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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 7  |  Issue : 2  |  Page : 69-72

Correlation of severity of asthma with serum Vitamin D3 and serum magnesium level in children aged 5–14 years


Department of Pediatrics, Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India

Date of Submission02-Jan-2020
Date of Decision22-Jan-2020
Date of Acceptance18-Feb-2020
Date of Web Publication10-Apr-2020

Correspondence Address:
Dr. Preeti Sharma
Department of Pediatrics, Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences, Rohtak - 124 001, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JPCC.JPCC_13_20

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  Abstract 


Background: Asthma is a common chronic respiratory disease affecting 1%–18% of the population in different countries. Many factors, such as genetic predisposition, early allergen exposure, infections, diet, tobacco smoke exposure, pollution, and Vitamin D3 status, are all proposed to influence the development and severity of asthma. Vitamin D3 alters human airway smooth muscle expression of chemokines and inhibits the expression of a steroid-resistant gene. Magnesium ion has an inhibitory action on smooth muscle contraction, histamine release from mast cells, and acetylcholine release from cholinergic nerve terminals, thus influencing the function of respiratory smooth muscles.
Aim: The aim is of this study is to assess serum Vitamin D3 level and serum magnesium level in children with asthma aged 5–14 years.
Materials and Methods: This was a cross-sectional study involving 75 children of 5–14 years of age having asthma, who were classified into intermittent, mild, moderate, and severe asthma, and serum Vitamin D3 levels and magnesium levels were estimated.
Results: Serum Vitamin D3 levels were significantly lower in children with severe asthma as compared to those with mild, moderate, or intermittent asthma, but serum magnesium levels were found to have no correlation with the severity of asthma in our study.
Conclusion: Vitamin D3 insufficiency is widely prevalent in Indian children with asthma and significantly correlated with the severity of asthma. Serum magnesium levels within the normal range and correlation of the severity of asthma with serum magnesium levels cannot be established in our study.

Keywords: Asthma, magnesium, Vitamin D3


How to cite this article:
Sharma P, Khanna A, Mittal K. Correlation of severity of asthma with serum Vitamin D3 and serum magnesium level in children aged 5–14 years. J Pediatr Crit Care 2020;7:69-72

How to cite this URL:
Sharma P, Khanna A, Mittal K. Correlation of severity of asthma with serum Vitamin D3 and serum magnesium level in children aged 5–14 years. J Pediatr Crit Care [serial online] 2020 [cited 2020 May 31];7:69-72. Available from: http://www.jpcc.org.in/text.asp?2020/7/2/69/282216




  Introduction Top


Asthma is a heterogeneous disease which is characterized by chronic airway inflammation. It is defined by the history of respiratory symptoms such as wheeze, shortness of breath, chest tightness, and cough that vary over time and in intensity, together with variable expiratory airflow limitation affecting an estimated 330 million individuals worldwide with a reported prevalence of 5%–20% in children aged between 6 and 15 years.[1],[2] In India, the estimated burden of asthma is >30 million. In children, incidence reported by 6–7 years and 13–14 years are 2.3% and 3.3%, respectively.[3],[4] Vitamin D3 has been shown to have a role in both innate and adaptive immunity by promoting phagocytosis and modulating the effects of TH1, TH2, and regulatory T-cells.[5] Further evidence suggests that Vitamin D3 alters human airway smooth muscle expression of chemokines and inhibits the expression of a steroid-resistant gene.[6] Magnesium is a cation having modulatory effect on the contractile state of smooth muscle cells in various tissues. Hypomagnesemia leads to contraction while hypermagnesemia leads to relaxation.[7] Hence, this study was carried out to detect the prevalence of hypomagnesemia with Vitamin D insufficiency and deficiency among asthmatic children group (5–14 years) of India. This study also aims to assess the relationship between serum magnesium and Vitamin D levels with the severity of asthma.


  Materials and Methods Top


This study was a cross-sectional observational study conducted in the Department of Pediatrics, in PGIMS Rohtak, from January 2018 to February 2019, including 75 children of age group 5–14 years who were diagnosed case of asthma and classified according to the severity as per the EPR3 (guidelines for the diagnosis and management of asthma [Table 1].[8] Among these children, 50 (66.55%) were male and 25 (33.34%) were female. Children with chronic renal disease, disease of calcium, and bone metabolism or those who were on Vitamin D3 supplementation, calcium therapy were excluded from the study. The ethics committee approved the study. After taking informed consent, a prestructured pro forma was used to record the relevant information from individual cases selected for the study. A detailed clinical examination was conducted, and under aseptic precautions, blood was drawn for relevant investigations, and then, the child was subjected for pulmonary function test (peak expiratory flow rate).
Table 1: Classifying asthma severity in children 5-11 years of age[8]

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Vitamin D3 level was measured in the serum of patients using chemiluminescent immunoassay on Beckman Coulter, Access 2 instrument technique.

