceps endurance in a group of COPD patients and reported no significant correlation, and attributed their finding to muscle resistance to vitamin D [24]. There are few studies evaluating the effect of vitamin D supplementation on six -minute walk test as a primary outcome in COPD patients. But in a double-blind randomized controlled trial in patients with heart failure, vitamin D supplementation did not improve exercise tolerance, muscle strength and six minute walk distance [25].

There are few reports investigating the contribution of vitamin D status to respiratory muscle strength in COPD patients. Also, there is little study to address the optimal level of 25 (OH) D in COPD patients to achieve maximum exercise capacity. Based on large cross-sectional data, when serum level of 25(OH) D increases from 9 ng/ml to 37 ng/ml, muscle strengths increases too and higher level of 25 (OH) D associated with better lower extremity function [26]. According to the statement of International osteoporosis Foundation in 2010, the target serum level of 25(OH) D of 30ng/ml should be maintained in all elderly patients [27]. In our study, the serum level of 25(OH) D after three months was correlated positively with distance walked during 6MW test at the end of study. All patients achieved serum level of 25(OH) D more than 30 ng/ by the end of the study with mean serum level of 62.7 ± 16 ng/ml. Similarly, the increase in 6MWD in insufficiency group was more than deficient patients by the end of the study. As mentioned, higher serum level of 25 (OH) D correlates with better skeletal muscle function and may enhance exercise tolerance. We treated our patients with almost the same regimen, irrespective of being insufficient or deficient in vitamin D that means 50,000 IU orally weekly for 4-8 weeks. Therefore, we assumed that the percentage of patients whose improvement in 6MWT was more than MCID would differ significantly in two subgroups but data analysis showed that was not the case. We attributed this finding to the small number of patients in each subgroup as the measured P value was only 0.06.
Patients with COPD often experience increased dyspnea during exercise that limits their exercise performance further. Ventilatory demands increase during exercise, and expiratory flow limitation causes progressive hyperinflation, so greater respiratory muscle activity is needed to overcome the increased elastic work at high lung volumes. The increased work of breathing translates into increased perception of dyspnea [28]. However, this exertional dyspnea might be in some part due to increased respiratory drive secondary to peripheral muscle dysfunction [29]. We assumed that vitamin D replacement would decrease perceived dyspnea during 6-minute walk distance test at least by improving peripheral muscle dysfunction. We used Borg category scale to rate the dyspnea. However, the mean Borg scale score during walk test before and after the intervention showed no significant improvement in perceived dyspnea while there was significant difference in distance before and after vitamin D replacement. The observed discrepancy between dyspnea score and the distance may be due to inability of elderly patients to discriminate easily between terms such as slight dyspnea and somewhat sever dyspnea (2 vs.4 score respectively). Based on the documentations by Muza et al., [30] psychometric measures such as visual analogue and Borg scale have good reproducibility but the proximity of verbal descriptors might be confusing and discouraging for patients with COPD. Therefore, rating dyspnea by Borg scale might not be highly sensitive [30,31].

Mean FEV1 value increased from baseline value at the three months in our study. But, the increase in deficient patients [25(OH) D<10 ng/ ml] did not reach statistically significant value. However, in patients with vitamin D insufficiency; the increase in mean value of FEV1 was significant. Black et al., [32] surveyed the relationship between vitamin D status and pulmonary function tests and showed men and women with serum level of 25(OH) D above 35ng/ml had FEV1 values 176 milliliter more than their matched controls [32]. However, Lehouk et al., [33] showed that high dose vitamin D administration to COPD patients with vitamin D insufficiency did not affect the FEV1 or the time to first exacerbation [33]. Also in a randomized clinical trial, severe COPD patients did not show any significant change in their physical performance or respiratory health status despite receiving 2000 vitamin D daily for 6 weeks [34]. In Hertfordshire Cohort Study, UK, the investigators did not find any significant relationship between serum 25(OH) D and FEV1 in COPD patients [35]. In addition Kunisaki et al., [36] showed that vitamin D status has no relationship with short term response of FEV1 to inhaled steroid [36].The observed increase in mean FEV1 in the patients with vitamin D insufficiency in our study may not reflect the positive effect of vitamin supplementation on lung function test but may rather signify the seasonal and biologic variations of lung function tests in COPD patients.

There were limitations in our study. First; we did not study the effect of vitamin D replacement on end expiratory volume, inspiratory capacity and static dynamic hyperinflation during exercise. We did not measure muscle strength and quadriceps endurance before and after vitamin D supplementation. We did not follow patients beyond three months to evaluate their physical performance. Also, the number of matched COPD patients with sufficient vitamin D status was very small in our pulmonary clinic so we had no control group. Lastly, the sample size was very small.

