DOI: http://dx.doi.org/10.18203/2349-3933.ijam20162517

Assessment and evaluation of vitamin D levels in patients of moderate persistent asthma: a prospective study in rural hilly area

Vivek Sood, Atal Sood

Abstract


Background: The discovery of non-classical actions of vitamin D has opened new applications. Among these is its anti-inflammatory role in inflammatory diseases like asthma. Low levels of vitamin D have been associated with asthma severity and recurrent exacerbations. Emerging evidence suggests that vitamin D deficiency (VDD) is also associated with increased airway hyper-responsiveness, decreased pulmonary function and decreased response to standard anti-asthma therapy.

Methods: In this prospective study, vitamin D levels were assessed in 50 consecutive consenting subjects of moderate persistent asthma diagnosed as per GINA guidelines. Levels were assessed in relation to exacerbations, seasonal variation in spring, rainy and winter season and lung function. 

Results: 62% subjects were having deficient levels of 25 (OH) Vitamin D (<20 ng/ml). None of study participant had sufficient levels of vitamin D. There was lack of seasonal effect due to variation in sun exposure in different seasons on levels of vitamin D. This study found no correlation (r=0.078) between levels of vitamin D and number of exacerbations in patients of asthma on regular treatment. In subjects groups having less and more than 3 exacerbations in nine months, difference of vitamin D levels and lung function was also statistically not significant.

Conclusions: Findings of this study were consistent with HUNT study that concluded non association of low serum 25 (OH) D levels with airway obstruction. However, considerable variation in different study results with regard to seasonal, lung function and exacerbational variation underline the need for a meta-analysis in this field.


Keywords


Vitamin D in asthma, Seasonal variation of vitamin D, Lung function and vitamin D

Full Text:

PDF

References


Health Quality Ontario. Clinical Utility of Vitamin D Testing: An Evidence-Based Analysis. Ont Health Technol Assess Ser. 2010;10(2):1-93.

Vishwanath P, Kulkarni P, Prashant A. Vitamin D deficiency in India: Are we over concerned?. Int J Health Allied Sci. 2014;3:77-8

Matsuoka LY, Wortsman J, Haddad JG, Kolm P, Hollis BW. Racial Pigmentation and the Cutaneous Synthesis of Vitamin D. Arch Dermatol. 1991;127(4):536-38.

Lo CW, Paris PW, Holick MF. Indian and Pakistani immigrants have the same capacity as Caucasians to produce vitamin D in response to ultraviolet irradiation.Am J Clin Nutr. 1986;44(5):683-5.

Ritu G, Gupta A. Vitamin D Deficiency in India: Prevalence, Causalities and Interventions. Nutrients. 2014;6(2):729-75.

Lin Z, Li W. The Roles of Vitamin D and Its analogs in Inflammatory Diseases. Curr Top Med Chem. 2016;16(11):1242-61.

Niruban SJ, Alagiakrishnan K, Beach J, Senthilselvan A. Association between vitamin D and respiratory outcomes in Canadian adolescents and adults. J Asthma. 2015;52(7):653-61.

Korn S, Hübner M, Jung M, Blettner M, Buhl R. Severe and uncontrolled adult asthma is associated with vitamin D insufficiency and deficiency. Respir Res .2013;14(1):25.

Confino-Cohen R, Brufman I, Goldberg A, Feldman BS. Vitamin D, asthma prevalence and asthma exacerbations: a large adult population-based study. Allergy. 2014;69:1673-80.

Kerley CP, Elnazir B, Faul J, Cormican L. Vitamin D as an adjunctive therapy in asthma. Part 1: A review of potential mechanisms. Pulm Pharmacol Ther. 2015;32:60-74.

Berraies A, Hamzaoui K, Hamzaoui A. Link between vitamin D and airway remodeling. J Asthma Allergy. 2014;7:23-30.

Kamran A, Alam SM, Qadir F. Prevalence of vitamin D deficiency and insufficiency among adult asthmatic patients in Karachi. Pak J Pharm Sci. 2014; 27(6 Spec No.):2139-44.

Kolokotroni O, Papadopoulou A, Middleton N, Kouta C, Raftopoulos V, Nicolaidou P et al. Vitamin D levels and status amongst asthmatic and non-asthmatic adolescents in Cyprus: a comparative cross-sectional study. BMC Public Health 2015;15:48.

Brehm JM, Schuemann B, Fuhlbrigge AL, et al. Serum Vitamin D Levels and Severe Asthma Exacerbations in the Childhood Asthma Management Program Study. The Journal of allergy and clinical immunology. 2010;126(1):52-8.

Menon J, Maranda L, Nwosu BU. Serum 25-hydroxyvitamin D levels do not correlate with asthma severity in a case-controlled study of children and adolescents. J Pediatr Endocrinol Metab. 2012; 25(7-8):673-9.

Jung JY, Kim YS, Kim SK, Kim HY, Oh YM, Lee SM, Seo JB, Lee SD; KOLD Study. Relationship of vitamin D status with lung function and exercise capacity in COPD. Respirology. 2015; 20(5):782-9.

Larose TL, Langhammer A, Chen Y, Camargo CA Jr, Romundstad P, Mai XM. Serum 25-hydroxyvitamin D levels and lung function in adults with asthma: the HUNT Study. Eur Respir J. 2015;45(4):1019-26.

Heidari B, Mirghassemi MBH, Seasonal variations in serum vitamin D according to age and sex. Caspian J Intern Med. 2012;3(4):535-40.

Andersen R, Brot C, Jakobsen J, Mejborn H, Mølgaard C, Skovgaard L et al. Seasonal changes in vitamin D status among Danish adolescent girls and elderly women: the influence of sun exposure and vitamin D intake. European Journal of Clinical Nutrition. 2013;67(3):270-4.

Kull M, Kallikorm R, Tamm A, Lember M. Seasonal variance of 25-(OH) vitamin D in the general population of Estonia, a Northern European country. BMC Public Health. 2009;9(1):22.

Bolland MJ, Grey AB, Ames RW, Mason BH, Horne AM, Gamble GD et al. The effects of seasonal variation of 25-hydroxyvitamin D and fat mass on a diagnosis of vitamin D sufficiency. Am J Clin Nutr. 2007;86(4):959-64.