Vitamin D and Pneumonia

Pneumonia

Pneumonia is a lower respiratory infection that affects the lungs. Pneumonia can usually be treated at home in a few weeks. However, pneumonia can be more serious in someone with a weak immune system and can lead to hospitalization. Vitamin D is an important part of your immune system. Vitamin D can help to increase the amount of good immune proteins that fight and destroy bacteria. People with low levels of vitamin D are more likely to develop pneumonia, and are also more likely to have worse outcomes and longer recoveries from pneumonia. Having high levels of vitamin D may be a way to help prevent pneumonia, but more experiments need to be done to say for sure. Some studies have shown that people with higher vitamin D levels recover faster from pneumonia and have less severe symptoms. More experiments are needed to show whether or not taking vitamin D supplements can help to prevent or treat pneumonia. If you want to take vitamin D to prevent or help treat pneumonia, it is unlikely to cause you any harm, as long as you take less than 10,000 IU per day. However, it’s not proven that taking vitamin D will help to prevent or treat pneumonia. If you have pneumonia, you shouldn’t take vitamin D in place of any treatment medications. Talk to your physician for more advice about taking supplements.

What is pneumonia?

Pneumonia is a lower respiratory infection that affects the lungs. The infection causes air sacs in your lungs to become inflamed and filled with fluid or pus. Pneumonia can usually be treated at home in a few weeks. However, pneumonia can be more serious in someone with a weak immune system and can lead to hospitalization. There are different kinds of pneumonia, which depend on how and where you get the infection. Community-acquired pneumonia is when you get the infection from someone or somewhere in the general community, not from a hospital. This type is the most common and can be caused by a bacteria, virus, or fungus. Hospital-acquired pneumonia comes from bacteria in hospitals and occurs most often in people hooked up to breathing machines^1,2.

What are the symptoms of pneumonia?

Symptoms of pneumonia can be mild and similar to a cold or flu but can be more severe in people with weak immune systems. General symptoms of pneumonia include^1,2:

• Fever and chills
• Low body temperature in the elderly and people with weak immune systems
• Coughing
• Chest pain
• Shortness of breath
• Fatigue
• Nausea and vomiting

Bacterial pneumonia usually causes someone to cough up mucus and have a high fever. Pneumonia that is caused by a virus usually causes a lower fever and little to no mucus. Sometimes, elderly people can become mentally confused when they develop pneumonia.

How common is pneumonia?

Pneumonia is a major cause of illness all over the world. Up to 10 million Americans get pneumonia each year. There are some things that can increase your chances of developing pneumonia, such as^1,2,3,4:

• Being under the age of 2 years old or over 65 years old.
• Having another health condition, like chronic lung disease, diabetes, or cerebral palsy.
• Smoking cigarettes.
• Having a respiratory infection recently, like the cold or flu.
• Difficulty swallowing due to conditions like stroke or dementia.
• Living in a nursing home.
• Recent surgery or trauma.
• Using alcohol excessively.

There are many factors that can increase your risk of getting pneumonia and most of them are related to a weakened immune system. Someone with a weak immune system is less likely to be able to fight the pneumonia bacteria or virus.

How does pneumonia spread?

Pneumonia is a respiratory illness, meaning that you can breathe in the bacteria or virus from the air. The germs that cause pneumonia can spread when someone who is infected coughs, sneezes, or even talks. Droplets containing the germs travel through the air and can be directly inhaled by another person through the mouth or nose. The droplets may also land on a surface and you could pick them up and then become infected after touching your eyes, nose, or mouth.

What is the link between pneumonia and vitamin D?

Vitamin D is an important part of the immune system. Vitamin D receptors are found on the surface of a cell where they receive chemical signals. By attaching themselves to a receptor, these chemical signals direct a cell to do something, for example, to act in a certain way, or to divide or die. There are vitamin D receptors found on cells in the immune system and the respiratory tract, and vitamin D can bind to these receptors. Vitamin D works in the immune system by lowering levels of bad inflammatory proteins, while at the same time increasing amounts of good antimicrobial proteins that can destroy invading germs, like the ones that cause pneumonia. Having enough vitamin D in your body may help to strengthen your immune system to better fight infections⁵. When someone has low levels of vitamin D, the protective barriers of cells aren’t as strong, which means it is easier for bacteria and viruses to enter and cause illness⁶.

