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 Table of Contents  
EDITORIAL
Year : 2020  |  Volume : 7  |  Issue : 2  |  Page : 55-56

The role of Vitamin D in asthma management: Myth or reality?


Department of Pediatrics, Wanless Hospital, Miraj, Maharashtra, India

Date of Submission29-Feb-2020
Date of Acceptance07-Mar-2020
Date of Web Publication10-Apr-2020

Correspondence Address:
Dr. Vinayak Patki
Department of Pediatrics, Wanless Hospital, Miraj, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JPCC.JPCC_37_20

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How to cite this article:
Patki V. The role of Vitamin D in asthma management: Myth or reality?. J Pediatr Crit Care 2020;7:55-6

How to cite this URL:
Patki V. The role of Vitamin D in asthma management: Myth or reality?. J Pediatr Crit Care [serial online] 2020 [cited 2020 Sep 25];7:55-6. Available from: http://www.jpcc.org.in/text.asp?2020/7/2/55/282230



Asthma is a chronic respiratory disease characterized by increased airway inflammation and hyperresponsiveness and is a major public health issue. It is one of the most common diseases affecting millions of population globally. Association between asthma pathogenesis and Vitamin D has become a matter of great interest for many researchers worldwide in the past two decades.

Vitamin D is a fat-soluble nutrient which is a modulator of calcium absorption and bone health. It also plays an important role in immune regulation and respiratory infections.[1] Studies have concluded that decreased level of serum 25 (OH) D is correlated with an increased prevalence, hospitalization, and increased emergency visits along with declined lung function and increased airway hyperresponsiveness in asthmatic children.[2]

Gupta et al. was one of the pioneer researches to point out the role of Vitamin D in the asthma pathogenesis at the molecular level. They found that children with both moderate and severe asthma had significantly diminished levels of anti-inflammatory interleukin (IL)-10 in airway lavage samples when compared with nonasthmatic controls. The addition of Vitamin D3 enhanced IL-10 secretion without increasing IL13 or IL17 levels. Thus, this study also demonstrated the steroid-sparing properties of Vitamin D which may have additional benefits in the management of severe asthma.[3]

A cross-sectional survey on 75 Italian asthmatic children found that the prevalence of Vitamin D-deficiency was 53.3%.[4] In another survey from North America, 17% of asthmatics had Vitamin D deficiency, and a positive correlation was observed between Vitamin D levels and lung function.[5]

Kaaviyaa et al. demonstrated that Vitamin D deficiency is associated with inadequate asthma control in children with moderate persistent asthma, on inhaled corticosteroids, in their small observational studies of Indian Children.[6]

However, a study conducted by Thuesen et al. on 4999 Danish adults reported contrasting results and concluded that 25 (OH) D levels do not have any effect on the development of asthma and allergic symptoms.[7]

Esfandiar et al. in their study stated that though the presence of Vitamin D deficiency effectively predicts increased risk for childhood asthma, the severity or control status of this event may not be predicted by confirming Vitamin D deficiency.[8]

In this present issue, Sharma et al., in their prospective observational study of 75 children, demonstrated that 66.66% of the patients admitted with asthma had Vitamin D3 insufficiency and 9.33% had deficiency. Among Vitamin D3 deficient patients, 71.4% had moderate persistent asthma. However, the correlation between the level of asthma control and Vitamin D3 sufficiency levels could not be demonstrated.[9]

There is no evidence to suggest that asthmatic patients should be screened for Vitamin D deficiency or insufficiency. However, the high-risk group (obese patients and who have limited sun exposure) must be screened for this deficiency.

