Children with severe asthma had much lower levels of vitamin D – Dec 2011

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@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.

PMID: 21908411

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Severe 11 ng
Moderate 17 ng
Control 23 ng

See also VitaminDWiki

• Overview Asthma and Vitamin D
• All items in category Breathing and Vitamin D 452 items
• Children with low vitamin D were 4.8X more likely to get asthma – Oct 2011
• Cresendo of papers on Asthma, Allergy, and Vitamin D – Sept 2011

• Severe asthma strongly associated with low vitamin D – Sept 2011
• Asthma worse with low Vitamin D only at age 4 - cohort study Sept 2011
• Magnesium and Vitamin D - similar and different
  • Deficiencies of Magnesium and Vitamin D are both associated with asthma.

See also web

• Clinical Trials for Asthma and Vitamin D 30 as of Feb 2014