Asthma and lower airway disease
Decreased serum vitamin D levels in children with asthma are associated with increased corticosteroid use

https://doi.org/10.1016/j.jaci.2010.03.008Get rights and content

Background

There is little knowledge about clinical variables associated with vitamin D (VitD) insufficiency in asthmatic children.

Objective

We sought to investigate disease variables associated with VitD insufficiency in patients with childhood asthma and interaction of VitD with corticosteroid-mediated anti-inflammatory responses.

Methods

We analyzed 25-hydroxyvitamin D serum levels in 100 asthmatic children to investigate relationships between 25-hydroxyvitamin D levels and patients' characteristics. We determined VitD's effects on dexamethasone (DEX) induction of mitogen-activated protein kinase phosphatase 1 and IL-10 in PBMCs.

Results

The median 25-hydroxyvitamin D serum level was 31 ng/mL. Forty-seven percent of subjects had VitD levels in the insufficient range (<30 ng/mL), whereas 17% were VitD deficient (<20 ng/mL). Log10 IgE (P = .01, ρ = −0.25) and the number of positive aeroallergen skin prick test responses (P = .02, ρ = −0.23) showed a significant inverse correlation with VitD levels, whereas FEV1 percent predicted (P = .004, ρ = 0.34) and FEV1/forced vital capacity ratio (P = .01, ρ = 0.30) showed a significant positive correlation with VitD levels. The use of inhaled steroids (P = .0475), use of oral steroids (P = .02), and total steroid dose (P = .001) all showed significant inverse correlations with VitD levels. The amount of mitogen-activated protein kinase phosphatase 1 and IL10 mRNA induced by VitD plus DEX was significantly greater than that induced by DEX alone (P < .01). In an experimental model of steroid resistance in which DEX alone did not inhibit T-cell proliferation, addition of VitD to DEX resulted in significant dose-dependent suppression of cell proliferation.

Conclusions

Corticosteroid use and worsening airflow limitation are associated with lower VitD serum levels in asthmatic patients. VitD enhances glucocorticoid action in PBMCs from asthmatic patients and enhances the immunosuppressive function of DEX in vitro.

Section snippets

Subjects

Children with asthma referred to National Jewish Health were identified through focused searches of laboratory data using codes for the 25-hydroxyvitamin D assay. Data were collected between April 1, 2008, and October 31, 2009. Patients' medical information was obtained by using the National Jewish Health electronic medical record and the National Jewish Research Database.13 Patients between the ages of 0 and 18 years who had 25-hydroxyvitamin D serum levels (used interchangeably with VitD

Subjects' characteristics

25-Hydroxyvitamin D levels and clinical features were analyzed in a total of 100 children with asthma aged 0 to 18 years (Table I). Racial data were available for 81 of the subjects. Seventy-nine percent of the participants were white, 9% were American Indian or Alaska Native (including Hispanic), 6% were African American, 3% were Asian, and 4% were of reported mixed race (data not shown).17 The median latitude was 39.0°N. The median eosinophil counts and total IgE levels were 311 cells/mm3 and

Discussion

In our population of pediatric patients with asthma, who were primarily from latitudes above 35°N, the prevalence of VitD insufficiency (<30 ng/mL) was 47%, with 17% of patients being VitD deficient (<20 ng/mL). These percentages were higher than in a recent study involving childhood asthma and VitD that was done in an equatorial population from Costa Rica, in which 28% had VitD insufficiency.12 The majority of our patients (79%) had VitD levels collected during a time period in which cutaneous

References (28)

  • Epidemiology and Statistics Unit, Research and Program Services Division: American Lung Association

    Trends in asthma morbidity and mortality

    (2009)
  • A.H. Liu et al.

    Childhood asthma

  • Expert Panel Report 3 (EPR-3): guidelines for the diagnosis and management of asthma—summary report 2007

    J Allergy Clin Immunol

    (2007)
  • B.J. Lipworth

    Systemic adverse effects of inhaled corticosteroid therapy: a systematic review and meta-analysis

    Arch Intern Med

    (1999)
  • Cited by (333)

    • Vitamin D, acute respiratory infection, and Asthma/COPD

      2023, Feldman and Pike's Vitamin D: Volume Two: Disease and Therapeutics
    • The Role of Comorbidities in Difficult-to-Control Asthma in Adults and Children

      2022, Journal of Allergy and Clinical Immunology: In Practice
    • The Role of Vitamins in the Pathogenesis of Asthma

      2023, International Journal of Molecular Sciences
    View all citing articles on Scopus

    Supported by National Institutes of Health grants AI070140 and HL37260.

    Disclosure of potential conflict of interest: The authors have declared that they have no conflict of interest.

    View full text