Vitamin D in rehabilitation of older patients with chronic obstructive pulmonary disease and laryngeal cancer

AIM: To examine the clinical efficacy of vitamin D in the complex rehabilitation of older patients with chronic obstructive pulmonary disease (COPD) and laryngeal cancer.

MATERIALS AND METHODS: The open, prospective, randomized, and controlled study enrolled 63 patients with stage II COPD and stage II laryngeal cancer with vitamin D deficiency/insufficiency. The main group consisted of 32 patients who took vitamin D in corrective and maintenance doses for 12 months. The control group consisted of 31 patients with similar comorbid pathology who did not take vitamin D. Cytokine status (interleukin-4, interleukin-8, and tumor necrosis factor-α), C-reactive protein (CRP), and coagulation indices were studied. Dyspnea severity was assessed according to the visual analog scale and mMRC scale, and functional abilities were assessed according to the 6-min walking test. Standard statistical methods were used to process the results.

RESULTS: The mean vitamin D levels in patients with laryngeal cancer and COPD were 17.0±1.1 and 17.1±1.3 ng/mL in the main and control group, respectively. On admission, all patients had increased activity of proinflammatory serum cytokines, decreased activity of anti-inflammatory cytokines, increased levels of CRP, and hypercoagulation. An improvement in the balance of cytokine status was noted in the main group after 12 months, whereas the imbalance persisted in the control group. At 12 months, the CRP level significantly decreased in the main group in comparison with pretreatment data (3.47±0.77 mg/L, p=0.02), and in the 6-min walking test, the distance walked increased in comparison with the initial data (244.43±11.25 m, p <0.01).

CONCLUSION: Vitamin D deficiency/insufficiency in patients with COPD and laryngeal cancer promotes cytokine level imbalance, chronic inflammation, and reduced functional capacity. The administration of vitamin D in corrective and maintenance doses for 12 months helped reduce the activity of chronic inflammation markers, normalize cytokine levels, and improve exercise tolerance. Rehabilitation programs for older people should consider including vitamin D supplementation to reduce the risk of COPD exacerbations.