Relationship between serum vitamin D, disease severity, and airway remodeling in children with asthma.
Am J Respir Crit Care Med. 2011 Dec 15;184(12):1342-9. Epub 2011 Sep 8.
Gupta A, Sjoukes A, Richards D, Banya W, Hawrylowicz C, Bush A, Saglani S.
Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK. atulgupta at doctors.org.uk
RATIONALE: Little is known about vitamin D status and its effect on asthma pathophysiology in children with severe, therapy-resistant asthma (STRA).
OBJECTIVES: Relationships between serum vitamin D, lung function, and pathology were investigated in pediatric STRA.
METHODS: Serum 25-hydroxyvitamin D [25(OH)D(3)] was measured in 86 children (mean age, 11.7 yr): 36 with STRA, 26 with moderate asthma (MA), and 24 without asthma (control subjects). Relationships between 25(OH)D(3), the asthma control test (ACT), spirometry, corticosteroid use, and exacerbations were assessed. Twenty-two of 36 children with STRA underwent fiberoptic bronchoscopy, bronchoalveolar lavage, and endobronchial biopsy with assessment of airway inflammation and remodeling.
MEASUREMENTS AND MAIN RESULTS: 25(OH)D(3) levels (median [IQR]) were significantly lower in
- STRA (28 [22-38] nmol/L) than in
- MA (42.5 [29-63] nmol/L) and
- control subjects (56.5 [45-67] nmol/L) (P < 0.001).
There was a positive relationship between 25(OH)D(3) levels and percent predicted FEV(1) (r = 0.4, P < 0.001) and FVC (r = 0.3, P = 0.002) in all subjects. 25(OH)D(3) 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 and STRA.
Airway smooth muscle (ASM) mass, but not epithelial shedding or reticular basement membrane thickness, was inversely related to 25(OH)D(3) 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 and 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.
Comment in : Am J Respir Crit Care Med. 2011 Dec 15;184(12):1324-5.
Severe 11 ng
Moderate 17 ng
Control 23 ng
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