Researchers think that vitamin D may be a factor in whether or not someone develops pneumonia and how severe their symptoms may be. Studies have shown that people who develop pneumonia tend to have low levels of vitamin D⁶. Some researchers think that giving vitamin D supplements to people with pneumonia may help them to improve faster. Overall, more experiments are needed to say for sure whether or not taking vitamin D supplements can help to prevent or treat pneumonia.

What does the research say in general about pneumonia and vitamin D?

Preventing pneumonia

Not many studies have been done about preventing pneumonia with vitamin D supplements in the general population. A study done in older adults in Finland found that people who had the lowest levels of vitamin D had the highest chances of developing pneumonia. Low vitamin D levels were found to be a very strong risk factor for developing pneumonia⁷. Some studies have found that low levels of vitamin D are very common in the elderly, who are at high risk of developing pneumonia⁸. Young children also have higher chances of getting pneumonia. Some research has shown that vitamin D deficiency is strongly linked to severe pneumonia in children⁹. A study done in the United States about sunlight exposure and pneumonia found that the months with the most sunlight were linked to a decrease in people with pneumonia¹⁰. Vitamin D is made in the skin from sunlight, so more sun exposure may lead to higher vitamin D levels.

Treating and recovering from pneumonia

Some studies that have been done about vitamin D and pneumonia have looked at how long it takes people to recover from the illness. People who have very low levels of vitamin D are more likely to have worse outcomes and longer recoveries from pneumonia than people with higher levels of vitamin D. Researchers think that someone’s vitamin D levels can have an impact on how fast and how well they recover from pneumonia¹¹. A few experiments have given vitamin D supplements to people with pneumonia and looked at their recovery time. Some of these studies have shown that people recover faster from pneumonia if they take vitamin D supplements. However, the results have been mixed^12,13. One study found that children with pneumonia who also had rickets had worse outcomes and longer recoveries from pneumonia. Rickets is a disease in children that comes from vitamin D deficiency. The children with rickets were 4 times more likely to have a slower recovery from pneumonia than children with higher vitamin D levels⁹. Overall, more experiments are needed to determine whether or not taking vitamin D can help to treat pneumonia.

What does recent research say about vitamin D and pneumonia?

Preventing pneumonia

A study published in 2013looked at vitamin D levels and rates of community acquired pneumonia in a large group of people in the United States. The researchers found that¹⁴:

• People with the lowest vitamin D levels had more than double the chances of getting pneumonia, compared to people with high vitamin D levels.

The researchers think that taking vitamin D supplements may be a way to lower your risk of developing pneumonia. Since this study was observational, they can’t say for sure that low vitamin D levels cause pneumonia.

Treating and recovering from pneumonia

An experiment done in 2010looked at children with pneumonia. The researchers gave them either a one-time dose of 100,000 IU vitamin D or a dummy pill, along with normal antibiotics for pneumonia. They found that¹²:

• Children in the vitamin D group survived longer without having a repeat pneumonia illness compared to the children getting the dummy pill.
• Children who took vitamin D supplements had lower numbers of new pneumonia illnesses after antibiotic treatment.

The researchers conclude that vitamin D supplements may not have an immediate effect on pneumonia treatment, but it may help to prevent repeats of pneumonia in the future by strengthening the immune system. A study done in 2012 in the Netherlandslooked at vitamin D levels in a group of people with community acquired pneumonia. The researchers found that¹⁵:

• People with low levels of vitamin D were more likely to be hospitalized and were more likely to die within 30 days compared to people with high levels of vitamin D.

The researchers conclude that having high vitamin D levels may be linked to better outcomes and survival from pneumonia. A study published in 2014 from Germanylooked at vitamin D levels in a group of people with pneumonia. The researchers found that¹⁶:

• People who needed to be hospitalized had lower levels of vitamin D.
• Of the people who were hospitalized, those with the lowest levels of vitamin D had longer hospital stays.
• People with low levels of vitamin D had more severe forms of pneumonia.

The researchers conclude that there is a link between vitamin D levels and pneumonia severity.

