Vitamin D is one of the alternate COPD therapies – March 2021

Considerations for and Mechanisms of Adjunct Therapy in COPD

J Clin Med. 2021 Mar 16;10(6):1225. doi: 10.3390/jcm10061225.
Rachana Mandru 1, Christine Y Zhou 2, Rachel Pauley 2, Robert M Burkes 1 burkesrt at ucmail.uc.edu

 Download the PDF from VitaminDWiki

Inhaled bronchodilators and corticosteroids, when indicated, form the backbone of COPD therapy. However, over the last decade there has been an emergence of adjunct therapies in oral or inhaled form that are now part of the therapeutic approach to COPD. While these therapies have shown to be beneficial when used in the appropriate instances, there are particular considerations that need to be minded when using these therapies.
This review article discussed the mechanism of

• oflumilast,
• macrolide antibiotics,
• other chronic antibiotic regimens,
• vitamin D supplementation,
• oral corticosteroids,
• n-acetylcysteine, and
• nebulized hypertonic saline,

the clinical data behind each of these therapies, adverse events associated with therapy, and the expert recommendations for their utilization. Our goal is to provide a brief but informative and clinically useful review of commonly encountered therapies used in advanced COPD.

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7 Vitamin D (clipped from PDF)

Supplementation of vitamin D is an attractive additive therapy for those with COPD who are vitamin D deficient for a variety of reasons. 1,25-Hydroxy-vitamin D, the active form of the vitamin, has a pleitropic effect on the immune system but promoting the expression of genes coding for innate defensins, regulating macrophage differentiation, signaling cell apoptosis, modulating cellular adhesion, and promoting a more anti-inflammatory response to invading pathogens and noxious stimulants [48-51]. Further, there is a putative musculoskeletal benefit to supplementation of vitamin D in pulmonary rehabilitation patients [52]. At the current time, researchers are attempting to more accurately define the clinical benefit of vitamin D sufficiency and supplantation in the COPD population.
Observational studies suggest persons with COPD and 25-OH-vitamin D levels <20ng/mL may lose more lung function over time and report higher incidence of exacerbations [53], however, this study could not determine if supplementation of those with vitamin D deficiency was clinically meaningful. Trials assessing the effect of vitamin D supplementation in deficient participants have been performed and, taken as single studies, it does not seem vitamin D supplementation has much benefit in protection against COPD exacerbations and other longitudinal outcomes [54,55]. There are several nuances of these studies that suggests the role of vitamin D supplementation in COPD requires further investigation, however, with the major one being that participants in both of these trials started their supplementation with vitamin D levels very near normal on average. Joliffe [56] conducted a meta-analysis with the two abovementioned trials as well as a third [57], and concluded that those who have very low vitamin D levels (<10 ng/mL or <25 nmol/L) have a significantly reduced incidence rate of COPD exacerbations if supplemented with vitamin D. Likely because of this compiled data, GOLD now recommends considering vitamin D supplementation in deficient COPD patients [1]. It should be noted that patients should have vitamin D levels and deficiency addressed by primary care providers or endocrinologists and at this time no solid recommendations can be made by guidelines as to who would best benefit from a purely pulmonary standpoint from vitamin D supplementation.