Reference range:[9]

  • Category – serum Vitamin D3 levels
  • Sufficiency: >20 ng/ml (>50 nmol/L)
  • Insufficiency: 12–20 ng/ml (30–50 nmol/L)
  • Deficiency: <12 ng/ml (<30 nmol/L).


Magnesium: serum magnesium was measured by using spectrophotometry technique.

Reference range: 1.7–2.5 mg/dL.[10]

Statistical analysis

At the end of the study, the data were collected and entered into Microsoft Excel. Continuous variables were expressed as mean ± standard deviation and categorical variables were expressed as number/percentage. Statistical analysis was performed using SPSS version 20.0 (IBM SPSS Statistics).

  1. Differences between continuous variables were assessed using Student's t-test for normally distributed data
  2. Differences between categorical variables were assessed using the Chi-square test or Fischer's exact test. A value of P < 0.05 was considered statistically significant.



  Results Top


[Table 2] shows the demographic profile of the children according to gender and the severity of asthma. A total of 26 males and 17 females found to be intermittent, 15 males and 5 females with mild persistent and 9 males and 3 females as moderate persistent. Severe persistence was not seen in any of the patients. [Figure 1] and [Table 3] show a significant correlation of serum Vitamin D3 level with the severity of asthma. Among deficient patients, 71.4% had moderate persistent asthma, 28.5% mild persistent asthma and among insufficient patients, 32% had moderate persistent asthma, 12% mild persistent asthma, 56% intermittent asthma, showing that children who are Vitamin D3 insufficient or deficient have a higher incidence of severe asthma.
Table 2: Severity of asthma according to gender

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Figure 1: Comparison of serum Vitamin D3 levels with severity of asthma

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Table 3: Correlation between the severity of asthma and Vitamin D3 levels

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Moreover, results show stage-wise decline in serum levels of Vitamin D3 with an increase in the severity of asthma. There is no significant difference in serum magnesium levels in asthmatic patients. According to [Table 4], Thirty-eight (50.66%) patients had serum magnesium levels in the range of 1.7–2, 36 (48%) patients had between 2.1 and 3 and only 1 (1.33%) patient had magnesium level >3. All had serum magnesium levels within the normal range. As shown in [Table 5], no significant correlation can be established between hypomagnesemia and asthma severity. Furthermore, the duration of pediatric intensive care unit stay, number of acute exacerbations, asthma control at the time of presentation compared in our study to the asthma severity but did not show any significant correlation.
Table 4: Distribution of patients according to their serum magnesium level

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Table 5: Correlation between the severity of asthma and magnesium levels

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  Discussion Top


Bronchial asthma is a chronic condition characterized by recurrent bronchospasm resulting from reversible bronchial hyperresponsiveness in response to stimuli of a level or intensity which usually does not cause such narrowing in most individuals.[11] Asthma is the major health problem worldwide and increase in the prevalence of asthma has been reported in recent years, particularly in developing countries like India with the prevalence of about 2%. Calcitriol (active form of Vitamin D3) is involved in insulin secretion, inhibition of interleukin production by T-lymphocytes and immunoglobulin by B-lymphocytes, differentiation of monocyte precursor cells, and modulation of cell proliferation. Cells of the immune system such as T-lymphocytes activated B-lymphocytes, and dendritic cells express Vitamin D3 receptors.[12] The age of children in the study population ranged from 5 years to 14 years. The mean age of the study patients was 8.75 ± 2.64 years. The study included 50 males and 25 females with a male-to-female ratio of 2:1. The slightly higher number of males in the study was probably a bias due to small sample size. A male preponderance in asthma has been reported by various authors. Vittal have been reported a higher prevalence in boys (3.1%) as compared to girls (4.1%) in a study from Shimla.[13] A study by Chhabra et al. from Delhi has shown a significantly higher prevalence of current asthma in boys as compared to girls (12.8% and 10.7%, respectively).[14] Our result demonstrated that 66.66% of patients admitted with asthma had Vitamin D3 insufficiency and 9.33% had deficiency and among deficient patients, 71.4% had moderate persistent asthma as compared to 28.5% had mild persistent asthma, while no patient with intermittent asthma had Vitamin D deficiency. The study showed that children who are Vitamin D3 insufficient or deficient have a higher incidence of severe asthma but statistically found to be insignificant correlation between the level of asthma control and Vitamin D3 sufficiency levels.

