Allergy Asthma Immunol Res.  2013 Sep;5(5):289-294. 10.4168/aair.2013.5.5.289.

The Effect of Vitamin D Status on Pediatric Asthma at a University Hospital, Thailand

• Krobtrakulchai W
• Praikanahok J
• Visitsunthorn N
• Vichyanond P
• Manonukul
• Pratumvinit B
• Jirapongsananuruk O

• KMID: 2260809
• DOI: http://doi.org/10.4168/aair.2013.5.5.289

Abstract

PURPOSE
In the USA and Europe, hypovitaminosis D is associated with increased asthma severity, emergency department (ED) visit, and impaired pulmonary function in asthmatic patients. However, in tropical countries, data on the effect of vitamin D status on asthma is limited. This study evaluates the relationship between vitamin D status and the level of asthma control as well as other asthmatic parameters.
METHODS
Asthmatic children were evaluated for serum 25-hydroxyvitamin D, pulmonary function tests, a skin prick test, and the level of asthma control.
RESULTS
A total of 125 asthmatic children were recruited (boys, 66.4%). Their mean age+/-SD was 10.8+/-3.0 years. Vitamin D statuses were: deficiency (<20 ng/mL) in 19.2% of the patients, insufficiency (20-30 ng/mL) in 44.8%, and sufficiency (>30 ng/mL) in 36%. The vitamin D levels were 25.9+/-9.4 ng/mL in uncontrolled patients, 29.2+/-8.6 ng/mL in partly controlled patients, and 27.9+/-8.0 ng/mL in controlled patients (P>0.05). There were no significant differences in pulmonary function, asthma exacerbation, inhaled-corticosteroid (ICS) dose, anti-inflammatory drugs, or ED visit or hospitalization between different vitamin D statuses. Vitamin D deficiency patients were older and had a delayed onset of asthma than insufficiency or sufficiency patients. There was no significant correlation between serum vitamin D and pulmonary function/doses of ICS.
CONCLUSIONS
High prevalences of vitamin D deficiency and insufficiency were found in asthmatic children in Thailand; however, there was no significant relationship between vitamin D status and the level of asthma control or other asthma parameters.

Keyword

Asthma; children; corticosteroid; 25-hydroxyvitamin D; vitamin D

MeSH Terms

Asthma
Child
Emergencies
Europe
Hospitalization
Humans
Prevalence
Respiratory Function Tests
Skin
Thailand
Vitamin D
Vitamin D Deficiency
Vitamins
Vitamin D
Vitamins

Figure

• 

  Fig. 1 The box plot of serum vitamin D levels in uncontrolled, partly controlled, and controlled asthmatic patients.

• 

  Fig. 2 The distribution of serum vitamin D levels in pediatric asthmatic patients.

Reference

1. Global Initiative for Asthma. Global strategy for asthma management and prevention [Internet]. NIH publication;c2010. updated 2010. cited 2010 Aug 12. Available from: http://www.ginasthma.org.

2. Trakultivakorn M, Sangsupawanich P, Vichyanond P. Time trends of the prevalence of asthma, rhinitis and eczema in Thai children-ISAAC (International Study of Asthma and Allergies in Childhood) Phase Three. J Asthma. 2007; 44:609–611.

3. Litonjua AA, Weiss ST. Is vitamin D deficiency to blame for the asthma epidemic? J Allergy Clin Immunol. 2007; 120:1031–1035.

4. Holick MF. Vitamin D deficiency. N Engl J Med. 2007; 357:266–281.

5. Freishtat RJ, Iqbal SF, Pillai DK, Klein CJ, Ryan LM, Benton AS, Teach SJ. High prevalence of vitamin D deficiency among innercity African American youth with asthma in Washington, DC. J Pediatr. 2010; 156:948–952.

6. Brehm JM, Celedon JC, Soto-Quiros ME, Avila L, Hunninghake GM, Forno E, Laskey D, Sylvia JS, Hollis BW, Weiss ST, Litonjua AA. Serum vitamin D levels and markers of severity of childhood asthma in Costa Rica. Am J Respir Crit Care Med. 2009; 179:765–771.

