COPD and low plasma vitamin D levels: Correlation or causality?

Luca Gallelli*, Erika Cione, Stefania Zampogna and Gino Scalone

Published: 27 October, 2018 | Volume 2 - Issue 1 | Pages: 011-012

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death and its prevalence and incidence is also related to smoking behavior [1]. COPD is still a chronic inflammatory and progressive disease caused by multifactorial agents including environmental pollutants [2]. Besides that, it is emerging that endogenous epigenetic factors induced by lifestyle and environment [3] could play a role in the etiopathogenesis of the disease [4].

In the last years, several authors suggested that low vitamin D levels seem to be related with the increase of COPD manifestations [5]. Moreover, a multicentre, double-blind, randomised controlled trial documented that vitamin D supplementation protects against moderate or severe exacerbation of the disease, but not by upper respiratory infections [6]. However, low levels of vitamin D can be extended to many other diseases, including multiple sclerosis, diabetes, colon rectal cancer, headache or drug use [7-11]. Moreover, it is also important to remember that Vitamin D deficiency is common in high latitude regions, such as northern Europe, New Zealand, northern USA, and Canada where weaker ultraviolet B rays is not able to produce enough vitamin D. Finally, methodological factors (using low sensitivity methods) could contribute to misleading evaluation of circulating vitamin D levels. In any case, here we shall remind that vitamin D has a fundamental role in immunity [12]. In particular, it has been reported that vitamin D is able to shift the pro-inflammatory T-helper cell 1 to anti-inflammatory T-helper cell 2 [13]. Therefore, benefits of vitamin D supplementation in chronic diseases which directly or indirectly affect immune system are obvious. Today, the burden of COPD in never smokers is higher than previously believed. Therefore, more research is needed to unravel the characteristics of non-smokers COPD [1]. Notably, vitamin D levels are reported to be significantly lower in smoker’ssubjects than in non-smokers ones [14]. Therefore, low plasma vitamin D levels in COPD seems to be more a causality than a correlation.

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  1. Terzikhan N, Verhamme KM, Hofman A, Stricker BH, Brusselle GG, et al. Prevalence and incidence of COPD in smokers and non-smokers: the Rotterdam Study. European journal of epidemiology. 2016; 31: 785-792. Ref.: https://goo.gl/4cW5ku
  2. Punturieri A, Szabo E, Croxton TL, Shapiro SD, Dubinett SM. Lung cancer and chronic obstructive pulmonary disease: needs and opportunities for integrated research. Journal of the National Cancer Institute. 2009; 101: 554-559. Ref.: https://goo.gl/c5qK3w
  3. Cione E, Gallelli L. Direct Detection of Circulating MicroRNAs Unveiled the Absence of MicroRNA-218-5p in Smoker Subjects. American journal of respiratory and critical care medicine. 2017; 196: 532. Ref.: https://goo.gl/jQNNdy
  4. Sauler M, Lamontagne M, Finnemore E, Herazo-Maya JD, Tedrow J, Zhang X, et al. The DNA repair transcriptome in severe COPD. The European respiratory journal. 2018; 52. Ref.: https://goo.gl/9DV2gP
  5. Romme EA, Rutten EP, Smeenk FW, Spruit MA, Menheere PP, et al. Vitamin D status is associated with bone mineral density and functional exercise capacity in patients with chronic obstructive pulmonary disease. Annals of medicine. 2013; 45: 91-96. Ref.: https://goo.gl/nzBDpE
  6. Martineau AR, James WY, Hooper RL, Barnes NC, Jolliffe DA, et al. Vitamin D3 supplementation in patients with chronic obstructive pulmonary disease (ViDiCO): a multicentre, double-blind, randomised controlled trial. The Lancet Respiratory medicine. 2015; 3: 120-130. Ref.: https://goo.gl/cMrz5t
  7. Torkildsen O, Knappskog PM, Nyland HI, Myhr KM. Vitamin D-dependent rickets as a possible risk factor for multiple sclerosis. Archives of neurology. 2008; 65: 809-811. Ref.: https://goo.gl/6GpjLh
  8. Afzal S, Bojesen SE, Nordestgaard BG. Low 25-hydroxyvitamin D and risk of type 2 diabetes: a prospective cohort study and metaanalysis. Clin Chem. 2013; 59: 381-391. Ref.: https://goo.gl/7QNjbv
  9. Lee JE, Li H, Chan AT, Hollis BW, Lee IM, et al. Circulating levels of vitamin D and colon and rectal cancer: the Physicians' Health Study and a meta-analysis of prospective studies. Cancer Prev Res (Phila). 2011; 4: 735-743. Ref.: https://goo.gl/2yoAXJ
  10. Iannacchero R, Costa A, Squillace A, Gallelli L, Cannistra U, et al. P060. Vitamin D deficiency in episodic migraine, chronic migraine and medication-overuse headache patients. J Headache Pain. 2015; 16 (Suppl 1): A184. Ref.: https://goo.gl/m2s568
  11. Siniscalchi A, De Arro G, Michniewicz A, Gallelli L. Conventional and New Antiepileptic Drugs on Vitamin D and Bone Health: What We Know to Date? Curr Clin Pharmacol. 2016; 11: 69-70. Ref.: https://goo.gl/EjxsDh
  12. Heulens N, Korf H, Janssens W. Innate immune modulation in chronic obstructive pulmonary disease: moving closer toward vitamin D therapy. J Pharmacol Exp Ther. 2015; 353: 360-368. Ref.: https://goo.gl/veWLP5
  13. Cantorna MT, Humpal-Winter J, DeLuca HF. In vivo upregulation of interleukin-4 is one mechanism underlying the immunoregulatory effects of 1,25-dihydroxyvitamin D(3). Archives of biochemistry and biophysics. 2000; 377: 135-138. Ref.: https://goo.gl/CzMXdu
  14. Ren W, Gu Y, Zhu L, Wang L, Chang Y, et al. The effect of cigarette smoking on vitamin D level and depression in male patients with acute ischemic stroke. Comprehensive psychiatry. 2016; 65: 9-14. Ref.: https://goo.gl/nCS2Fg

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