All the children included had serum magnesium levels within the normal range that is 1.7–2.5 mg/dL. No controls were included; therefore, comparison in serum magnesium levels between asthmatic and nonasthmatic children cannot be established. Thus, our study showed no significant correlation between serum magnesium level and asthma severity. Youssef aimed at outlining the possible role of magnesium in the pathogenesis and treatment of bronchial asthma including 27 asthmatic children and 15 healthy controls, measuring both intracellular and extracellular magnesium levels. The results found a significant correlation between the severity of asthma and serum magnesium levels, both intracellular and extracellular.[15] Similarly, Kakish et al. conducted a study comparing serum magnesium levels of 176 children with asthma acute exacerbation and 94 with chronic stable asthma with 232 healthy controls concluded that there was no significant difference in serum magnesium levels when compared in asthmatic children during acute attack and between exacerbation with that of control.[16]

Hence, there are limited data suggesting correlation between the severity of asthma and serum magnesium level in children, also with the studies available having inconclusive results regarding the same, further studies need to be conducted.


  Conclusion Top


We conclude that Vitamin D3 insufficiency is widely prevalent in Indian children with asthma. Vitamin D3 deficiency was found to be significantly associated with the severity of asthma and patients with more severe asthma were found to have significantly lower Vitamin D3 levels as compared to cases with mild or intermittent asthma. All children have serum magnesium levels within the normal range and correlation of the severity of asthma with serum magnesium levels cannot be established in study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Moorman JE, Rudd RA, Johnson CA, King M, Minor P, Bailey C, et al. National surveillance for asthma – United States, 1980-2004. MMWR Surveill Summ 2007;56:1-54.  Back to cited text no. 1
    
2.
Aït-Khaled N, Pearce N, Anderson HR, Ellwood P, Montefort S, Shah J, et al. Global map of the prevalence of symptoms of rhinoconjunctivitis in children: The International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three. Allergy 2009;64:123-48.  Back to cited text no. 2
    
3.
Sharma SK, Banga A. Prevalence and risk factors for wheezing in children from rural areas of north India. Allergy Asthma Proc 2007;28:647-53.  Back to cited text no. 3
    
4.
Awasthi S, Kalra E, Roy S, Awasthi S. Prevalence and risk factors of asthma and wheeze in school-going children in Lucknow, North India. Indian Pediatr 2004;41:1205-10.  Back to cited text no. 4
    
5.
Gombart AF, Borregaard N, Koeffler HP. Human cathelicidin antimicrobial peptide (CAMP) gene is a direct target of the vitamin D receptor and is strongly up-regulated in myeloid cells by 1,25-dihydroxyvitamin D3. FASEB J 2005;19:1067-77.  Back to cited text no. 5
    
6.
Banerjee A, Damera G, Bhandare R, Gu S, Lopez-Boado Y, Panettieri R Jr., et al. Vitamin D and glucocorticoids differentially modulate chemokine expression in human airway smooth muscle cells. Br J Pharmacol 2008;155:84-92.  Back to cited text no. 6
    
7.
de Valk HW, Kok PT, Struyvenberg A, van Rijn HJ, Haalboom JR, Kreukniet J, et al. Extracellular and intracellular magnesium concentrations in asthmatic patients. Eur Respir J 1993;6:1122-5.  Back to cited text no. 7
    
8.
National Asthma Education and Prevention Program. Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma-Summary Report 2007 [published correction appears in J Allergy Clin Immunol 2008;121:1330]. J Allergy Clin Immunol 2007;120(5 Suppl):S94-S138. doi:10.1016/j.jaci.2007.09.043.  Back to cited text no. 8
    
9.
Munns CF, Shaw N, Kiely M, Specker BL, Thacher TD, Ozono K, et al. Global consensus recommendations on prevention and management of nutritional rickets. Horm Res Paediatr 2016;85:83-106.  Back to cited text no. 9
    
10.
Shaikh MN, Malapati BR, Gokani R, Patel B, Chatriwala M. Serum magnesium and Vitamin D levels as indicators of asthma severity. Pulm Med 2016;2016:1643717.  Back to cited text no. 10
    
11.
Agarwal R, Dhooria S, Aggarwal AN, Maturu VN, Sehgal IS, Muthu V, et al. Guidelines for diagnosis and management of bronchial asthma: Joint ICS/NCCP (I) recommendations. Lung India 2015;32:S3-42.  Back to cited text no. 11
    
12.
Aranow C. Vitamin D and the immune system. J Investig Med 2011;59:881-6.  Back to cited text no. 12
    
13.
Vittal BG. A study of magnesium and other serum electrolyte levels during nebulized salbutamol therapy. J Clin Diagn 2010;4:3460-4.  Back to cited text no. 13
    
14.
Chhabra P, Sharma G, Kannan AT. Prevalence of respiratory disease and associated factors in an urban area of delhi. Indian J Community Med. 2008;33:229-32. doi:10.4103/0970-0218.43227.  Back to cited text no. 14
    
15.
Youssef MF. Magnesium status and therapeutic effects in asthmatic children. EC Paediatr 2018;73:194-203.  Back to cited text no. 15
    
16.
Kakish KS. Serum magnesium levels in asthmatic children during and between exacerbations. Arch Pediatr Adolesc Med 2001;155:181-3.  Back to cited text no. 16
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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