Vitamin D Improved Asthma Symptoms in Vitamin D Deficient Asthmatic Patients

by | Sep 9, 2019 | 2017, Asthma, Vitamin D - General

Written by Chrystal Moulton, Staff Writer. Long term supplementation with vitamin D reduces occurrence of asthmatic exacerbations and corticosteroid use in asthmatic patients with vitamin D deficiency.

vitamin DResearch on risk factors related to vitamin D deficiency and asthma show a strong association between the two ailments 1.  In the current study 2, researchers sought to define the association between vitamin D abnormalities and asthmatic exacerbations and show that long term treatment with vitamin D could improve the symptoms of asthma in asthmatic patients. Phase 1 of the study was a cross-sectional retrospective analysis completed on 119 asthmatic patients. Researchers assessed lung capacity (FEV/ VC), fractional exhaled nitric oxide, allergic reactions, medications used, smoking habits, and other comorbidities. They also conducted lab tests for eosinophil, ferritin, folic acid and B12. In phase 2 of the trial, researchers conducted an intervention study with patients (from phase 1) exhibiting vitamin D deficiency. These individuals (n=90) had 25-OHD< 20ng/ml and as a result were supplemented with vitamin D for one year. Initial dose was an intramuscular dose of 100,000 IU of cholecalciferol. Patients were then instructed to take a weekly dose of 5000IU of cholecalciferol provided as an oral drop (20 drops of 10,000IU/mL oral solution) plus a daily dose of 400IU in a chewable tablet (tablet also contained 1500mg calcium carbonate). Patients were to maintain scheduled asthma medication use throughout the phase 2 of the study. During treatment period for 3 months, researchers assessed fractional nitric oxide values, FEV, VC, occurrence of exacerbations and the number of patients needing one of more courses of oral corticosteroids. Vitamin D level (25-OHD) and circulation eosinophils were measured at the end of the one-year study period.

Data from the cross-sectional study or phase 1 showed that vitamin D was significantly and inversely related to the occurrence of exacerbations within a year (R= 0.474, p<0.001), inhaled corticosteroid score (R=0.336, p=0.008), and GINA asthma severity class (R= 0.290, p=0.001). Serum 25-OHD levels were also directly linked to median annual value of FEV1% predicted (R=0.25, p=0.005) and FEV1/VC% (R=0.26, p=0.004). In other words, as serum 25-OHD levels decreased, severity of asthmatic reactions, exacerbations, and the need to use corticosteroid medication increased. Moreover, Linear Model analysis over one year showed that 25-OHD deficiency was associated with exacerbations (p<0.001), rhinosinusitis (p=0.015), and osteoporosis (p=0.010). Nutrients other than vitamin D (such as folic acid, ferritin, and B12), lung function, and other comorbidities had no effect on the occurrence of exacerbations.

In the intervention study (phase 2), 66 of 90 patients completed the trial. However, 55 were completely adherent to the treatment protocol. Data were recorded for both adherent patients [group 3] as well as the non-adherent patients [group 2, n=11] over 1 year of cholecalciferol supplementation. Among adherent patients (n=55), after one year of vitamin D supplementation, researchers saw a significant decrease in asthma exacerbations [baseline: 2.6; after 1yr vitamin D supplementation: 1.6, p<0.001], corticosteroid use [baseline: 64%; after 1yr vitamin D supplementation: 40%, p=0.007], and blood eosinophil level [baseline: 390 x 106/L; after 1yr vitamin D supplementation: 270 x 106/L, p=0.002]. Patients had significant increase in 25-OHD levels [baseline: 13 ng/mL; after 1yr vitamin D supplementation: 31.7ng/mL, p<0.001], FEV1 [baseline: 1.86; after 1yr vitamin D supplementation: 2.11 p<0.001], FEV1 /VC% [baseline: 63; after 1yr vitamin D supplementation: 67, p=0.002]. No change was found in fractional nitric oxide levels. In non-adherent patients, results after one year were very similar to baseline. No significant changes were seen in 25-OHD, circulating eosinophils, FEV1, and FEV1/VC%.

Overall, the cross-sectional phase demonstrated that an increase in asthma severity is directly associated with vitamin D deficiency in asthmatic patients. The intervention phase showed that long term supplementation with vitamin D improved asthma symptoms in patients with vitamin D deficiency. These findings agree with other studies that show an association between low vitamin D and airway obstruction in both asthmatics 3-6 and the general population 7,8. Researchers in the study suggested that a daily dose of 1500-2000IU of vitamin D would be sufficient for improving 25-OHD levels in vitamin D deficient patients 9.

Source:  Solidoro, Paolo, Michela Bellocchia, Ilaria Aredano, Alessio Mattei, Emanuele Pivetta, Filippo Patrucco, Monica Boita et al. “Asthmatic patients with vitamin d deficiency have decreased exacerbations after vitamin replacement.” Nutrients 9, no. 11 (2017): 1234.

© 2017 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/)

Click here to read the full text study.

Posted September 9, 2019.

Chrystal Moulton BA, PMP, is a 2008 graduate of the University of Illinois at Chicago. She graduated with a bachelor’s in psychology with a focus on premedical studies and is a licensed project manager. She currently resides in Indianapolis, IN.

References:

  1. Paul G, Brehm JM, Alcorn JF, Holguín F, Aujla SJ, Celedón JC. Vitamin D and asthma. American journal of respiratory and critical care medicine. 2012;185(2):124-132.
  2. Solidoro P, Bellocchia M, Aredano I, et al. Asthmatic patients with vitamin d deficiency have decreased exacerbations after vitamin replacement. Nutrients. 2017;9(11):1234.
  3. Brehm JM, Acosta-Pérez E, Klei L, et al. Vitamin D insufficiency and severe asthma exacerbations in Puerto Rican children. American journal of respiratory and critical care medicine. 2012;186(2):140-146.
  4. Beyhan-Sagmen S, Baykan O, Balcan B, Ceyhan B. Association between severe vitamin D deficiency, lung function and asthma control. Archivos de Bronconeumología (English Edition). 2017;53(4):186-191.
  5. Confino‐Cohen R, Brufman I, Goldberg A, Feldman B. Vitamin D, asthma prevalence and asthma exacerbations: a large adult population‐based study. Allergy. 2014;69(12):1673-1680.
  6. Korn S, Hübner M, Jung M, Blettner M, Buhl R. Severe and uncontrolled adult asthma is associated with vitamin D insufficiency and deficiency. Respiratory research. 2013;14(1):25.
  7. Black PN, Scragg R. Relationship between serum 25-hydroxyvitamin d and pulmonary function in the third national health and nutrition examination survey. CHEST Journal. 2005;128(6):3792-3798.
  8. Larose TL, Langhammer A, Chen Y, Camargo CA, Romundstad P, Mai X-M. Serum 25-hydroxyvitamin D levels and lung function in adults with asthma: the HUNT Study. European Respiratory Journal. 2015;45(4):1019-1026.
  9. Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism. 2011;96(7):1911-1930.