Chronic obstructive pulmonary disease
Chronic obstructive pulmonary disease (COPD) is one of the most common lung diseases.
There are two main forms of COPD:
- Chronic bronchitis is identified by a long-term cough with mucus.
- Emphysema is a slow destruction of the lungs over time.
Most people with COPD have a combination of both conditions.
Symptoms include cough with mucus, shortness of breath that worsens with mild activity, fatigue, frequent respiratory infections, and wheezing. Symptoms vary and become worse at times. This is known as flare-ups or acute attacks.
Risk factors for COPD include:
- Gases or fumes in workplaces
- Exposure to secondhand smoke and air pollution
- Cooking over flames without proper ventilation
Sunlight exposure and COPD risk
In Finland, people hospitalized for an acute attack of COPD had higher death rates between December and May. Rates of viral respiratory infections are highest at that time because there is less sunlight.
Ultraviolet-B (UVB) light and vitamin D may reduce the risk of COPD flare-ups. Two studies reported that farmers had lower rates of COPD attacks. However, farmers in general have higher rates of COPD, possibly because they are exposed to more organic matter and chemicals.
Vitamin D and COPD
Vitamin D levels
According to U.S. studies, there is a strong relationship between vitamin D levels and forced air capacity. This includes the total amount of air forced from the lungs after taking the deepest breath possible. It also includes the amount of air forced during the first second of exhalation.
Vitamin D deficiency occurs frequently in COPD. This is shown in a few studies:
- Former smokers in the Netherlands with low levels of vitamin D had more severe COPD. Rates of those with less than 20 ng/ml (50 nmol/l) increased from 30% for ex-smokers with normal lung function to 75% for those with the most advanced COPD.
- In Japan during a six-year study, baseline vitamin D levels did not predict lung function decline. However, vitamin D levels change with time. That may have affected the findings.
How vitamin D works
Vitamin D may protect against COPD flare-ups by:
- Protecting the body against viral and bacterial infections. These infections often trigger COPD attacks.
- Reducing compounds in the body that destroy tissues. This includes matrix metalloprotease-9 (MMP-9). MM-9 may contribute to COPD.
There is little evidence that vitamin D reduces the risk of developing COPD. However, this possibility cannot be ruled out.
Vitamin D and calcium
Those with COPD have an increased risk of osteoporosis. Vitamin D can reduce the risk of osteoporosis. People with COPD should supplement with vitamin D and calcium. Doses of 800 international units (IU) (20 mcg)/day of vitamin D plus calcium have been shown to provide some protection against osteoporosis.
Based on the evidence, vitamin D levels above 30–40 ng/mL (75-–100 nmol/L) may reduce the risk of COPD. To reach these levels, most people need to take 1000–5000 international units (IU) (25–125 mcg)/day of vitamin D3. This is the active form of vitamin D produced under the skin. However, there is considerable variation from person to person. To determine proper dosage, vitamin D blood levels should be measured before and several months after taking vitamin D3 supplements or increasing UVB exposure.
This evidence summary was written by:
William B. Grant, Ph.D.
Sunlight, Nutrition, and Health Research Center (SUNARC)
P.O. Box 641603
San Francisco, CA 94164-1603, USA
Complete bibliography of research used in this summary
The research we have cited in our summary is listed below, with links to PubMed abstracts and full-text for those who wish to explore further.
- Ampikaipakan, S. N. Hughes, D. A. Hughes, J. C. Amen, T. Bentham, G. Wilson, A. M. Vitamin D and COPD: seasonal variation is important. Thorax. 2010 Jun 26;
- Black, P. N. Scragg, R. Relationship between serum 25-hydroxyvitamin d and pulmonary function in the third national health and nutrition examination survey. Chest. 2005 Dec; 128 (6): 3792-8.
- Blair, A. Malker, H. Cantor, K. P. Burmeister, L. Wiklund, K. Cancer among farmers. A review. Scand J Work Environ Health. 1985 Dec; 11 (6): 397-407.
