Comparison of the association between circulating vitamin D₃ levels and clinical outcomes in patients with asthma and chronic obstructive pulmonary disease: a prospective observational study

Abstract

Vitamin D has an immune-modulating effect, related to the pathophysiology of asthma and chronic obstructive pulmonary disease (COPD). However, few studies have focused on the difference between patients with asthma and COPD in the association of circulating vitamin D levels with clinical outcomes. We sought to investigate the associations of circulating vitamin D levels with health-related quality of life (HR-QOL), severity, and exacerbations. Subjects included 152 asthma patients and 50 COPD patients. We measured plasma concentrations of 25-hydroxyvitamin D₃ [25(OH)D₃]. HR-QOL was assessed using the EuroQoL 5-Dimension (EQ-5D) and the 12-item Short Form Health Survey (SF-12) scales. Exacerbations were recorded during a one-year follow-up. Associations between plasma 25 (OH)D₃ concentrations and outcome variables were evaluated using linear regression. Plasma concentrations of 25(OH)D₃ were positively associated with the EQ-5D index value and the SF-12 physical component score in patients with asthma; however, such associations were not observed in patients with COPD. A significant association between severity and plasma concentrations of 25(OH)D₃ was found only in patients with COPD. The hazard ratios (95% confidence interval) of plasma 25(OH)D₃ concentrations (per 1 ng/mL decrease) for time to first exacerbation was 1.38 (1.10–1.75; p = 0.006) and 0.95 (0.87–1.03; p = 0.179) in patients with COPD and asthma, respectively. Lower concentrations of plasma 25(OH)D₃ contributed to lower HR-QOL in patients with asthma, and were associated with severity and risk of future exacerbations in patients with COPD.