Vitamin D 3  supplementation in adults with bronchiectasis: A pilot study

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Abstract

Vitamin D supplementation prevents acute respiratory infections and, through modulating innate and adaptive immunity, could have a potential role in bronchiectasis management. The primary aims of this pilot study were to assess serum 25-hydroxyvitamin D (25(OH)D) levels in New Zealand adults with bronchiectasis, and their 25(OH)D levels after vitamin D ₃ supplementation. Adults with bronchiectasis received an initial 2.5 mg vitamin D ₃ oral loading dose and 0.625 mg vitamin D ₃ weekly for 24 weeks. The primary outcome was serum 25(OH)D levels before and after vitamin D ₃ supplementation. Secondary outcomes (time to first infective exacerbation, exacerbation frequency, spirometry, health-related quality of life measures, sputum bacteriology and cell counts and chronic rhinosinusitis) were also assessed. This study is registered with the Australian New Zealand Clinical Trials Registry (ACTRN 12612001222831). The initial, average 25(OH)D level was 71 nmol/L (95% confidence interval (CI): [58, 84]), rising to 218 nmol/L (95% CI: [199, 237]) at 12 weeks and 205 nmol/L (95% CI: [186, 224]) at 24 weeks. The initial serum cathelicidin level was 25 nmol/L (95% CI: [17, 33]), rising to 102 nmol/L (95% CI: [48, 156]) at 12 weeks and 151 nmol/L (95% CI: [97, 205]) at 24 weeks. Over the 24-week study period, we observed statistically significant changes of 1.11 (95% CI: [0.08, 2.14]) in the Leicester Cough Questionnaire and −1.97 (95% CI: [−3.71, −0.23]) in the Dartmouth COOP charts score. No significant adverse effects were recorded. Many New Zealand adults with bronchiectasis have adequate 25(OH)D levels. Weekly vitamin D ₃ supplementation significantly improved 25(OH)D levels.

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EPOS 2012: European position paper on rhinosinusitis and nasal polyps 2012. A summary for otorhinolaryngologists

W.J. Fokkens, V.J. Lund, J Mullol … (2012)

The European Position Paper on Rhinosinusitis and Nasal Polyps 2012 is the update of similar evidence based position papers published in 2005 and 2007. The document contains chapters on definitions and classification, we now also proposed definitions for difficult to treat rhinosinusitis, control of disease and better definitions for rhinosinusitis in children. More emphasis is placed on the diagnosis and treatment of acute rhinosinusitis. Throughout the document the terms chronic rhinosinusitis without nasal polyps (CRSsNP) and chronic rhinosinusitis with nasal polyps (CRSwNP) are used to further point out differences in pathophysiology and treatment of these two entities. There are extensive chapters on epidemiology and predisposing factors, inflammatory mechanisms, (differential) diagnosis of facial pain, genetics, cystic fibrosis, aspirin exacerbated respiratory disease, immunodeficiencies, allergic fungal rhinosinusitis and the relationship between upper and lower airways. The chapters on paediatric acute and chronic rhinosinusitis are totally rewritten. Last but not least all available evidence for management of acute rhinosinusitis and chronic rhinosinusitis with or without nasal polyps in adults and children is analyzed and presented and management schemes based on the evidence are proposed. This executive summary for otorhinolaryngologists focuses on the most important changes and issues for otorhinolaryngologists. The full document can be downloaded for free on the website of this journal: http://www.rhinologyjournal.com.

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Vitamin D and Respiratory Tract Infections: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Peter Bergman, Åsa U. Lindh, Linda Björkhem-Bergman … (2013)

Background Low levels of 25-OH vitamin D are associated with respiratory tract infection (RTI). However, results from randomized controlled trials are inconclusive. Therefore, we performed a systematic review and meta-analysis to assess the preventive effect of vitamin D supplementation on RTI. Methods Randomized, controlled trials of vitamin D for prevention of RTI were used for the analysis. The risks of within-trial and publication bias were assessed. Odds ratios of RTI were pooled using a random-effects model. Heterogeneity was assessed using Cochran's Q and I2. Meta-regressions and subgroup analyses were used to assess the influence of various factors on trial outcome. The pre-defined review protocol was registered at the PROSPERO international prospective register of systematic reviews, registration number CRD42013003530. Findings Of 1137 citations retrieved, 11 placebo-controlled studies of 5660 patients were included in the meta-analysis. Overall, vitamin D showed a protective effect against RTI (OR, 0.64; 95% CI, 0.49 to 0.84). There was significant heterogeneity among studies (Cohran's Q p<0.0001, I2 = 72%). The protective effect was larger in studies using once-daily dosing compared to bolus doses (OR = 0.51 vs OR = 0.86, p = 0.01). There was some evidence that results may have been influenced by publication bias. Interpretation Results indicate that vitamin D has a protective effect against RTI, and dosing once-daily seems most effective. Due to heterogeneity of included studies and possible publication bias in the field, these results should be interpreted with caution.

