|Year : 2020 | Volume
| 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 Submission||29-Feb-2020|
|Date of Acceptance||07-Mar-2020|
|Date of Web Publication||10-Apr-2020|
Dr. Vinayak Patki
Department of Pediatrics, Wanless Hospital, Miraj, Maharashtra
Source of Support: None, Conflict of Interest: None
|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
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. 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.
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.
A cross-sectional survey on 75 Italian asthmatic children found that the prevalence of Vitamin D-deficiency was 53.3%. 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.
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.
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.
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.
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.
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.
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).
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.
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