In conclusion, it is worthy to state that to optimize medical treatment of patients with COPD and increase their exercise tolerance, not only airflow limitation but also peripheral muscle weakness needs to be treated appropriately. Functional capacity of COPD patients would not improve unless their lower limb muscle becomes more efficient in energy consumption.
 Download the PDF from VitaminDWiki.

Asthma & COPD combined - Sept 2015

Vitamin D deficiency is associated with impaired disease control in asthma-COPD overlap syndrome patients.
Int J Chron Obstruct Pulmon Dis. 2015 Sep 24;10:2017-25. doi: 10.2147/COPD.S91654. eCollection 2015.
Odler B1, Ivancsó I1, Somogyi V1, Benke K2, Tamási L1, Gálffy G1, Szalay B3, Müller V1.

The association between vitamin D and clinical parameters in obstructive lung diseases (OLDs), including COPD and bronchial asthma, was previously investigated. As asthma-COPD overlap syndrome (ACOS) is a new clinical entity, the prevalence of vitamin D levels in ACOS is unknown.
Our aim was to assess the levels of circulating vitamin D (25-hydroxyvitamin D 25(OH)D) in different OLDs, including ACOS patients, and its correlation with clinical parameters.
A total of 106 men and women (control, n=21; asthma, n=44; COPD, n=21; and ACOS, n=20) were involved in the study. All patients underwent detailed clinical examinations; disease control and severity was assessed by disease-specific questionnaires (COPD assessment test, asthma control test, and modified Medical Research Council); furthermore, 25(OH)D levels were measured in all patients.
The 25(OH)D level was significantly lower in ACOS and COPD groups compared to asthma group (16.86±1.79 ng/mL and 14.27±1.88 ng/mL vs 25.66±1.91 ng/mL). A positive correlation was found between 25(OH)D level and forced expiratory volume in 1 second (r=0.4433; P<0.0001), forced vital capacity (FVC) (r=0.3741; P=0.0004), forced expiratory flow between 25% and 75% of FVC (r=0.4179; P<0.0001), and peak expiratory flow (r=0.4846; P<0.0001) in OLD patient groups. Asthma control test total scores and the 25(OH)D level showed a positive correlation in the ACOS (r=0.4761; P=0.0339) but not in the asthma group. Higher COPD assessment test total scores correlated with decreased 25(OH)D in ACOS (r=-0.4446; P=0.0495); however, this was not observed in the COPD group.
Vitamin D deficiency is present in ACOS patients and circulating 25(OH)D level may affect disease control and severity.

PMID: 26451099  Download the PDF from VitaminDWiki

COPD and Vitamin D loading + 2,000 IU daily - Clinical Trial announced Nov 2015

Vitamin D Supplementation and Muscle Characteristics in Trained Subjects
Loading dose of 140,000 IU followed by 2,000 IU daily
250 mg (small amount) of Calcium

Meta-analyses of many studies of Breathing and Vitamin D:

Breathing and Vitamin D INTERVENTIION studies

See also VitaminDWiki

See also web

  • FDA Clears Olodaterol (Striverdi Respimat) for COPD July 2014
    improved lung function compared with placebo vs Vitamin D provides 17X better improvement
    Note: could not find the above quoted text when looked at again in Jan 2015
    The most common side effects in the clinical study were nasopharyngitis, upper respiratory tract infection, bronchitis, cough, urinary tract infection, dizziness, rash, diarrhea, back pain, and arthralgia.
  • olodaterol New drug report in UK - with all of the trial data
  • COPD clininical trials with Vitamin D intervention 12 as of Nov 2016

Charts of recent increase in COPD deaths

Big increase in COPD death rate (age adjusted)
  PDF in VitaminDWiki.
Give Them Comfort: Controlling COPD Symptoms at the End of Life Feb 2009 has the following chart

Venn diagrams of breathing problems

Image Image

COPD has become the 3rd largest global cause of disability: ages 50-69

Global Burden of Backpain

COPD helped by weekly 50,000 IU Vitamin D – several trials        

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7634 asthma-COPD.pdf PDF admin 08 Jan, 2017 21:30 579.00 Kb 127
7628 COPD Venn.jpg admin 07 Jan, 2017 16:00 19.67 Kb 765
5575 COPD increase.jpg admin 06 Jun, 2015 14:18 26.39 Kb 3515
4988 Jan 2015.pdf PDF 2015 admin 30 Jan, 2015 14:10 419.60 Kb 952
4972 COPD venn.jpg Google Images admin 24 Jan, 2015 21:58 44.96 Kb 4902
4971 COPD Death rate.jpg admin 24 Jan, 2015 21:58 22.87 Kb 5403
4970 Changing the burden of COPD mortality - 2006.pdf PDF admin 24 Jan, 2015 21:57 171.66 Kb 760
4969 Exercise tolerance COPD.pdf PDF 2013 admin 24 Jan, 2015 16:01 590.08 Kb 786
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