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Vitamin-D deficiency is associated with chronic bacterial colonisation and disease severity in bronchiectasis
  1. James D Chalmers1,
  2. Brian J McHugh1,
  3. Catherine Docherty2,
  4. John R W Govan2,
  5. Adam T Hill1,3
  1. 1The University of Edinburgh/MRC Centre for Research Inflammation, The Queen's Medical Research Institute, Edinburgh, UK
  2. 2Cystic Fibrosis Group, University of Edinburgh, School of Medicine and Veterinary Medicine, Edinburgh, UK
  3. 3Department of Respiratory Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
  1. Correspondence to Dr James D Chalmers, The University of Edinburgh/MRC Centre for Research Inflammation, The Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, UK; jamesdchalmers{at}googlemail.com

Abstract

Introduction Vitamin-D deficiency has been linked to an increased risk of respiratory infections. The objective of this study was to determine the frequency and clinical importance of vitamin-D deficiency in patients with bronchiectasis.

Methods 25-hydroxyvitamin-D was measured by immunoassay in 402 stable patients with bronchiectasis. Patients were classified as vitamin-D deficient (serum 25-hydroxyvitamin-D <25 nmol/l), insufficient (25 nmol/l–74 nmol/l) or sufficient (≥75 nmol/l). Disease severity was assessed, including exacerbation frequency, measurement of airway inflammatory markers, sputum bacteriology and lung function over 3 years follow-up.

Results 50% of bronchiectasis patients were vitamin-D deficient, 43% insufficient and only 7% sufficient. This compared to only 12% of age and sex matched controls with vitamin-D deficiency (p<0.0001). Vitamin-D deficient patients were more frequently chronically colonised with bacteria (p<0.0001), 21.4% of vitamin-D deficient subjects were colonised with Pseudomonas aeruginosa compared to 10.4% of insufficient patients and 3.6% of sufficient patients, p=0.003. Vitamin-D deficient patients had lower FEV1% predicted (p=0.002), and more frequent pulmonary exacerbations (p=0.04). Vitamin-D deficient patients had higher sputum levels of inflammatory markers and demonstrated a more rapid decline in lung function over 3 years follow-up. Defects in neutrophil function and assessment of airway LL-37 levels did not provide a mechanistic explanation for these findings. Vitamin-D deficient patients had, however, higher levels of Vitamin-D Binding Protein in sputum sol.

Conclusions Vitamin-D deficiency is common in bronchiectasis and correlates with markers of disease severity. The mechanism of this association is unclear.

  • Bacterial Infection
  • Bronchiectasis
  • Innate Immunity
  • Neutrophil Biology
  • Respiratory Infection
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