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Related studies have shown that a considerable proportion of patients with COPD have insufficient vitamin D levels (153), and vitamin D deficiency is associated with a decline in lung function and an increased risk of acute exacerbations of COPD (138, 154), which may be related to a decrease in glutathione peroxidase 4 (GPX4) and an increase in iron parameters (155)

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Of these issues, emerging data suggest that particular attention be given to the potential risk for poor energy availability and increased iron requirements at the altitudes typical of elite athlete training (~ 16002400 m) to interfere with optimal adaptations

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