Connection between Vitamin D and Asthma Management

Earlier on, it was seen that Vitamin D was only used to regulate calcium and osteomalacia levels in bone to prevent diseases such as rickets in children and Arthritis in adults. Then recently, it was seen that Vitamin D was seen to express in 35 tissues and respiratory epithelium, thus it was a possible source to study it’s modulates in the immune function too.

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When the immune function regarding Vitamin D was studied, it was observed to have two functions. Firstly, it was seen that its ability to induce respiratory virus infection and secondly, it was seen to suppress the inflammatory responses.

On observing the above phenomenon, a simple observation emerged that linked lower Vitamin D status to poor asthma control in every age group. They were found to operate in a very diverse range of settings and ages and so a compelling hypothesis emerged that vitamin D could have a role in protecting against asthma exacerbation.

Hypothesis which led to clear findings

The key finding was that Vitamin D had protective effects against asthma exacerbations to a percentage upto 50% reduction. Vitamin D even reduced the asthma exacerbations which were under the influence of oral steroids.

This reflects the fact that those other trials tended to enroll patients with milder disease, so the finding relating to exacerbations requiring oral steroid treatment was restricted to these three trials that included patients with more severe disease and even they included quite a lot of patients with mild-to-moderate disease as well.

The hospitalization finding was related to a broader range of the trials, in fact seven of the trials, so that's more generalizable. The interesting thing was that, although we saw a protective effect of vitamin D on the asthma attack outcome, we didn't see significant effects on the other outcomes we looked at such as day-to-day symptom control, lung function or other bio markers of airway inflammation.

Mechanisms which explain the findings

Vitamin D is known to boost innate immune responses to viral pathogens such as rhinovirus which is the common precipitants of asthma exacerbations. So it may be that vitamin D is upper respiratory infections such as colds and flu, which would otherwise trigger exacerbations.

The other explanation to this is that Vitamin D could be inducing the anti-inflammatory responses. It may be incorporating the secretion of interleukin 10 and other cytokines which can reduce the symptoms of asthma which can relate to the uncontrolled airway inflammation. If that can be controlled then we can stop, terminate or even prevent an exacerbation.

CONCLUSION

Although this finding is exciting, it doesn't actually take us quite yet to a point where we can make a clinical recommendation and include it in guidelines.

Another point is that only about half of asthma sufferers actually experience severe exacerbations of the sort that we're reporting on. Our review doesn't suggest that vitamin D will benefit the group who doesn't suffer these exacerbations.

This study has just been an add-on study to the fact that Vitamin D can be used in addition to the standard asthma treatment. It is definitely not a replacement for the treatment and nobody should be only increasing the amount of Vitamin D in their dosage to treat asthma, it just proposes the fact that Vitamin D can be added in the daily diet at a higher level which has a progressive effect to treat Vitamin D.

The crux of the study reveals that we can make a strong clinical recommendation that Vitamin D benefits everyone and it might have very significant benefit for the people who are deficient in the same and it just throws a progressive light on that.