Key points from the research

• People with low levels of vitamin D are more likely to get pneumonia.
• Vitamin D can help reduce inflammation caused by the pneumonia infection and increase the number of proteins that fight against germs.
• Some studies have shown that people with higher levels of vitamin D recover faster from pneumonia.
• People with low levels of vitamin D tend to have more severe pneumonia symptoms.
• More experiments are needed to determine whether or not taking vitamin D supplements can help to prevent or treat pneumonia.

What does this mean for me?

Research has found that there is a link between vitamin D and pneumonia. People who have low levels of vitamin D tend to get pneumonia more often and tend to have worse symptoms and longer recovery times. Most observational studies show that having higher levels of vitamin D can help to prevent pneumonia and help with recovery. However, not many experiments have shown that taking vitamin D supplements can help to prevent or treat pneumonia. If you want to take vitamin D to prevent or help treat pneumonia, it is unlikely to cause you any harm, as long as you take less than 10,000 IU per day. However, it’s not proven that taking vitamin D will help to prevent or treat pneumonia. If you have pneumonia, you shouldn’t take vitamin D in place of any treatment medications. Talk to your physician for more advice about taking supplements.

References

1. Mayo Clinic. Pneumonia. Web. 2014. Accessed at https://www.mayoclinic.org/diseases-conditions/pneumonia/symptoms-causes/syc-20354204
2. WebMD. Pneumonia-Topic Overview. Web. 2014. Accessed at https://www.webmd.com/lung/understanding-pneumonia-basics
3. American Lung Association. Understanding Pneumonia. Web. 2014. Accessed at https://www.lung.org/lung-health-diseases/lung-disease-lookup/pneumonia/learn-about-pneumonia
4. New York Times. Pneumonia- Adults (Community Acquired). Web. 2013.
5. Olliver M, Spelmink L, Hiew J, et al. Immunomodulatory effects of vitamin D on innate and adaptive immune responses to Streptococcus pneumonia. J Infec Dis 2013;208:1474-81.
6. Youssef DA, Ranasinghe T, Grant WB & Peiris AN. Vitamin D’s potential to reduce the risk of hospital-acquired infection. Dermato-Endocrinology 2012;4(2):167-175.
7. Aregbesola A, Voutilainen S, Nurmi T, et al. Serum 25-hydroxyvitamin D3 and the risk of pneumonia in an ageing general population. J Epidemiol Community Health 2013;67:533-6.
8. Asamura T. Low serum 1,25-dihydroxyvitamin D level and risk of respiratory infections in institutionalized older people. Gerontology 2010;56(6):542-3.
9. Banajeh SM. Nutritional rickets and vitamin D deficiency- association with the outcomes of childhood very severe pneumonia: a prospective cohort study. Pediatric Pulmonology 2009;44:1207-15.
10. White  ANJ, Ng V, Spain CV, et al. Let the sun shine in: effects of ultraviolet radiation on invasive pneumococcal disease risk in Philadelphia, Pennsylvania. BMC Infectious Diseases 2009;9(196)1-11.
11. Leow L, Simpson T, Cursons R, et al. Vitamin D, innate immunity and outcomes in community acquired pneumonia. Respirology 2011;16:611-6.
12. Manaseki-Holland S, Qader G, Masher MI, et al. Effects of vitamin D supplementation to children diagnosed with pneumonia in Kabul: a randomized controlled trial. Tropical Medicine and International Health 2010;15(10):1148-1155.
13. Choudhary N & Gupta P. Vitamin D supplementation for severe pneumonia- a randomized controlled trial. Indian Pediatrics 2011;49:449-454.
14. Quraishi SA, Bittner EA, Christopher KB, et al. Vitamin D status and community-acquired pneumonia: results from the Third National Health and Nutrition Examination Survey. PLoS ONE 2013;8(11):1-7.
15. Remmelts HHF, van de garde EMW, Meijvis SCA, et al. Addition of vitamin D status to prognostic scores improves the prediction of outcome in community-acquired pneumonia. CID 2012;55:1488-1494.
16. Pletz MW, Terkamp C, Scumacher U, et al. Vitamin D deficiency in community-acquired pneumonia: low levels of 1,25(OH)2D are associated with disease severity. Respiratory Research 2014;15(53):1-17.