Relationship Between Serum Vitamin D, Disease Severity and Airway Remodeling in Children with Asthma.
Am J Respir Crit Care Med. 2011 Sep 8.
Gupta A, Sjoukes A, Richards D, Banya W, Hawrylowicz C, Bush A, Saglani S.
Royal Brompton hospital, London, United Kingdom; King's College London, London, United Kingdom.
Rationale Little is known about vitamin D status and its effect on asthma pathophysiology in children with __severe, therapy resistant asthma (STRA)_. Relationships between serum vitamin D, lung function, and pathology were investigated in pediatric STRA.
Methods Serum 25-hydroxyvitamin D (25[OH]D3) was measured in 86 children (mean age 11.7 years), 36 STRA, 26 moderate asthmatics (MA) and 24 non-asthmatic controls. Relationships between 25[OH]D3, the asthma control test (ACT), spirometry, corticosteroid usage, and exacerbations were assessed. 22/36 children with STRA underwent fibreoptic bronchoscopy, bronchoalveolar lavage and endobronchial biopsy with assessment of airway inflammation and remodeling.
Results 25OHD3 levels (median [IQR]) were significantly lower in STRA (28[22-38])nmol/L than MA (42.5[29-63])nmol/L and controls (56.5[45-67])nmol/L (p<0.001).
There was a positive relationship between 25[OH]D3 levels and %predicted forced expired volume (FEV1) (r=0.4, p<0.001) and forced vital capacity (FVC) (r=0.3, p=0.002) in all subjects. 25[OH]D3 levels were positively associated with ACT (r=0.6, p<0.001), and inversely associated with exacerbations (r=-0.6, p<0.001) and inhaled steroid dose (r=-0.39, p=0.001) in MA & STRA.
Airway smooth muscle (ASM) mass, but not epithelial shedding or reticular basement membrane thickness, was inversely related to 25[OH]D3 levels (r=-0.6, p=0.008). There was a positive correlation between ASM mass and bronchodilator reversibility (r=0.6, p=0.009) and an inverse correlation between ASM mass and ACT (r=-0.7, p<0.001)
Conclusions Lower vitamin D levels in children with STRA were associated with increased ASM mass, worse asthma control and lung function. The link between vitamin D, airway structure and function suggests vitamin D supplementation may be useful in pediatric STRA.
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- forced expired volume
- forced vital capacity
- asthma control test
- inhaled steroid dose
- airway smooth muscle mass
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