• Users Online: 379
  • Print this page
  • Email this page


 
 
Table of Contents
ORIGINAL ARTICLE
Year : 2018  |  Volume : 67  |  Issue : 1  |  Page : 17-20

Vitamin D deficiency in chronic obstructive pulmonary disease and bronchogenic carcinoma


1 Department of Chest Diseases, Faculty of Medicine, Cairo University, Cairo, Egypt
2 Department of Chemical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt

Date of Submission16-Oct-2017
Date of Acceptance20-Nov-2017
Date of Web Publication21-Mar-2018

Correspondence Address:
Yasmine H El-Hinnawy
16 El Tayaran Street, Nasr City, Cairo 11759
Egypt
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ejcdt.ejcdt_7_17

Get Permissions

  Abstract 

Rationale Vitamin D has been known to have an important role as an anti-inflammatory agent and immune modulator. The aim of this work was to evaluate the impact of vitamin D deficiency on chronic obstructive pulmonary disease (COPD) and bronchogenic carcinoma.
Patients and methods The study population consisted of 58 patients. All were male patients and were divided into two groups: group A consisted of patients with COPD (n=30) [diagnosed by history, examination and pulmonary function testing and further evaluated by BMI, 6 min walk test and oxygen saturation by pulse oximeter (SpO2)] and group B (n=28) consisted of patients with bronchogenic carcinoma not having COPD (diagnosed by history, examination, pulmonary function testing to exclude COPD, computed tomography chest and biopsy, which was obtained through fibreoptic bronchoscopy, ultrasound guided or computed tomography guided). All were tested for 25-OH vitamin D3/D2.
Results The relation between vitamin D deficiency and COPD severity was studied, revealing no statistically significant correlation. The relation between vitamin D deficiency and bronchogenic carcinoma revealed a statistically significant correlation. Although vitamin D deficiency was not statistically significant among different histological types of bronchogenic carcinoma, vitamin D level (mean±SD: 53.15±17.61) was higher in squamous cell carcinoma than that found in small cell cancer (30.32±14.83) and adenocarcinoma (22.75±8.67).
Conclusion Vitamin D deficiency has been known to have an impact on the respiratory system. We were not able to find a relation linking COPD to vitamin D deficiency. However vitamin D deficiency seemed to be more related to the development of bronchogenic carcinoma. Although the type of bronchogenic carcinoma did not show statistical significance regarding deficiency of vitamin D. Squamous cell carcinoma patients didn’t show deficiency in contrast to other types. Vitamin D deficiency seemed related to bronchogenic carcinoma more than it is to COPD.

Keywords: chronic obstructive pulmonary disease, bronchogenic carcinoma, vitamin D deficiency


How to cite this article:
El-Hinnawy YH, Soliman YM, Halim RM. Vitamin D deficiency in chronic obstructive pulmonary disease and bronchogenic carcinoma. Egypt J Chest Dis Tuberc 2018;67:17-20

How to cite this URL:
El-Hinnawy YH, Soliman YM, Halim RM. Vitamin D deficiency in chronic obstructive pulmonary disease and bronchogenic carcinoma. Egypt J Chest Dis Tuberc [serial online] 2018 [cited 2020 Apr 3];67:17-20. Available from: http://www.ejcdt.eg.net/text.asp?2018/67/1/17/228138




  Introduction Top


It has been established that vitamin D has an important role as an anti-inflammatory agent [1] and immune modulator [2]. Many studies have shown the specific association of vitamin D with chronic obstructive pulmonary disease (COPD) [3],[4], and recently its role in the development of malignancies [5], especially bronchogenic carcinoma [6].

Vitamin D metabolism [7] has an impact on COPD through certain mechanisms [3] and an impact on malignancy through certain pathways [8].


  Rationale Top


COPD and bronchogenic carcinoma are both predisposed by smoking. Hence, is there a relation between vitamin D deficiency and both conditions?


  Patients and methods Top


The study was carried out during the period between May 2016 and May 2017. A total of 58 patients from the chest department outpatient clinic for the COPD cases and inpatient for the bronchogenic cases, Kasr Al-Ainy Hospital, Faculty of Medicine, Cairo University, were included in the study. All were male patients and were divided into two groups: group A consisted of patients with COPD [diagnosed by history, examination and pulmonary function testing and further evaluated by BMI, 6 min walk test and oxygen saturation by pulse oximeter (SpO2)] and group B consisted of patients with bronchogenic carcinoma not having COPD (diagnosed by history, examination and pulmonary function testing to exclude COPD, computed tomography chest and biopsy, which was obtained through fibreoptic bronchoscopy, ultrasound guided or computed tomography guided).

Group A comprised 30 patients and group B comprised 28 patients (all were chronic heavy smokers).

All were tested for 25-OH vitamin D3/D2, carried out using ORGENTEC Diagnostika GmbH ELISA (ORGENTEC Diagnostika GmbH, Carl-Zeiss-Straβe, Germany).

