Co-relation between childhood asthma and serum vitamin D levels – a cross sectional study

Introduction: Asthma is a word of Greek origin that means to "breathe hard" or "to pant". One of the first persons to write about asthma was Hippocrates. He was able to recognize the spasmodic nature of the disease and believed its onset to be caused by moisture, occupation and climate. Objective: To evaluate serum Vitamin D levels in children’s suffering from asthma. Methodology: It is a cross sectional study was undertaken in children with asthma. Results: out of 110 asthmatics, 28 cases were in the age group of 1-5 years, 49 cases were in the age group 6-12 years, 33 cases were in the age group of 13-18 years and out of 110 asthmatic children 68 cases were male and 32 cases were females,14 children were in the age group of 1-5 years had deficient Vitamin D levels, 10 children’s had insufficient levels and 4 children’s had sufficient levels of Vitamin D, 28 children were in the age group of 6-12 years had deficient Vitamin D levels, 14 children’s had insufficient levels and 7 children’s had sufficient levels of Vitamin D, 21 children were in the age group of 13-18 years had deficient Vitamin D levels. Conclusion: There has been a growing interest in the potential role of vitamin D in asthma management, because it might help to reduce upper respiratory infections that can lead to exacerbations of asthma. Several clinical trials have tested whether taking vitamin D as a supplement has an effect on asthma attacks, symptoms, and lung function in children.


Introduction
Asthma is a word of Greek origin that means to "breathe hard" or "to pant". One of the first persons to write about asthma was Hippocrates. He was able to recognize the spasmodic nature of the disease and believed its onset to be caused by moisture, occupation and climate. He suspected that asthma was comparable to epilepsy and had its own nature arising from external cause. In 1968 Sir John Floyer in his book "A Treaties of Asthma" have said that asthma is due to the constriction of bronchi. He also distinguished between different "species" of asthma by contrasting continuous asthma with periodic or convulsive asthma. He also found that elements of the environment could trigger asthma attacks.
Vitamin D is not a true vitamin, because individuals with adequate exposure to sunlight do not require any dietary supplements. It is steroid hormone acting on There is a controversy regarding the normal levels of deficiency and insufficiency [2,3].

Objective
To evaluate serum Vitamin D levels in children's suffering from asthma In the present study done, out of 110 asthmatics, 28 cases were in the age group of 1-5 years, 49 cases were in the age group 6-12 years, 33 cases were in the age group of 13-18 years and out of 110 asthmatic children 68 cases were male and 32 cases were females. In the present study, 14 children were in the age group of 1-5 years had deficient Vitamin D levels, 10 children's had insufficient levels and 4 children's had sufficient levels of Vitamin D.
In the present study, 28 children were in the age group of 6-12 years had deficient Vitamin D levels, 14 children's had insufficient levels and 7 children's had sufficient levels of Vitamin D.
In the present study, 21 children were in the age group of 13-18 years had deficient Vitamin D levels, 10 children's had insufficient levels and 2 children's had sufficient levels of Vitamin D.

Discussion
In a  In the present study done, out of 110 asthmatics, 28cases were in the age group of 1-5 years, 49cases were in the age group 6-12 years, 33 cases were in the age group of 13-18 years and out of 110 asthmatic children 68 cases were male and 32 cases were females. In a retrospective cohort study assessing maternal intake of Vitamin D during pregnancy and risk of recurrent wheeze in children at 3 years of age it was found that increasing maternal Vitamin D intake during pregnancy decreased the risk of wheeze symptoms in early childhood [6].
In a study done by Korn et al in Germany in 280 adult asthmatics, it was found that 25(OH) D levels below 30ng/ml were common in adult asthma and most pronounced in patients with severe and/or uncontrolled asthma [7].
In a Cross-sectional study of 54 adults with persistent asthma in Denver, Colorado, serum Vitamin D was positively correlated with FEV1, glucocorticoid response and Vitamin D insufficiency or deficiency, (30ng/ml) was associated with airway hyper responsiveness [8].
A cross-sectional study of 7,648 Finnish adults at 31 years of age found that lack of Vitamin D supplementation (assessed in infancy) was associated with increased risk of asthma. However, this study lacked Vitamin D measures and had inadequate followup data on study participants [9]. . Another study by Freishtat et al which was a casecontrol study of 106 African American subjects 6 to 20 years of age found strong positive association between Vitamin D insufficiency and deficiency and asthma in African Americans [10].  [12][13][14][15][16][17].
There is growing literature suggesting a link between Vitamin D deficiency and asthma in children, but systematic reviews are lacking. The aim of this study is to evaluate the prevalence of Vitamin D deficiency in asthmatic children and to assess the correlations of Vitamin D levels with asthma incidence, asthma control, and lung functions. PubMed, EMBASE, and Cochrane Library were searched for observational studies on asthma and Vitamin D. Two authors independently extracted data. Meta-analysis was performed using the Review Manager Software. A total of 23 (11 case-control, 5 cohort, and 7 cross-sectional) studies enrolling 13,160 participants were included in the review. Overall, Vitamin D deficiency and insufficiency were prevalent in 28.5% and 26.7% children with asthma, respectively. Similar to our review, they also reported mixed results for association of Vitamin D levels with prevalence, incidence, and severity of asthma. This review also included studies where Vitamin D levels were measured during pregnancy. We excluded such studies, therefore number of cohort studies were less in our review. Yadav and Mittal conducted a randomized controlled trial of oral Vitamin D3 (cholecalciferol) supplementation of 60,000 IU per month for 6 months in children and reported better peak expiratory flow rate improvement, better asthma control, and reduced need of emergency visit and oral steroids use in Vitamin D group compared to placebo group. However, the Vitamin D levels were not measured in the study.
In another pediatric RCT, 500 units of Vitamin D supplementation daily for 6 months showed decreased asthma exacerbation in Vitamin D group though Vitamin D levels did not change before and after supplementation and lung function improved significantly in both arms. The Vitamin D assessment (VIDA) trial randomized 408 adults with poorly controlled asthma to supplement with high-dose Vitamin D or placebo. Vitamin D supplementation did not alter the rate of first treatment failure during 28 weeks. In a subgroup analysis, subjects with a rise in Vitamin D levels >30 ng/ml had decreased rate of treatment failure and acute asthma exacerbations compared to placebo. These trials suggest that Vitamin D supplementation will not be of help in all asthmatic children but in certain group of children [19][20][21][22][23].

Conclusion
Low blood levels of vitamin D have been linked to increased risk of asthma attacks in children.
There has been a growing interest in the potential role of vitamin D in asthma management, because it might help to reduce upper respiratory infections that can lead to exacerbations of asthma.
Several clinical trials have tested whether taking vitamin D as a supplement has an effect on asthma attacks, symptoms, and lung function in children.

What this study adds?
Asthmatic children had significantly lower Vitamin D levels.