Vitamin D Deficiency Prevalent in Chronic Lung Patients

According to a recent study published in Thorax, a leading respiratory medicine journal, vitamin D deficiency is a frequent occurrence in chronic obstructive pulmonary disease (COPD) patients and has been found to correlate directly to the severity of the disease. With more than half of COPD and emphysema patients developing a vitamin D deficiency during their lifetime, understanding the importance of vitamin D and how to overcome this deficiency is an important step in managing the disease.

The Role of Vitamin D in Chronic Lung Disease

According to the U.S. Department of Health and Human Services, vitamin D is essential for the “formation, growth, and repair of bones and for normal calcium absorption and immune function.” However, for patients with chronic lung diseases, this important vitamin is thought to play a key role in preventing the loss of lung function over time.

“While there are still a lot of studies that need to be done on vitamin D and the lungs, it is thought that in patients with advanced disease the vitamin helps prevent the decline in lung function over time,” said Samuel A. Allen, D.O., pulmonologist, critical care specialist and director of the Pulmonary Hypertension Center at Beaumont Hospital in Troy, Michigan. “Vitamin D can also help people recover from infections. So patients with good levels of vitamin D will probably recover from an infection better than those dealing with a deficiency.”

In addition, low levels of vitamin D can result in osteoporosis and osteomalacia (softening of the bones), as vitamin D plays a critical role in calcium absorption, which is key to building strong bones.

The Cause of Vitamin D Deficiency

The cause of vitamin D deficiency in patients with chronic lung diseases is twofold. First, because eating requires a great deal of energy for people living with COPD and emphysema, many individuals do not consume enough foods that are rich in vitamin D.

“Because eating can often be physically exhausting, many people living with chronic lung conditions do not eat three meals a day,” said Dr. Allen. “In addition, most patients tend to eat foods that have a high volume of fat and protein because that is what their body needs as their condition worsens. However, these meals usually do not contain a good amount of vitamin D.”

Second, because patients with severe respiratory issues do not regularly participate in outdoor activities, they are not receiving the sunlight they need to absorb adequate amounts of vitamin D. These deficiencies are further complicated by the chronic steroid use included in many individual’s treatment plans.

“When taken in high doses over an extended period of time, steroids can inhibit the absorption of vitamin D and calcium in the intestines,” said Dr. Allen. “So the vitamin D that patients are able to take in through their diet and sunlight is impaired because they are chronically on steroids.”

Increasing Vitamin D Intake

To increase their intake of vitamin D, patients with chronic lung diseases can do a number of things, including adding vitamin D3 supplements to their daily regimen.

“I tell my patients first and foremost to take vitamin D3 supplements, rather than plain vitamin D or vitamin D with calcium. This seems to work better than others because vitamin D3 provides both the dietary and sunlight-activated vitamins in one supplement,” said Dr. Allen. “For all practical purposes, patients should be taking 1,000 IUs (international units] of vitamin D3 a day.”

In addition, individuals should get 20 to 30 minutes of sunlight each day, if possible. Eating five or six small meals a day rather than three large meals is also recommended, as eating smaller portions requires much less energy. These meals should also include foods that are rich in vitamin D, such as swordfish, tuna, sake salmon, and cod liver oil.

“I tell my patients to have sake salmon or tuna at least once a week. Then for breakfast, my recommendation would be to drink eight ounces of vitamin D-fortified orange juice and a yogurt that is also fortified with vitamin D,” said Dr. Allen. “However, the biggest thing patients can do is stop smoking, because smoking impairs vitamin D absorption, accelerates lung conditions and has been known to cause issues with bone loss.”

Note: Because exceeding dietary recommendations can result in vitamin D toxicity, it is important to speak with your physician before making these changes to your treatment plan.