Vitamin D Beyond Bones in Chronic Obstructive Pulmonary Disease: Time to Act

• Published in: American journal of respiratory and critical care medicine 2009-04, Vol.179 (8), p.630-636
• Main Authors: Janssens, Wim, Lehouck, An, Carremans, Claudia, Bouillon, Roger, Mathieu, Chantal, Decramer, Marc
• Format: Article
• Language: English
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anti-Inflammatory Agents - administration & dosage; Biological and medical sciences; Bone and Bones - drug effects; Bone and Bones - metabolism; Cardiovascular disease; Chronic illnesses; Chronic obstructive pulmonary disease; Chronic obstructive pulmonary disease, asthma; Clinical trials; Comorbidity; Dietary Supplements; Drug dosages; Enzymes; Fractures; Genomes; Homeostasis; Humans; Immunity - drug effects; Intensive care medicine; Medical sciences; Metabolism; Metabolites; Osteoporosis; Pneumology; Pulmonary Disease, Chronic Obstructive - blood; Pulmonary Disease, Chronic Obstructive - drug therapy; Pulmonary Disease, Chronic Obstructive - immunology; Pulmonary Disease, Chronic Obstructive - pathology; Rickets; Skin; Vitamin D; Vitamin D - administration & dosage; Vitamin D - analogs & derivatives; Vitamin D - blood; Vitamin D Deficiency - blood; Vitamin D Deficiency - drug therapy; Vitamin D Deficiency - immunology; Vitamin D Deficiency - pathology; Vitamin deficiency; Vitamins - administration & dosage
• ISSN: 1073-449X; 1535-4970
• DOI: 10.1164/rccm.200810-1576PP

The discovery that the vitamin D endocrine system regulates a very large number of genes and their associated biological processes improves our insight into the fundamental role of vitamin D and sun exposure for human health. Accumulating epidemiological data are linking a low vitamin D nutritional status to highly prevalent diseases such as cancer, autoimmune diseases, and chronic infections. Approximately half of the world's elderly, and to a lesser extent the adult population, have insufficient to deficient 25-hydroxyvitamin D (25-OHD) serum levels, and several intervention studies are being undertaken to study the impact of adequate vitamin D supplementation in chronic diseases. In this perspective we claim that chronic obstructive pulmonary disease (COPD) is a candidate disease for which vitamin D supplementation might be beneficial. Epidemiological studies revealed a dose-dependent association between serum 25-OHD levels and pulmonary function so that adequate vitamin D supplementation may extend beyond its protection against osteoporotic fractures. In line with the novel insights on its immune function, it is tempting to speculate that vitamin D may down-regulate the inflammatory immune response in the airways while boosting innate immune defense against different microorganisms. Apart from its affects on osteoporosis, vitamin D may also interfere with other comorbidities of COPD such as skeletal muscle weakness, cardiovascular disease, and cancer. Because respiratory treatments in COPD fail to reverse disease progression, interventional trials that may exploit the broader potential of vitamin D are warranted. A further challenge of such studies is to define optimal serum 25-OHD levels for such noncalcemic endpoints.