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Relationship between serum 25-hydroxyvitamin d and pulmonary function in the third national health and nutrition examination survey.

Peter Black, Robert Scragg (2005)

Age, gender, height, ethnicity, and smoking are important determinants of lung function but do not explain all of the variation between individuals. Low concentrations of vitamin D have been associated with a number of diseases, including osteoporosis, hypertension, and type I diabetes. It is possible that serum concentrations of vitamin D might also influence pulmonary function. To determine the relationship between serum concentrations of 25-hydroxy vitamin D and pulmonary function. The analysis was conducted using data from the Third National Health and Nutrition Examination Survey, which was a cross-sectional survey of the US civilian population that was conducted from 1988 to 1994. The analyses were restricted to 14,091 people who > or = 20 years of age, were interviewed at mobile examination centers, and had undergone spirometry, and in whom serum 25-hydroxy vitamin D levels had been measured. After adjustment for age, gender, height, body mass index, ethnicity, and smoking history, the mean FEV1 was 126 mL (SE, 22 mL), and the mean FVC was 172 mL (SE, 26 mL) greater for the highest quintile of serum 25-hydroxy vitamin D level (> or = 85.7 nmol/L) compared with the lowest quintile (< or = 40.4 nmol/L; p < 0.0001). With further adjustment for physical activity, the intake of vitamin D supplements, milk intake, and the level of serum antioxidants, the mean difference between the highest and lowest quintiles of 25-hydroxy vitamin D was 106 mL (SE, 24 mL) for FEV1, and 142 mL (SE, 29 mL) for FVC (p < 0.0001). There is a strong relationship between serum concentrations of 25-hydroxy vitamin D, FEV1, and FVC. Further studies are necessary to determine whether supplementation with vitamin D is of any benefit in patients with respiratory disease.

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Author and article information

Journal

Journal ID (nlm-ta): Chron Respir Dis

Journal ID (iso-abbrev): Chron Respir Dis

Journal ID (publisher-id): CRD

Journal ID (hwp): spcrd

Title: Chronic Respiratory Disease

Publisher: SAGE Publications (Sage UK: London, England )

ISSN (Print): 1479-9723

ISSN (Electronic): 1479-9731

Publication date (Electronic): 28 February 2018

Publication date (Print): November 2018

Volume: 15

Issue: 4

Pages: 384-392

Affiliations

[1 ]Department of Surgery, The University of Auckland, Auckland, New Zealand

[2 ]Department of Respiratory Medicine, Middlemore Hospital, Auckland, New Zealand

[3 ]Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA

[4 ]School of Population Health, The University of Auckland, Auckland, New Zealand

[5 ]Department of Biostatistics and Epidemiology, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand

[6 ]Ko Awatea, Counties Manukau District Health Board, Auckland, New Zealand

[7 ]Department of Radiology, Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand

[8 ]Middlemore Clinical Trials Unit, Middlemore Hospital, Auckland, New Zealand

[9 ]Faculty of Science and Engineering, University of Waikato, Hamilton, New Zealand

Author notes

[*]Jim Bartley, Department of Surgery, The University of Auckland, 10 Owens Road, Epsom, Auckland 1023, New Zealand. Email: jimbartley56@ 123456gmail.com

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Carlos A Camargo Jr http://orcid.org/0000-0002-5071-7654

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Publisher ID: 10.1177_1479972318761646

DOI: 10.1177/1479972318761646

PMC ID: 6234573

PubMed ID: 29490469

SO-VID: 5d713c92-7b04-4bc1-96fe-35e28839c8e5

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This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

History

Date received : 11 September 2017

Date accepted : 24 January 2018

Funding

Funded by: The Health Research Council of New Zealand;

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Vitamin D ₃ supplementation in adults with bronchiectasis: A pilot study

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Most cited references 26

EPOS 2012: European position paper on rhinosinusitis and nasal polyps 2012. A summary for otorhinolaryngologists

Vitamin D and Respiratory Tract Infections: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Relationship between serum 25-hydroxyvitamin d and pulmonary function in the third national health and nutrition examination survey.

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