Does Vitamin E Supplementation Help in COPD? (Commentary) (Chronic Obstructive Pulmonary Disease) (Report‪)‬

Since around the turn of the last century, a large amount of data has appeared on the importance of diet, especially of the antioxidants and micronutrients such as of vitamin C and E in the prevention and management of chronic obstructive pulmonary disease (COPD) and asthma (1-3). Review of the epidemiological evidence has generally suggested a beneficial effect of antioxidant vitamins as well as of fruits and vegetables (1). A protective effect of fruits and possibly vitamin E intake was observed on mortality from COPD in five population-based cohorts of 2917 middle aged men from Finland, Italy and the Netherlands--the COPD mortality risk for vitamin E intake was 0.77 (95% CI = 0.55-1.06) after adjustment for age, smoking and country (2). Analyzing the data from the Third National Health and Nutritional Examination Survey (NHANES III) on the US population in 1988-1994 (n=18162 subjects of age 17 yr or above), the authors reported a better lung function with higher levels of antioxidant nutrients (4). Dietary allowances of antioxidant vitamins were recommended for populations chronically exposed to photo-oxidant air pollution such as the ozone, cigarette smoking or vigorous exercise (3). Chronic obstructive pulmonary disease is a progressive and disabling disorder. Emergence of COPD with a highly significant morbidity and mortality is a serious health care burden in our country (5). The prevalence rates in general population in adults are high in both men (5.0%) and women (3.2%) (5). Unfortunately, the treatment, mostly comprising of bronchodilators of different groups, is entirely symptomatic. Findings of these epidemiological observations demonstrating benefits with dietary supplements have therefore raised the hope of managing COPD with an additional approach to currently available therapy (1-4). Several experimental studies in the past had shown that the antioxidant levels were low in the stable COPD patients but tended to rise following oxidative stress such as that during acute exacerbations or following exercise (6-9). The mean serum concentration of vitamin E was 10.0 [micro]g/ml during acute exacerbations in 24 patients of COPD compared to 11.0 [micro]g/ml in 23 control patients (7). Vitamin E levels were also found to be lower in skeletal muscle biopsies of 21 patients of COPD than in 12 healthy age-matched controls implying an increase in muscle total antioxidant capacity (9). It is therefore logical to attempt treatment with antioxidants such as the vitamin E supplementation.