Age-Dependent Associations Between 25-Hydroxy Vitamin D Levels and COPD Symptoms: Analysis of SPIROMICS

Abstract

Introduction: Age and vitamin D levels may affect symptom burden in chronic obstructive pulmonary disease (COPD). We used the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS) to determine independent associations between vitamin D levels and COPD symptoms in different age strata.

Methods: Serum 25-hydroxy (OH)-vitamin D levels were modeled continuously and categorically (<20 ng/ml versus ≥20 ng/ml). Stratifying by age group (middle-age: 40-64 years old and older: >65 years old), multivariable modeling was performed to identify relationships between 25-OH-vitamin D levels and the COPD Assessment Test (CAT), the modified Medical Research Council score (mMRC), the St George's Respiratory Questionnaire (SGRQ) total and subdomain scores, the Veterans' Specific Activity Questionnaire, and the 6-minute walk test distance.

Results: InIn the middle-aged group, each 5 ng/ml higher 25-OH-vitamin D level was independently associated with more favorable CAT score (-0.35 [-0.67 to -0.03], P=0.03), total SGRQ (-0.91 [-1.65 to -0.17]; P=0.02), and the SGRQ subdomains (Symptoms:-1.07 [-1.96 to -0.18], P=0.02; Impact: -0.77 [-1.53 to -0.003], P=0.049; Activity: -1.07 [-1.96 to -0.18], P=0.02). These associations persisted after the addition of comorbidity score, reported vitamin D supplementation, outdoor time, or season of blood draw to models. No associations were observed between 25-OH-vitamin D levels and symptom scores in the older age group.

Discussion: When controlled for clinically relevant covariates, higher 25-OH-vitamin D levels are associated with more favorable respiratory-specific symptoms and quality-of-life assessments in middle-age but not older COPD individuals. Study of the role of vitamin D supplementation in the symptom burden of younger COPD patients is needed.

Keywords: COPD; COPD epidemiology; COPD outcomes; COPD symptoms; vitamin D.

Conflict of interest statement

RMB Received Grants from the National Institutes of Health (NIH) during the conduct of this study. DJC received grants from the NIH and the COPD Foundation during the conduct of this study. IZB reports grants from the National Heart, Lung, and Blood Institute (NHLBI) during the conduct of the study; grants and personal fees from Theravance and Mylan, grants from Amgen, personal fees from Astra Zeneca, GlaxoSmithKline, Boehringer Ingelheim, Verona Pharma, and Grifols outside the submitted work. CBC reports grants from the NIH/NHLBI, grants from the Foundation of the NIH, and grants from the COPD Foundation during the conduct of the study; personal fees from PulmonX, NUVAIRA and MGC Diagnostics and other from GlaxoSmithKline, outside the submitted work. MKH reports personal fees from GlaxoSmithKline, AstraZeneca, Boehringer Ingelheim, Mylan, Merck, and Verona, and other from Novartis and Sunovion, outside the submitted work. PGW reports personal fees from Regeneron, Sanofi, Theravance, NGM, Glenmark, Genentech, and Amgen, outside the submitted work. SCL reports grants from the NIH. RP III reports grants from the NHLBI and grants from COPD Foundation, during the conduct of the study; grants from the Department of Veterans Affairs, and personal fees from Partner Therapeutics, outside the submitted work. APC reports grants from the NIH, during the conduct of the study; grants from the NIH, non-financial support from VIDA, and personal fees from GlaxoSmithKline, outside the submitted work. NP reports grants from the NIH. RAW reports grants and personal fees from AstraZeneca / Medimmune / Pearl, grants and personal fees from Boehringer Ingelheim, grants and personal fees from GlaxoSmithKline, personal fees from Contrafect, Roche, Merck, Circassia, Pneuma, Verona, Mylan/Theravance, AbbVie, ChemRx, Propeller Health, Kiniksa, Bristol Myers Squibb, Galderma, and Kinevant and grants from Sanofi-Aventis, outside the submitted work. MBD reports grants from the NIH and the NHLBI during the conduct of the study; personal fees from Boehringer-Ingelheim, GlaxoSmithKline, AstraZeneca, Mylan-Theravance, Parion, Midmark, and Phillips and grants from the Department of Defense outside the submitted work. WWL, TMP, RPB, LRL and TTB have nothing to disclose.

JCOPDF © 2021.

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