7. Sutherland ER, Goleva E, Jackson LP, Stevens AD, Leung DY. Vitamin D levels, lung function, and steroid response in adult asthma. Am J Respir Crit Care Med. 2010; 181:699–704.

8. Searing DA, Zhang Y, Murphy JR, Hauk PJ, Goleva E, Leung DY. Decreased serum vitamin D levels in children with asthma are associated with increased corticosteroid use. J Allergy Clin Immunol. 2010; 125:995–1000.

9. Devereux G, Litonjua AA, Turner SW, Craig LC, McNeill G, Martindale S, Helms PJ, Seaton A, Weiss ST. Maternal vitamin D intake during pregnancy and early childhood wheezing. Am J Clin Nutr. 2007; 85:853–859.

10. Peterlik M, Boonen S, Cross HS, Lamberg-Allardt C. Vitamin D and calcium insufficiency-related chronic diseases: an emerging worldwide public health problem. Int J Environ Res Public Health. 2009; 6:2585–2607.

11. Lips P. Worldwide status of vitamin D nutrition. J Steroid Biochem Mol Biol. 2010; 121:297–300.

12. Andersen R, Mølgaard C, Skovgaard LT, Brot C, Cashman KD, Chabros E, Charzewska J, Flynn A, Jakobsen J, Kärkkäinen M, Kiely M, Lamberg-Allardt C, Moreiras O, Natri AM, O'Brien M, Rogalska-Niedzwiedz M, Ovesen L. Teenage girls and elderly women living in northern Europe have low winter vitamin D status. Eur J Clin Nutr. 2005; 59:533–541.

13. Green TJ, Skeaff CM, Rockell JE, Venn BJ, Lambert A, Todd J, Khor GL, Loh SP, Muslimatun S, Agustina R, Whiting SJ. Vitamin D status and its association with parathyroid hormone concentrations in women of child-bearing age living in Jakarta and Kuala Lumpur. Eur J Clin Nutr. 2008; 62:373–378.

14. Soontrapa S, Soontrapa S, Bunyaratavej N, Rojanasthien S, Kittimanon N, Lektrakul S. Vitamin D status of Thai premenopausal women. J Med Assoc Thai. 2009; 92:Suppl 5. S17–S20.

15. Chailurkit LO, Kruavit A, Rajatanavin R. Vitamin D status and bone health in healthy Thai elderly women. Nutrition. 2011; 27:160–164.

16. Cohen J. Applied multiple regression correlation analysis for the behavioral sciences. Hillsdale, NJ: Lawrence Erlbaum Associates, Inc.;2003.

17. Holick MF. Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease. Am J Clin Nutr. 2004; 80:1678S–1688S.

18. Binkley N, Novotny R, Krueger D, Kawahara T, Daida YG, Lensmeyer G, Hollis BW, Drezner MK. Low vitamin D status despite abundant sun exposure. J Clin Endocrinol Metab. 2007; 92:2130–2135.

19. Gupta A, Sjoukes A, Richards D, Banya W, Hawrylowicz C, Bush A, Saglani S. Relationship between serum vitamin D, disease severity, and airway remodeling in children with asthma. Am J Respir Crit Care Med. 2011; 184:1342–1349.

20. 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; 158:437–441.

21. Devereux G, Wilson A, Avenell A, McNeill G, Fraser WD. A casecontrol study of vitamin D status and asthma in adults. Allergy. 2010; 65:666–667.

22. Ciaccio CE, Portnoy JM. Vitamin D insufficiency and risk of severe asthma exacerbations. Curr Allergy Asthma Rep. 2010; 10:387–388.

23. Alyasin S, Momen T, Kashef S, Alipour A, Amin R. The relationship between serum 25 hydroxy vitamin d levels and asthma in children. Allergy Asthma Immunol Res. 2011; 3:251–255.