Vitamin D has an immunomodulatory role. the aim of the present study is to assess the effect of vitamin D supplementation on exacerbation rate of COPD patient with a vitamin D deficiency.
Rationale: Although vitamin D is well known for its function in calcium homeostasis and bone mineralisation, several studies have shown immunomodulatory effects of vitamin D. Vitamin D deficiency is a common problem in patients with COPD.. Objective: To assess the effect of vitamin D supplementation on exacerbation rate in patients with COPD and a vitamin D deficiency. Study design: Randomized, multi-center, double-blind, placebo-controlled intervention study. Study population: 240 patients aged 40 years and older with COPD and a vitamin D deficiency (25-hydroxyvitamin D concentration(25OHD)\<50 nmol/l) with a COPD exacerbation. An exacerbation is defined as sustained worsening of respiratory symptoms during 48 hours and requiring oral corticosteroid, antibiotic or combination treatment that was initiated by a physician. Respiratory symptoms include at least one of the Anthonisen criteria (increased dyspnoea, sputum volume or purulence). Patients with a severe vitamin D deficiency (25OHD\<15 nmol/l), known osteoporosis and/or use of vitamin D supplementation \> 400 IU per day will be excluded. Intervention: Participants will be randomly allocated to receive vitamin D3 16800 IU or placebo orally once a week during 1 year. Main study parameters/endpoints: The primary endpoint is exacerbation rate. Follow-up of the study: Recruitment of participants is more troublesome than expected due to several reasons, more use of vitamin D supplements, higher 250hydroxyvitamin D levels than anticipated, less suitability due to presence other exclusion criteria. 29/8/2017 total number recruited participants is 119 10/7/2018 closure of recruitment, total number recruited participants is 158
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
158
Leiden University Medical Center
Leiden, Netherlands
Radboud University Medical Center
Nijmegen, Netherlands
Exacerbation rate
Definition of an exacerbation is according to the Anthonisen criteria
Time frame: 1 year
Time to first and second exacerbation
Time to first and second exacerbation
Time frame: 1 year
Time to first hospitalisation
Time to first hospitalisation
Time frame: 1 year
FEV1
Forced Expiratory Volume in 1 sec
Time frame: 1 year
IC
Inspiratory capacity
Time frame: 1 year
FEV1/FVC
Forced expiratory volume in 1 sec/ forced vital capacity
Time frame: 1 year
FRC
Functional residual capacity
Time frame: 1 year
RV
Residual volume
Time frame: 1 year
TLC
Total lung capacity
Time frame: 1 year
MIP
Maximal inspiratory pressure
Time frame: 1 year
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MEP
Maximal expiratory pressure
Time frame: 1 year
SMWT
Six-minute walk test
Time frame: 1 year
Chair stand test
Chair stand test
Time frame: 1 year
3-meter walking test
3-meter walking test
Time frame: 1 year
Tandem stand test
Tandem stand test
Time frame: 1 year
Total score physical function tests
The sum score of the physical function tests
Time frame: 1 year
Hand grip strength
Hand grip strength
Time frame: 1 year
Quality of life (SGRQ)
QoL by the St George respiratory questionnaire
Time frame: 1 year
Quality of life (SF12)
QoL by the 12 item short form survey
Time frame: 1 year
Anxiety (HADS)
Anxiety by the hospital anxiety and depression scale
Time frame: 1 year
Depression (CESD)
Depression by the center for epidemiologic studies depression scale
Time frame: 1 year
Quality of life (CCQ)
QoL by the Clinical COPD Questionnaire score
Time frame: 1 year
Concentrations of antimicrobial peptides and pro-inflammatory mediators in nasal secretions
AMPs in nasal secretions
Time frame: 1 year
Ex-vivo cytokine production capacity of peripheral blood mononuclear cells and immunophenotyping
cytokine production capacity by PBMCs
Time frame: 1 year
Typing of bacteria and viruses in nasal secretions
Typing of bacteria and viruses in nasal secretions
Time frame: 1 year
Use of corticosteroids
Use of corticosteroids
Time frame: 1 year
Use of antibiotics
Use of antibiotics
Time frame: 1 year
Physical activity (SQUASH)
physical activity by short questionnaire to assess health-enhancing physical activity
Time frame: 1 year