Data were coded and entered using the statistical package for the social sciences, version 24 (SPSS; SPSS Inc., Chicago, Illinois, USA). Data were summarized using mean, SD, median, minimum and maximum for quantitative data and using frequency (count) and relative frequency (percentage) for categorical data. Comparisons between quantitative variables were carried out using the nonparametric Kruskal–Wallis and Mann–Whitney tests [9]. For comparing categorical data, χ2-test was performed. The exact test was used instead when the expected frequency was less than 5 [10]. Correlations between quantitative variables were carried out using Spearman’s correlation coefficient [11]. P values less than 0.05 were considered as statistically significant.


  Results Top


The relation between vitamin D deficiency and COPD severity was studied revealing no statistically significant correlation ([Table 1]). The relation between vitamin D deficiency and bronchogenic carcinoma revealed a statistically significant correlation ([Table 2]). Although vitamin D deficiency was not statistically significant among different histological types of bronchogenic carcinoma, vitamin D level (mean±SD: 53.15±17.61) was higher in cell carcinoma than that found in small cell cancer (30.32±14.83) and adenocarcinoma (22.75±8.67) ([Table 3]).
Table 1 Vitamin D level correlation with chronic obstructive pulmonary disease severity

Click here to view
Table 2 Age and vitamin D level in both groups

Click here to view
Table 3 Vitamin D level among bronchogenic carcinoma cases with different histopathology

Click here to view



  Discussion Top


It has been well established that vitamin D has an anti-inflammatory role [1], and its deficiency was linked to the development of several respiratory disorders [12]. Vitamin D is thought to affect the respiratory system through several mechanisms [13].

Many studies linked vitamin D deficiency to the increased severity of COPD [3],[4]. However, in the study at hand, we did not find a statistically significant correlation between vitamin D deficiency and COPD severity, as measured by spirometry, as shown in [Table 1]. Moreover, from [Table 4], no significant correlation was found between vitamin D deficiency and the different prognostic markers of COPD in the form of smoking index, BMI, 6 min walk distance, and resting oxygen saturation. This may be because of the relatively small sample size. In addition, the studies that showed a link between vitamin D deficiency and COPD severity pointed to the effect of vitamin D on the comorbid osteoporosis in those patients [3],[4]. However, other studies have mentioned that vitamin D deficiency had a significant role in COPD exacerbations [14], which was not the case in our study, as most patients were follow-up patients in the outpatient clinic. Moreover, vitamin D deficiency was not considered as a marker for survival [15], although the parameters used in our study were considered strongly related to survival in COPD patients [16],[17].
Table 4 Descriptive data with regard to age, smoking index, BMI, 6 min walk test, and SpO2 in group A (chronic obstructive pulmonary disease cases)

Click here to view


Furthermore, vitamin D deficiency was thought to result in many types of malignancy [5]; among these malignancies was bronchogenic carcinoma [18]. Different mechanisms for the impact of vitamin D deficiency on bronchogenic carcinoma were proposed [19]. In this study, it was noticed that there was a significant statistical difference between COPD patients and bronchogenic carcinoma patients with regard to vitamin D deficiency, as shown in [Table 2]. This may be attributed to the fact that vitamin D deficiency was established as a risk factor for the development of bronchogenic carcinoma despite smoking history [20]. It has also been found in this study that different types of bronchogenic carcinoma showed different levels of vitamin D deficiency, as revealed by [Table 3]. This was also noticed by Kargi et al. [20]. The explanation to this may be attributable to the fact that different types of lung cancer originated from different cells [21],[22],[23]. Thus, the response of different types of lung cancer to vitamin D deficiency might differ.


  Conclusion Top


Vitamin D deficiency is known to have an impact on the respiratory system. We were not able to find a relation linking COPD to vitamin D deficiency. However vitamin D deficiency seemed to be more related to the development of bronchogenic carcinoma. Although the type of bronchogenic carcinoma did not show statistical significance regarding deficiency of vitamin D. Squamous cell carcinoma patients didn’t show deficiency in contrast to other types. Vitamin D deficiency seemed related to bronchogenic carcinoma more than it is to COPD.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Hoe E, Nathanielsz J, Toh ZQ, Spry L, Marimla R, Balloch A et al. Anti-inflammatory effects of vitamin D on human immune cells in the context of bacterial infection. Nutrients 2016; 8:806.  Back to cited text no. 1
    
2.
Wöbke TK, Sorg BL, Steinhilber D. Vitamin D in inflammatory diseases. Front Physiol 2014; 5:244.  Back to cited text no. 2
    
3.
Janssens W, Mathieu C, Boonen S, Decramer M. Vitamin D deficiency and chronic obstructive pulmonary disease: a vicious circle. Vitam Horm 2011; 86:379–399.  Back to cited text no. 3
    