Several clinical trials of Vitamin D to prevent asthma exacerbation and improve asthma control have been conducted in children and adults. Jolliffe et al. in their meta-analysis of seven studies with 955 participants found that Vitamin D supplementation reduced the rate of asthma exacerbation requiring treatment with systemic corticosteroids among all participants (adjusted incidence rate ratio 0·74, 95% confidence interval 0·56–0·97; P = 0·03; 955 participants in seven studies). There were no significant differences between the use of Vitamin D and placebo in the proportion of participants with at least one exacerbation or time of first exacerbation.[10]

Martineau et al., in their meta-analysis which included seven trials involving a total of 435 children and two trials involving a total of 658 adults, found that people who were given Vitamin D experienced fewer asthma attacks needing treatment with oral steroids. The average number of attacks per person per year went down from 0.44 to 0.28 with Vitamin D (high-quality evidence). Vitamin D reduced the risk of attending hospital with an acute asthma attack from 6/100 to around 3/100 (high-quality evidence). Vitamin D had little or no effect on lung function or day-to-day asthma symptoms (high-quality evidence).[11]

Trials with larger sample sizes are needed to provide the evidence of causality between Vitamin D and asthma. These trials will also be helpful in establishing the appropriate route, dose, and safety of Vitamin D supplementation for the prevention and treatment of asthma. Further researches are needed on the molecular level of Vitamin D receptor to explain the role of dietary Vitamin D in the prevention and management of asthma.



 
  References Top

1.
Chambers ES, Hawrylowicz CM. The impact of Vitamin D on regulatory T cells. Curr Allergy Asthma Rep 2011;11:29-36.  Back to cited text no. 1
    
2.
Ali NS, Nanji K. A review on the role of Vitamin D in asthma. Cureus 2017;9:e1288.  Back to cited text no. 2
    
3.
Gupta A, Dimeloe S, Richards DF, Chambers ES, Black C, Urry Z, et al. Defective IL-10 expression andin vitro steroid-induced IL-17A in paediatric severe therapy-resistant asthma. Thorax 2014;69:508-15.  Back to cited text no. 3
    
4.
Chinellato I, Piazza M, Sandri M, Peroni D, Piacentini G, Boner AL. Vitamin D serum levels and markers of asthma control in Italian children. J Pediatr 2011;158:437-41.  Back to cited text no. 4
    
5.
Devereux G, Wilson A, Avenell A, McNeill G, Fraser WD. A case-control study of Vitamin D status and asthma in adults. Allergy 2010;65:666-7.  Back to cited text no. 5
    
6.
Kaaviyaa AT, Krishna V, Arunprasath TS, Ramanan PV. Vitamin D deficiency as a factor influencing asthma control in children. Indian Pediatr 2018;55:969-71.  Back to cited text no. 6
    
7.
Thuesen BH, Skaaby T, Husemoen LL, Fenger M, Jørgensen T, Linneberg A. The association of serum 25-OH Vitamin D with atopy, asthma, and lung function in a prospective study of Danish adults. Clin Exp Allergy 2015;45:265-72.  Back to cited text no. 7
    
8.
Esfandiar N, Alaei F, Fallah S, Babaie D, Sedghi N. Vitamin D deficiency and its impact on asthma severity in asthmatic children. Ital J Pediatr 2016;42:108.  Back to cited text no. 8
    
9.
Sharma P, Alok K, Mittal K. Correlation of severity of asthma with serum Vitamin D3 and serum magnesium level in children aged 5-14 years. J Ped Crit Care 2020;7:69-72.  Back to cited text no. 9
    
10.
Jolliffe DA, Greenberg L, HooperRL, Griffiths CJ, Camargo CA Jr, Kerley CP, et al. Vitamin D supplementation to prevent asthma exacerbations: A systematic review and meta-analysis of individual participant data. Lancet Respir Med 2017;5:881-90.  Back to cited text no. 10
    
11.
Martineau AR, Cates CJ, Urashima M, Jensen M, Griffiths AP, Nurmatov U, et al. Vitamin D for the management of asthma. Cochrane Database Syst Rev 2016;9:CD011511. doi:10.1002/14651858.CD011511.pub2  Back to cited text no. 11
    




 

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