Observational Study

. 2020 Apr;157(4):856-865.

doi: 10.1016/j.chest.2019.11.047. Epub 2020 Jan 17.

Associations Among 25-Hydroxyvitamin D Levels, Lung Function, and Exacerbation Outcomes in COPD: An Analysis of the SPIROMICS Cohort

Robert M Burkes¹, Agathe S Ceppe², Claire M Doerschuk³, David Couper⁴, Eric A Hoffman⁵, Alejandro P Comellas⁶, R Graham Barr⁷, Jerry A Krishnan⁸, Christopher Cooper⁹, Wassim W Labaki¹⁰, Victor E Ortega¹¹, J Michael Wells¹², Gerard J Criner¹³, Prescott G Woodruff¹⁴, Russell P Bowler¹⁵, Cheryl S Pirozzi¹⁶, Nadia N Hansel¹⁷, Robert A Wise¹⁷, Todd T Brown¹⁸, M Bradley Drummond³; SPIROMICS Investigators

Collaborators, Affiliations

Collaborators

SPIROMICS Investigators:
Neil E Alexis, Wayne H Anderson, Mehrdad Arjomandi, Igor Barjaktarevic, R Graham Barr, Lori A Bateman, Surya P Bhatt, Eugene R Bleecker, Richard C Boucher, Russell P Bowler, Stephanie A Christenson, Alejandro P Comellas, Christopher B Cooper, David J Couper, Gerard J Criner, Ronald G Crystal, Jeffrey L Curtis, Claire M Doerschuk, Mark T Dransfield, Brad Drummond, Christine M Freeman, Craig Galban, MeiLan K Han, Nadia N Hansel, Annette T Hastie, Eric A Hoffman, Yvonne Huang, Robert J Kaner, Richard E Kanner, Eric C Kleerup, Jerry A Krishnan, Lisa M LaVange, Stephen C Lazarus, Fernando J Martinez, Deborah A Meyers, Wendy C Moore, John D Newell Jr, Robert Paine 3rd, Laura Paulin, Stephen P Peters, Cheryl Pirozzi, Nirupama Putcha, Elizabeth C Oelsner, Wanda K O'Neal, Victor E Ortega, Sanjeev Raman, Stephen I Rennard, Donald P Tashkin, J Michael Wells, Robert A Wise, Prescott G Woodruff, Lisa Postow, Lisa Viviano

Affiliations

¹ Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC. Electronic address: robert.burkes@unchealth.unc.edu.
² Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC.
³ Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC; Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC.
⁴ University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC.
⁵ Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, IA.
⁶ Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa Carver College of Medicine, Iowa City, IA.
⁷ Department of Epidemiology, Columbia University, New York, NY.
⁸ Division of Pulmonary, Critical Care, Sleep, and Allergy Medicine, University of Illinois at Chicago, Chicago, IL.
⁹ Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA.
¹⁰ Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI.
¹¹ Section of Pulmonary, Critical Care, Allergy, and Immunologic Disease, Wake Forest University, Winston-Salem, NC.
¹² Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL.
¹³ Division of Thoracic Medicine and Surgery, Temple University, Philadelphia, PA.
¹⁴ Division of Pulmonary Critical Care, Allergy, and Sleep Medicine, University of California, San Francisco, San Francisco, CA.
¹⁵ Division of Pulmonary, Critical Care, and Sleep Medicine, National Jewish Health, Denver, CO.
¹⁶ Division of Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, UT.
¹⁷ Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD.
¹⁸ Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University, Baltimore, MD.

PMID: 31958447
PMCID: PMC7118244
DOI: 10.1016/j.chest.2019.11.047

Observational Study

Associations Among 25-Hydroxyvitamin D Levels, Lung Function, and Exacerbation Outcomes in COPD: An Analysis of the SPIROMICS Cohort

Robert M Burkes et al. Chest. 2020 Apr.

. 2020 Apr;157(4):856-865.

doi: 10.1016/j.chest.2019.11.047. Epub 2020 Jan 17.

Authors

Collaborators

SPIROMICS Investigators:
Neil E Alexis, Wayne H Anderson, Mehrdad Arjomandi, Igor Barjaktarevic, R Graham Barr, Lori A Bateman, Surya P Bhatt, Eugene R Bleecker, Richard C Boucher, Russell P Bowler, Stephanie A Christenson, Alejandro P Comellas, Christopher B Cooper, David J Couper, Gerard J Criner, Ronald G Crystal, Jeffrey L Curtis, Claire M Doerschuk, Mark T Dransfield, Brad Drummond, Christine M Freeman, Craig Galban, MeiLan K Han, Nadia N Hansel, Annette T Hastie, Eric A Hoffman, Yvonne Huang, Robert J Kaner, Richard E Kanner, Eric C Kleerup, Jerry A Krishnan, Lisa M LaVange, Stephen C Lazarus, Fernando J Martinez, Deborah A Meyers, Wendy C Moore, John D Newell Jr, Robert Paine 3rd, Laura Paulin, Stephen P Peters, Cheryl Pirozzi, Nirupama Putcha, Elizabeth C Oelsner, Wanda K O'Neal, Victor E Ortega, Sanjeev Raman, Stephen I Rennard, Donald P Tashkin, J Michael Wells, Robert A Wise, Prescott G Woodruff, Lisa Postow, Lisa Viviano

