Asthma Severity In Children Associated With Low Vitamin D

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April 28, 2009

Asthma severity in children associated with low vitamin D levels

Asthma severity in children associated with low vitamin D levels

In the May 1, 2009 issue of American Journal of Respiratory and Critical Care Medicine, researchers at Harvard Medical School and Brigham and Women's Hospital in Boston report a link between insufficient levels of vitamin D and increased severity of asthma in children.

Asthma which is characterized by airway hyper-responsiveness to certain stimuli, results in coughing, wheezing, and shortness of breath. For unknown reasons, the prevalence of asthma is increasing, particularly in industrialized nations.

Juan Celedón, MD, DrPH, Augusto Litonjua, MD, MPH, and colleagues measured serum allergy markers and 25-hydroxyvitamin D levels in 616 children aged 6 to 14 living in the central valley of Costa Rica, an area that has a high incidence of asthma. Lung function tests and allergy skin testing were also conducted.

Twenty-eight percent of the children were found to have insufficient vitamin D levels of less than 30 nanograms per milliliter. Lower vitamin D levels were associated with increased allergy markers IgE and eosinophils. Those with higher vitamin D levels experienced a reduction in the risk of being hospitalized for any cause or using anti-inflammatory medications during the previous year. Higher vitamin D levels were also associated with decreased airway responsiveness.

"To our knowledge this is the first study to demonstrate an inverse association between circulating levels of vitamin D and markers of asthma severity and allergy," the authors write. "Our finding of insufficient vitamin D levels in 28 percent of asthmatic children in the Central Valley of Costa Rica supports previous findings that deficiency occurs even in sun-replete areas of the world."

"This study suggests that there may be added health benefits to vitamin D supplementation" Dr Celedón noted. "This study also provides epidemiological support for a growing body of in vitro evidence that vitamin D insufficiency may worsen asthma severity, and we suspect that giving vitamin D supplements to asthma patients who are deficient may help with their asthma control."

"Whether vitamin D supplementation can prevent the development of asthma in very young children is a separate question, which will be answered by clinical trials that are getting under way," he added.

In an accompanying editorial, Graham Devereux, MD, of the Department of Environmental and Occupational Medicine at the University of Aberdeen concluded, "Ultimately, it is only by investigating the effects of vitamin D in doses at, and above, those currently recommended that decisions can be made on the optimal intake of vitamin D and the possible prevention and treatment of asthma."

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The incidence of asthma cases has surged in recent years, although researchers aren’t sure exactly why. According to some studies, up to 5 percent of the US population is affected by asthma, with half of these cases developing before age 10 (Kasper DL et al 2005). Asthma attacks can be triggered by allergies and environmental irritants.

Scientists are also beginning to better understand the interaction between allergies, asthma, and oxidative stress. Oxidative stress occurs when highly reactive molecules, known as free radicals, interact with molecules within the body, especially DNA and mitochondrial membranes. Experimental evidence suggests that some pollutants, such as vehicle exhaust, may produce oxidative stress in the bronchial tubes (Gilmour MI et al 2006). Studies suggest that dietary supplementation with precursors of glutathione (an internal antioxidant), such as cysteine and alpha-lipoic acid, can enhance the pulmonary defenses, thus countering oxidative stress (Bridgeman MM et al 1991).

Butterbur (Petasites hybridus) is a perennial shrub that has been used since ancient times to treat a variety of conditions. As far back as the 17th century, butterbur was used to treat cough, asthma, and skin wounds (MMWR 2001). Today, researchers have uncovered the mechanism of action that makes butterbur effective.

Scientists have identified and isolated the compounds in butterbur that help reduce symptoms in asthma. Called petasins, these chemicals inhibit leukotrienes and histamines, which are responsible for symptom aggravation in asthma (Thomet OA et al 2002).

So far, a few research teams have examined butterbur’s effectiveness in asthmatics, with encouraging results. In one open trial of 64 adults and 16 children and adolescents, asthma patients were treated for two months with butterbur extract, followed by an optional two-month open trial. They were measured throughout the study for the severity and frequency of asthma attacks. According to researchers, all the measured symptoms improved throughout the study, and 40 percent of patients were able to reduce their intake of traditional asthma medications (Danesch UC 2004).



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