- Blair, A. Sandler, D. P. Tarone, R. Lubin, J. Thomas, K. Hoppin, J. A. Samanic, C. Coble, J. Kamel, F. Knott, C. Dosemeci, M. Zahm, S. H. Lynch, C. F. Rothman, N. Alavanja, M. C. Mortality among participants in the agricultural health study. Ann Epidemiol. 2005 Apr; 15 (4): 279-85.
- Brot, C. Jorgensen, N. R. Sorensen, O. H. The influence of smoking on vitamin D status and calcium metabolism. Eur J Clin Nutr. 1999 Dec; 53 (12): 920-6.
- Brownson, R. C. Reif, J. S. Chang, J. C. Davis, J. R. Cancer risks among Missouri farmers. Cancer. 1989 Dec 1; 64 (11): 2381-6.
- Cannell, J. J. Vieth, R. Umhau, J. C. Holick, M. F. Grant, W. B. Madronich, S. Garland, C. F. Giovannucci, E. Epidemic influenza and vitamin D. Epidemiol Infect. 2006 Dec; 134 (6): 1129-40.
- Cannell, J. J. Zasloff, M. Garland, C. F. Scragg, R. Giovannucci, E. On the epidemiology of influenza. Virol J. 2008; 529.
- Chishimba, L. Thickett, D. R. Stockley, R. A. Wood, A. M. The vitamin D axis in the lung: a key role for vitamin D-binding protein. Thorax. 2010 May; 65 (5): 456-62.
- Coussens, A. Timms, P. M. Boucher, B. J. Venton, T. R. Ashcroft, A. T. Skolimowska, K. H. Newton, S. M. Wilkinson, K. A. Davidson, R. N. Griffiths, C. J. Wilkinson, R. J. Martineau, A. R. 1alpha,25-dihydroxyvitamin D3 inhibits matrix metalloproteinases induced by Mycobacterium tuberculosis infection. Immunology. 2009 Aug; 127 (4): 539-48.
- de Batlle, J. Romieu, I. Anto, J. M. Mendez, M. Rodriguez, E. Balcells, E. Ferrer, A. Gea, J. Rodriguez-Roisin, R. Garcia-Aymerich, J. Dietary habits of firstly admitted Spanish COPD patients. Respir Med. 2009 Dec; 103 (12): 1904-10.
- De Serres, G. Lampron, N. La Forge, J. Rouleau, I. Bourbeau, J. Weiss, K. Barret, B. Boivin, G. Importance of viral and bacterial infections in chronic obstructive pulmonary disease exacerbations. J Clin Virol. 2009 Oct; 46 (2): 129-33.
- Diaz, L. Noyola-Martinez, N. Barrera, D. Hernandez, G. Avila, E. Halhali, A. Larrea, F. Calcitriol inhibits TNF-alpha-induced inflammatory cytokines in human trophoblasts. Journal of reproductive immunology. 2009 Jul; 81 (1): 17-24.
- Donaldson, G. C. Wedzicha, J. A. COPD exacerbations .1: Epidemiology. Thorax. 2006 Feb; 61 (2): 164-8.
- Forli, L. Bjortuft, O. Boe, J. Vitamin D status in relation to nutritional depletion and muscle function in patients with advanced pulmonary disease. Exp Lung Res. 2009 Aug; 35 (6): 524-38.
- Forli, L. Halse, J. Haug, E. Bjortuft, O. Vatn, M. Kofstad, J. Boe, J. Vitamin D deficiency, bone mineral density and weight in patients with advanced pulmonary disease. J Intern Med. 2004 Jul; 256 (1): 56-62.
- Franco, C. B. Paz-Filho, G. Gomes, P. E. Nascimento, V. B. Kulak, C. A. Boguszewski, C. L. Borba, V. Z. Chronic obstructive pulmonary disease is associated with osteoporosis and low levels of vitamin D. Osteoporos Int. 2009 Mar 20;
- Gilbert, C. R. Arum, S. M. Smith, C. M. Vitamin D deficiency and chronic lung disease. Can Respir J. 2009 May-Jun; 16 (3): 75-80.
