Original article
Asthma, lower airway diseases
The effects of vitamin D supplementation on airway functions in mild to moderate persistent asthma

https://doi.org/10.1016/j.anai.2014.07.005Get rights and content

Abstract

Background

Vitamin D is hypothesized to have some roles in innate and adaptive immunity, inflammation reduction, and remodeling; therefore, it is supposed to affect the asthma phenotype, severity, and response to inhaled corticosteroid (ICS).

Objective

To explore the synergistic effects of vitamin D supplementation in addition to asthma controllers (ICS or ICS plus long-acting β-agonist) on airway functions.

Methods

A randomized clinical trial was conducted in 130 individuals aged 10 to 50 years who lived in Tehran during a 24-week period. Data on age, sex, body mass index, stage of asthma, serum total IgE, history of allergic rhinitis, atopic dermatitis, food allergy, and urticaria were collected. Spirometric parameters (forced expiratory volume in 1 second [FEV1] and ratio of FEV1 to forced vital capacity) and serum vitamin D measurement were obtained before and 8 and 24 weeks after the intervention. Patients were divided in 2 groups randomly. Both groups received asthma controllers (budesonide or budesonide plus formoterol) according to their stage, but the intervention group received vitamin D supplementation (100,000-U bolus intramuscularly plus 50,000 U orally weekly) in addition to asthma controllers.

Results

FEV1 improved significantly in both groups after 8 weeks, but no significant difference was found between the 2 groups at baseline (P = .20) or after 8 weeks (P = .99); however, a significant improvement was seen in the intervention group in the last 16 weeks, and FEV1 was significantly better in the intervention group than the other group after 24 weeks (P < .001).

Conclusion

Vitamin D supplementation associated with asthma controllers could significantly improve FEV1 in mild to moderate persistent asthma after 24 weeks.

Trial Registration

irct.ir Identifier: IRCT201302079608N1.

Introduction

There are no clear reasons for the increased prevalence of allergic diseases, especially asthma, in recent decades.[1], [2] Some epidemiologic studies suggest that vitamin D deficiency is associated with an increased incidence of asthma symptoms.[3], [4] Vitamin D has a critical role in corticosteroid resistance in asthma, suggesting that vitamin D may play a role in the control of asthma.5 Some studies suggest that vitamin D interacts with glucocorticoid signaling pathways5 and supplementation with the active pharmacologic form of vitamin D3 enhances dexamethasone-induced expression of interleukin (IL) 10 by T-regulatory cells.6 It has been already reported that vitamin D has several effects on the innate and adaptive immune system that might be relevant to asthma morbidity.[7], [8], [9], [10] A number of studies have concluded that low 25-hydroxy-vitamin D in mild to moderate asthma is correlated with poor asthma control, reduced lung function, reduced glucocorticoid response, more frequent exacerbations, and increased corticosteroid use.[10], [11], [12] Even though there are sufficient basic and epidemiologic studies to support a causal relationship between vitamin D and asthma, clinical data that address the effect of vitamin D supplementation on disease control and severity are limited in asthma patients. Therefore, the aim of this clinical trial was to investigate the synergistic role of vitamin D supplementation on airway functions in addition to standard asthma treatment.

Section snippets

Methods

This prospective, randomized, open-label, active controlled clinical trial was designed in an outpatient setting, and patients with mild to moderate persistent asthma 10 to 50 years old were enrolled according to inclusion and exclusion criteria. Rasool-e-Akram is a referral hospital in Tehran, and the study participants were selected from patients visited in the allergy or pulmonology clinics of the hospital. Because some interventional factors, such as skin pigmentation, diet, sun exposure

Results

A total of 130 patients who met the inclusion criteria were enrolled in this study and were randomly assigned to intervention and control groups. Age, sex, body mass index (BMI), stage of asthma (mild persistent or moderate persistent), history of atopic dermatitis, allergic rhinitis, food allergy or urticaria, serum total IgE, FEV1, ratio of FEV1 to forced vital capacity (FVC), and serum vitamin D were considered as variables for final analysis. Of 130 enrolled patients, 72 cases (55.4%) had

Discussion

Long-term inhaled corticosteroids are the main asthma controllers; however, a substantial proportion of patients do not achieve optimal asthma control despite high-dose treatment.23 In addition, many of the patients are prone to recurrent exacerbations because of common respiratory viral infections.2 Vitamin D is required for fetal lung development.24 It interacts with glucocorticoid signaling pathways.5 Investigations have found that vitamin D3 can induce expression of interleukin 10 by

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    Disclosures: Authors have nothing to disclose.

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