4.
Janssens W, Lehouck A, Decramer M, Gayan-Ramirez G. Vitamin D and chronic obstructive pulmonary disease. Chapter 11. In: Litonjua AA, editor. Vitamin D and the lung. Humana Press, Totowa, NJ: Springer; 2012. pp. 239–260.  Back to cited text no. 4
    
5.
Jacobs ET, Kohler LN, Kunihiro AG, Jurutka PW. Vitamin D and colorectal, breast, and prostate cancers: a review of the epidemiological evidence. J Cancer 2016; 7:232–240.  Back to cited text no. 5
    
6.
Liu J, Dong Y, Lu C, Wang Y, Peng L, Jiang M et al. Meta-analysis of the correlation between vitamin D and lung cancer risk and outcomes. Oncotarget 2017; 8:81040–81051.  Back to cited text no. 6
    
7.
Bikle DD. Vitamin D metabolism, mechanism of action, and clinical applications. Chem Biol 2014; 21:319–329.  Back to cited text no. 7
    
8.
Norton R, O’Connell MA. Vitamin D: potential in the prevention and treatment of lung cancer. Anticancer Res 2012; 32:211–222.  Back to cited text no. 8
    
9.
Chan YH. Biostatistics102: quantitative data − parametric & non-parametric tests. Singapore Med J 2003a; 44:391–396.  Back to cited text no. 9
    
10.
Chan YH. Biostatistics 103: qualitative data − tests of independence. Singapore Med J 2003b; 44:498–503.  Back to cited text no. 10
    
11.
Chan YH. Biostatistics 104: correlational analysis. Singapore Med J 2003c; 44:614–619.  Back to cited text no. 11
    
12.
Hejazi ME, Modarresi-Ghazani F, Entezari-Maleki T. A review of vitamin D effects on common respiratory diseases: asthma, chronic obstructive pulmonary disease, and tuberculosis. J Res Pharm Pract 2016; 5:7–15.  Back to cited text no. 12
[PUBMED]  [Full text]  
13.
Hughes DA, Norton R. Vitamin D and respiratory health. Clin Exp Immunol 2009; 158:20–25.  Back to cited text no. 13
    
14.
Bellocchia M, Boita M, Patrucco F, Ferrero C, Verri G, Libertucci D et al. Vitamin D deficiency and COPD exacerbations: Effect of vitamin D supplementation. Eur Respir J 2015; 46:PA3961.  Back to cited text no. 14
    
15.
Holmgaard DB, Mygind LH, Titlestad IL, Madsen H, Fruekilde PBN, Pedersen SS, Pedersen C. Serum vitamin D in patients with chronic obstructive lung disease does not correlate with mortality − results from a 10-year prospective cohort study. PLoS One 2013; 8:e53670.  Back to cited text no. 15
    
16.
Andrianopoulos V, Wouters EF, Pinto-Plata VM, Vanfleteren LE, Bakke PS, Franssen FM et al. Prognostic value of variables derived from the six-minute walk test in patients with COPD: results from the ECLIPSE study. Respir Med 2015; 109:1138–1146.  Back to cited text no. 16
    
17.
Celli BR, Cote CG, Lareau SC, Meek PM. Predictors of survival in COPD: more than just the FEV1. Respir Med 2008; 102(Suppl 1):S27–S35.  Back to cited text no. 17
    
18.
Weinstein SJ, Yu K, Horst RL, Parisi D, Virtamo J, Albanes D. Serum 25-hydroxyvitamin D and risk of lung cancer in male smokers: a nested case-control study. PLoS One 2011; 6:e20796.  Back to cited text no. 18
    
19.
Foong RE, Zosky GR. Vitamin D deficiency and the lung: disease initiator or disease modifier? Nutrients 2013; 5:2880–2900.  Back to cited text no. 19
    
20.
Kargi AB, Demir M, Tasdemir E, Kargi A. Vitamin D deficiency as a risk factor in non-squamous lung cancer subgroups − a preliminary study. J Clin Respir Dis Care 2016; 2:113.  Back to cited text no. 20
    
21.
Hanna JM, Onaitis MW. Cell of origin of lung cancer. J Carcinog 2013; 12:6.  Back to cited text no. 21
[PUBMED]  [Full text]  
22.
Kate DS, Natalie P, Inge B, Dirk A, Ji-Ying S, Anton B. Cell of origin of small cell lung cancer: inactivation of Trp53 and Rb1 in distinct cell types of adult mouse lung. Cancer Cell 2011; 19:754–764.  Back to cited text no. 22
    
23.
Sutherl KD, Berns A. Cell of origin of lung cancer. Mol Oncol 2010; 4:397–403.  Back to cited text no. 23
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
Abstract
Introduction
Rationale
Patients and methods
Results
Discussion
Conclusion
References
Article Tables

 Article Access Statistics
    Viewed1321    
    Printed163    
    Emailed1    
    PDF Downloaded164    
    Comments [Add]    

Recommend this journal