- Ginde, A. A. Mansbach, J. M. Camargo, C. A., Jr. Association between serum 25-hydroxyvitamin D level and upper respiratory tract infection in the Third National Health and Nutrition Examination Survey. Arch Intern Med. 2009 Feb 23; 169 (4): 384-90.
- Gorse, G. J. O’Connor T, Z. Young, S. L. Habib, M. P. Wittes, J. Neuzil, K. M. Nichol, K. L. Impact of a winter respiratory virus season on patients with COPD and association with influenza vaccination. Chest. 2006 Oct; 130 (4): 1109-16.
- Gorse, G. J. O’Connor, T. Z. Hall, S. L. Vitale, J. N. Nichol, K. L. Human coronavirus and acute respiratory illness in older adults with chronic obstructive pulmonary disease. J Infect Dis. 2009 Mar 15; 199 (6): 847-57.
- Grant, W. B. A possible role for Epstein-Barr virus infection in COPD?. Eur Respir J. 2008 Nov; 32 (5): 1412-3; author reply 1413.
- Hopkinson, N. S. Li, K. W. Kehoe, A. Humphries, S. E. Roughton, M. Moxham, J. Montgomery, H. Polkey, M. I. Vitamin D receptor genotypes influence quadriceps strength in chronic obstructive pulmonary disease. Am J Clin Nutr. 2008 Feb; 87 (2): 385-90.
- Hughes, D. A. Norton, R. Vitamin D and respiratory health. Clin Exp Immunol. 2009 Oct; 158 (1): 20-5.
- Janssens, W. Bouillon, R. Claes, B. Carremans, C. Lehouck, A. Buysschaert, I. Coolen, J. Mathieu, C. Decramer, M. Lambrechts, D. Vitamin D deficiency is highly prevalent in COPD and correlates with variants in the vitamin D-binding gene. Thorax. 2010 Mar; 65 (3): 215-20.
- Janssens, W. Lehouck, A. Carremans, C. Bouillon, R. Mathieu, C. Decramer, M. Vitamin D beyond bones in chronic obstructive pulmonary disease: time to act. Am J Respir Crit Care Med. 2009 Apr 15; 179 (8): 630-6.
- Johnston, N. W. The similarities and differences of epidemic cycles of chronic obstructive pulmonary disease and asthma exacerbations. Proc Am Thorac Soc. 2007 Dec; 4 (8): 591-6.
- Jorde, R. Saleh, F. Figenschau, Y. Kamycheva, E. Haug, E. Sundsfjord, J. Serum parathyroid hormone (PTH) levels in smokers and non-smokers. The fifth Tromsø study. Eur J Endocrinol. 2005 Jan.; 52 (1): 39-45.
- Jorgensen, N. R. Schwarz, P. Holme, I. Henriksen, B. M. Petersen, L. J. Backer, V. The prevalence of osteoporosis in patients with chronic obstructive pulmonary disease: a cross sectional study. Respir Med. 2007 Jan; 101 (1): 177-85.
- Kinnunen, T. Saynajakangas, O. Keistinen, T. Features of hospitalisations for acute exacerbation of COPD resulting in death. Monaldi Arch Chest Dis. 2007 Mar; 67 (1): 10-4.
- Kunisaki, K. M. Niewoehner, D. E. Singh, R. J. Connett, J. E. “Vitamin D Status and Longitudinal Lung Function Decline in the Lung Health Study”. Eur Respir J. 2010 Jul 1;
- Li, Y. Zhang, Z. Xu, Y. Xiong, S. Ni, W. Chen, S. TNF-alpha up-regulates matrix metalloproteinase-9 expression and activity in alveolar macrophages from patients with chronic obstructive pulmonary disease. Journal of Huazhong University of Science and Technology. Medical sciences = Hua zhong ke ji da xue xue bao. Yi xue Ying De wen ban = Huazhong keji daxue xuebao. Yixue Yingdewen ban. 2006; 26 (6): 647-50.
