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Surinder Janda, MD; Kirily Park, MD; Mark FitzGerald, MB, MD; Mahyar Etminan, PharmD, MSc, (Epid); John Swiston, MD, FCCP
Author and Funding Information

From the Department of Medicine, University of British Columbia.

Correspondence to: John Swiston, MD, FCCP, Division of Respirology, University of British Columbia, Vancouver General Hospital, 2775 Laurel St, Seventh Floor, Vancouver, BC V5Z 1M9 Canada; e-mail: swiston@interchange.ubc.ca


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;137(3):743. doi:10.1378/chest.09-2543
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To the Editor:

We thank Mascitelli and colleagues for their response to our article (September 2009).1 They suggested that because of the side effects of statin drugs, their questionable benefit in the elderly population, and the increased risk of osteopenia and osteoporosis in COPD, patients with COPD should have adequate levels of vitamin D before considering statin therapy.

Vitamin D therapy in COPD is an intriguing consideration. Given that vitamin D is inexpensive and safe, it would be a desirable treatment option if proven to be effective. We agree that there is an increased risk of osteopenia and osteoporosis in patients with COPD and that patients with vitamin D deficiency should be supplemented for prevention of this.2 However, the benefit of vitamin D on outcomes in COPD remains to be proven, and currently the effectiveness of this therapy is inferential and based on population analyses.3 We do not know at the present time that vitamin D has the same effect on COPD outcomes such as exacerbation rates, pulmonary function, exercise capacity, COPD mortality, and all-cause mortality as statins may have, as illustrated in our systematic review. Furthermore, there is no evidence that vitamin D therapy would obliviate the reported benefits of statin therapy.

Vitamin D has been shown to decrease falls and improve muscle strength in the general population,4 and we acknowledge that statins do have side effects, including myopathy and rhabdomyolysis that may worsen respiratory muscle function in patients with COPD. However, these side effects of statin therapy are very rare. The incidence of statin-induced myopathy, defined as any muscle symptom (pain, tenderness, or weakness) and accompanied by a creatine kinase concentration > 10 times normal, is one in 10,000 patients,5 whereas that of rhabdomyolysis is three in 100,000 patients.5 Specifically in patients with COPD, the only randomized controlled trial identified in our review (Lee et al6) reported that no patients in their study had a statin-induced adverse event.

Mascitelli and colleagues raise an interesting point and highlight the need to consider innovative and multifaceted approaches to the treatment of patients with COPD. We would suggest that vitamin D therapy, as with statin therapy, in COPD requires further investigation but as complementary lines of thought rather than parallel or exclusionary ones.

Janda S, Park K, FitzGerald JM, Etminan M, Swiston J. Statins in COPD: a systematic review. Chest. 2009;1363:734-743. [CrossRef] [PubMed]
 
Franco CB, Paz-Filho G, Gomes PE, et al. Chronic obstructive pulmonary disease is associated with osteoporosis and low levels of vitamin D. Osteoporos Int. 2009;2011:1881-1887. [CrossRef] [PubMed]
 
Janssens W, Lehouck A, Carremans C, Bouillon R, Mathieu C, Decramer M. Vitamin D beyond bones in chronic obstructive pulmonary disease: time to act. Am J Respir Crit Care Med. 2009;1798:630-636. [CrossRef] [PubMed]
 
Scott D, Blizzard L, Fell J, Jones G. Statin therapy, muscle function and falls risk in community-dwelling older adults. QJM. 2009;1029:625-633. [CrossRef] [PubMed]
 
Armitage J. The safety of statins in clinical practice. Lancet. 2007;3709601:1781-1790. [CrossRef] [PubMed]
 
Lee TM, Lin MS, Chang NC. Usefulness of C-reactive protein and interleukin-6 as predictors of outcomes in patients with chronic obstructive pulmonary disease receiving pravastatin. Am J Cardiol. 2008;1014:530-535. [CrossRef] [PubMed]
 

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References

Janda S, Park K, FitzGerald JM, Etminan M, Swiston J. Statins in COPD: a systematic review. Chest. 2009;1363:734-743. [CrossRef] [PubMed]
 
Franco CB, Paz-Filho G, Gomes PE, et al. Chronic obstructive pulmonary disease is associated with osteoporosis and low levels of vitamin D. Osteoporos Int. 2009;2011:1881-1887. [CrossRef] [PubMed]
 
Janssens W, Lehouck A, Carremans C, Bouillon R, Mathieu C, Decramer M. Vitamin D beyond bones in chronic obstructive pulmonary disease: time to act. Am J Respir Crit Care Med. 2009;1798:630-636. [CrossRef] [PubMed]
 
Scott D, Blizzard L, Fell J, Jones G. Statin therapy, muscle function and falls risk in community-dwelling older adults. QJM. 2009;1029:625-633. [CrossRef] [PubMed]
 
Armitage J. The safety of statins in clinical practice. Lancet. 2007;3709601:1781-1790. [CrossRef] [PubMed]
 
Lee TM, Lin MS, Chang NC. Usefulness of C-reactive protein and interleukin-6 as predictors of outcomes in patients with chronic obstructive pulmonary disease receiving pravastatin. Am J Cardiol. 2008;1014:530-535. [CrossRef] [PubMed]
 
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