Background: Vitamin D deficiency is common among patients with chronic obstructive pulmonary disorder (COPD) and has been associated with increased frequency of exacerbations and higher mortality. Recent Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines recommend assessing the vitamin D status of all patients hospitalized for COPD exacerbations, specifically to identify those with severe vitamin D deficiency, defined as <10 ng/mL, as this population has been shown to benefit the most from receiving supplementation. As of January 1, 2024, Piedmont Columbus Midtown Medical Clinic (MMC) orders vitamin D levels for COPD patients, if not previously obtained while inpatient, and prescribes supplementation for patients with below normal vitamin D levels, defined as <30 ng/mL. This study assesses the impact of this intervention on COPD exacerbation rates and time to repeat exacerbation.
Methods: A single-center, retrospective, observational, pre-post chart review compared clinical outcomes of COPD patients who completed a post-discharge visit at Piedmont Columbus MMC during January 1 to December 31, 2023, (pre-implementation) and January 1 to December 31, 2024, (post-implementation) following a COPD-related hospitalization at either Piedmont Columbus Regional (PCR) Midtown or PCR Northside. Patients were excluded if they received vitamin D supplementation prior to hospitalization or had a past medical history of lung cancer or parathyroid disorder. The primary objective was mean number of COPD exacerbations per person year. The secondary objective was time to repeat COPD exacerbation. Post-implementation results for each objective were stratified by baseline vitamin D levels into three pre-defined categories: sufficiency (≥30 ng/mL), deficiency (10-29 ng/mL), and severe deficiency (<10 ng/mL). A student t-test was used to evaluate the primary outcome, while the secondary outcome and stratification of post-implementation results were evaluated using descriptive statistics.
Results: A total of 30 patients were included in the study, with 17 being in the pre-implementation cohort and 13 being in the post-implementation cohort. Age was similar between groups, but a large difference was seen with sex and race. The post-implementation cohort had an average baseline vitamin D level of 18.7 ng/mL, which correlated with deficiency. The post-implementation cohort had fewer COPD exacerbations per person year on average (1.46 vs 1.71, p=0.76) but had a shorter time to repeat exacerbation compared to the pre-implementation cohort (98.6 days vs 142 days). Within the post-implementation cohort, patients with deficient baseline vitamin D levels experienced fewer exacerbations per person year and had a longer time to repeat exacerbation compared to those with sufficient or severely deficient baseline vitamin D levels.
Conclusion: Routine screening and supplementation of vitamin D in COPD patients may be associated with fewer exacerbations, though no statistically significant difference was observed in this small sample. Trends toward reduced exacerbation frequency following implementation suggest potential benefit, particularly among patients with baseline vitamin D deficiency. Larger studies are warranted to further evaluate the clinical impact of vitamin D optimization in this population.
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