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

Abstract

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. 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 (< 20ng/mL) vsnot deficient (≥ 20ng/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). 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). 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.