Affiliations

¹ Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC. Electronic address: robert.burkes@unchealth.unc.edu.
² Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC.
³ Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC; Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC.
⁴ University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC.
⁵ Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, IA.
⁶ Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa Carver College of Medicine, Iowa City, IA.
⁷ Department of Epidemiology, Columbia University, New York, NY.
⁸ Division of Pulmonary, Critical Care, Sleep, and Allergy Medicine, University of Illinois at Chicago, Chicago, IL.
⁹ Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA.
¹⁰ Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI.
¹¹ Section of Pulmonary, Critical Care, Allergy, and Immunologic Disease, Wake Forest University, Winston-Salem, NC.
¹² Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL.
¹³ Division of Thoracic Medicine and Surgery, Temple University, Philadelphia, PA.
¹⁴ Division of Pulmonary Critical Care, Allergy, and Sleep Medicine, University of California, San Francisco, San Francisco, CA.
¹⁵ Division of Pulmonary, Critical Care, and Sleep Medicine, National Jewish Health, Denver, CO.
¹⁶ Division of Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, UT.
¹⁷ Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD.
¹⁸ Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University, Baltimore, MD.

PMID: 31958447
PMCID: PMC7118244
DOI: 10.1016/j.chest.2019.11.047

Abstract

Background: The relationship between 25-hydroxyvitamin D (25-OH-vitamin D) and COPD outcomes remains unclear. Using the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS), we determined associations among baseline 25-OH-vitamin D and cross-sectional and longitudinal lung function and COPD exacerbations.

Methods: Serum 25-OH-vitamin D level was measured in stored samples from 1,609 SPIROMICS participants with COPD. 25-OH-vitamin D levels were modeled continuously and dichotomized as deficient (< 20 ng/mL) vs not deficient (≥ 20 ng/mL). Outcomes of interest included % predicted FEV₁ (current and 1-year longitudinal decline) and COPD exacerbations (separately any and severe, occurring in prior year and first year of follow-up).

Results: Vitamin D deficiency was present in 21% of the cohort and was more prevalent in the younger, active smokers, and blacks. Vitamin D deficiency was independently associated with lower % predicted FEV₁ (by 4.11%) at enrollment (95% CI, -6.90% to -1.34% predicted FEV₁; P = .004), 1.27% predicted greater rate of FEV₁ decline after 1 year (95% CI, -2.32% to -0.22% predicted/y; P = .02), and higher odds of any COPD exacerbation in the prior year (OR, 1.32; 95% CI, 1.00-1.74; P = .049). Each 10-ng/mL decrease in 25-OH-vitamin D was associated with lower baseline lung function (-1.04% predicted; 95% CI, -1.96% to -0.12% predicted; P = .03) and increased odds of any exacerbation in the year before enrollment (OR, 1.11; 95% CI, 1.01-1.22; P = .04).

Conclusions: Vitamin D deficiency is associated with worse cross-sectional and longitudinal lung function and increased odds of prior COPD exacerbations. These findings identify 25-OH-vitamin D levels as a potentially useful marker of adverse COPD-related outcomes.

Keywords: COPD; COPD epidemiology; COPD exacerbations; lung function; vitamin D.

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Figures

**Figure 1**
CONSORT diagram showing selection of analytical cohort. 25-OH-vitamin D = 25-hydroxyvitamin D; CONSORT = Consolidated Standards of Reporting Trials; SPIROMICS = Subpopulations and Intermediate Outcome Measures in COPD Study.

**Figure 2**
Distribution of vitamin D levels in the SPIROMICS cohort, stratified by GOLD FEV₁ stage. GOLD = Global Initiative for Chronic Obstructive Lung Disease. See Figure 1 caption for expansion of other abbreviation.

See this image and copyright information in PMC

Comment in

Vitamin D Deficiency in COPD: Biomarker, Treatable Trait, or Just a Common Comorbidity?
Milne S, Sin DD. Milne S, et al. Chest. 2020 Apr;157(4):755-756. doi: 10.1016/j.chest.2019.12.007. Chest. 2020. PMID: 32252921 No abstract available.

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Associations Among 25-Hydroxyvitamin D Levels, Lung Function, and Exacerbation Outcomes in COPD: An Analysis of the SPIROMICS Cohort

Collaborators

Affiliations

Associations Among 25-Hydroxyvitamin D Levels, Lung Function, and Exacerbation Outcomes in COPD: An Analysis of the SPIROMICS Cohort

Authors

Collaborators

Affiliations

Abstract

Figures

Comment in

References

Publication types

MeSH terms

Substances

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Molecular Biology Databases