- Lim, S. Roche, N. Oliver, B. G. Mattos, W. Barnes, P. J. Chung, K. F. Balance of matrix metalloprotease-9 and tissue inhibitor of metalloprotease-1 from alveolar macrophages in cigarette smokers. Regulation by interleukin-10. American journal of respiratory and critical care medicine. 2000 Oct; 162 (4 Pt 1): 1355-60.
- Linaker, C. Smedley, J. Respiratory illness in agricultural workers. Occup Med (Lond). 2002 Dec; 52 (8): 451-9.
- Mascitelli, L. Pezzetta, F. Goldstein, M. R. Statins, vitamin D, and COPD. Chest. 2010 Mar; 137 (3): 742-3; author reply 743.
- McManus, T. E. Marley, A. M. Baxter, N. Christie, S. N. Elborn, J. S. O’Neill, H. J. Coyle, P. V. Kidney, J. C. High levels of Epstein-Barr virus in COPD. Eur Respir J. 2008 Jun; 31 (6): 1221-6.
- McManus, T. E. Marley, A. M. Baxter, N. Christie, S. N. O’Neill, H. J. Elborn, J. S. Coyle, P. V. Kidney, J. C. Respiratory viral infection in exacerbations of COPD. Respir Med. 2008 Nov; 102 (11): 1575-80.
- Mercer, P. F. Shute, J. K. Bhowmik, A. Donaldson, G. C. Wedzicha, J. A. Warner, J. A. MMP-9, TIMP-1 and inflammatory cells in sputum from COPD patients during exacerbation. Respir Res. 2005; 6151.
- Moineddin, R. Nie, J. X. Domb, G. Leong, A. M. Upshur, R. E. Seasonality of primary care utilization for respiratory diseases in Ontario: a time-series analysis. BMC Health Serv Res. 2008; 8160.
- Monso, E. Riu, E. Radon, K. Magarolas, R. Danuser, B. Iversen, M. Morera, J. Nowak, D. Chronic obstructive pulmonary disease in never-smoking animal farmers working inside confinement buildings. Am J Ind Med. 2004 Oct; 46 (4): 357-62.
- Plans-Rubio, P. Prevention and control of influenza in persons with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2007; 2 (1): 41-53.
- Pukkala, E. Martinsen, J. I. Lynge, E. Gunnarsdottir, H. K. Sparen, P. Tryggvadottir, L. Weiderpass, E. Kjaerheim, K. Occupation and cancer – follow-up of 15 million people in five Nordic countries. Acta Oncol. 2009; 48 (5): 646-790.
- Quint, J. K. Wedzicha, J. A. Is vitamin D deficiency important in the natural history of COPD?. Thorax. 2010 March; 65 (3): 192-194.
- Robinson, D. S. Regulatory T cells and asthma. Clin Exp Allergy. 2009 Sep; 39 (9): 1314-23.
- Schellenberg, D. Pare, P. D. Weir, T. D. Spinelli, J. J. Walker, B. A. Sandford, A. J. Vitamin D binding protein variants and the risk of COPD. Am J Respir Crit Care Med. 1998 Mar; 157 (3 Pt 1): 957-61.
- Schembri, S. Morant, S. Winter, J. H. MacDonald, T. M. Influenza but not pneumococcal vaccination protects against all-cause mortality in patients with COPD. Thorax. 2009 Jul; 64 (7): 567-72.
- Shen, L. H. Zhang, X. M. Su, D. J. Yao, S. P. Yu, B. Q. Wang, H. W. Lu, F. Z. Association of vitamin D binding protein variants with susceptibility to chronic obstructive pulmonary disease. J Int Med Res. 2010 May-Jun; 38 (3): 1093-8.
- Tuchsen, F. Hannerz, H. Social and occupational differences in chronic obstructive lung disease in Denmark 1981-1993. Am J Ind Med. 2000 Mar; 37 (3): 300-6.
- Urashima, M. Segawa, T. Okazaki, M. Kurihara, M. Wada, Y. Ida, H. Randomized trial of vitamin D supplementation to prevent seasonal influenza A in schoolchildren. Am J Clin Nutr. 2010 May; 91 (5): 1255-60.