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Asthma epidemic and its relation to vitamin D deficiency

Posted on: September 23, 2011   by  John Cannell, MD


Although I have written more about the autism epidemic, another epidemic is occurring among our children, an asthma epidemic. About ten percent of the millions of asthmatic children around the world have severe therapy resistant asthma. These children live a tragic childhood of sickness, breathlessness, hospitalizations and fear that would break your heart to see.

On September 15, 2011, Dr. Atul Gupta and six colleagues from the Royal Brompton Hospital in London published a remarkable, first of its kind, paper on childhood asthma and vitamin D.

Gupta A, Sjoukes A, Richards D, Banya W, Hawrylowicz C, Bush A, Saglani S. Relationship Between Serum Vitamin D, Disease Severity and Airway Remodeling in Children with Asthma. Am J Respir Crit Care Med. 2011 Sep 15. [Epub ahead of print]

First, unlike autism, a number of papers exist on the subject of vitamin D and asthma and the authors review them. Dr. Gupta reminds us that previous studies show associations between low vitamin D levels and asthma control, severity, exacerbation, lower lung function, and response to treatment. Scientists have published enough papers on childhood asthma and vitamin D that one would think that doctors are routinely treating asthmatic children for their vitamin D deficiency but if you thought that, you would be wrong.

Like other scientists before him, the authors found vitamin D deficient asthmatic children are more likely to have lower lung function, poor asthma control, increased medication use and more frequent asthma attacks. Then Dr. Gupta took the next step by taking a tiny piece of lung from children with severe asthma, finding the vitamin D deficient children had more structural airway abnormalities than vitamin D sufficient children.

His conclusion is worth quoting,

“These findings suggest that detecting and treating low serum vitamin D levels in children with asthma may aid in treatment of specific structural airway changes.”

That is, it might be time to treat vitamin D deficiency in asthmatic children.

Why aren’t doctors treating these children with vitamin D if they are deficient? First, the pulmonologists (lung doctors) are too overwhelmed with the epidemic to read the scientific literature. Second, only one very small randomized controlled trial exists on asthma, but it found a dramatic reduction in hospitalizations in the children given vitamin D. Therefore, scientists say we need more studies before we act.

The problem with this argument is that the scientists saying this do not treat patients, with rare exceptions. They are scientists practicing science, not physicians treating patients. Doctors treating patients have always had to act on new scientific information based on what science knows now by doing a risk benefit analysis. You make such an analysis every time you get into your car. The small risk of an auto accident is worth the benefit of going to the movie.

The same is true of vitamin D and childhood asthma. The huge potential benefit is worth the tiny risk of taking vitamin D. Actually, as far as I know, the risk of treating vitamin D deficiency is close to zero. The dose for children is simple.

  • Under 25 pounds: 1,000 IU/day
  • 25-50 pounds: 2,000 IU/day
  • 50-75 pounds: 3,000 IU/day
  • 75-100 pounds: 4,000 IU/day
  • over 100 pounds: 5,000 IU/day.

If you have or know of asthmatic children, the parents can easily do this on their own without a blood test. With these doses, it is impossible for any child to be toxic although I understand the reasons patients and doctors want to test vitamin D levels.

Just think, millions of children around the world, living a childhood of desperation because the dermatologists won the argument about sun exposure.

7 Responses to Asthma epidemic and its relation to vitamin D deficiency

  1. Brant Cebulla

    Please also see our patient friendly summary written by Dr William Grant:

  2. [email protected]

    Brant – The “patient friendly summary” leaves me confused. It appears initially to indicate that D is beneficial, but then contradictorily says: “However, these infants may have an increased risk for asthma after the age of five years”… Is this due to the children going on after birth to become deficient in vitamin D by the age of 5 years, or in the Finnish instance, by 31 years of age of chronic deficiency? It would appear the point is being made that having adequate gestational levels of vitamin D predisposes to development of asthma later in life. Is this really what the intent of the document is? I surmise that many will come away from reading that document with the conviction that vitamin D supplementation during pregnancy is to be actively avoided.

  3. Brant Cebulla

    [email protected],
    Agreed, it is a confusing summary. We will have to make the summary clearer.

    I believe there are conflicting studies on whether or not vitamin D supplementation during gestation is inversely or positively associated with asthma risk. We will need an expert to fill in.

    Dr. Grant can you weigh in?

  4. Dr William Grant

    The strength of the link between low vitamin D and asthma has certainly strengthened since the asthma document was prepared for the Vitamin D Council website. There are now 150 papers listed at pubmed.gov with asthma and vitamin D in the title and/or abstract. Some of the more recent papers are listed here. Regarding vitamin D during pregnancy, in a study involving mice with low vitamin D, “There were corresponding deficits in lung function that could not be entirely explained by lung volume.” [Zosky et al., 2011]. A study in Australia found autumn and winter conception and premature birth associated with increased risk of asthma, suggesting vitamin D effects [Algert et al., 2011]. However, there are some papers such as the one mentioned in the reader’s comment, but such papers should be considered in light of all the papers on the topic. If I were to rewrite the document now, I would probably give that paper less prominence.

    Akbar NA, Zacharek MA. Vitamin D: immunomodulation of asthma, allergic rhinitis, and chronic rhinosinusitis. Curr Opin Otolaryngol Head Neck Surg. 2011 Jun;19(3):224-8.
    Algert CS, Bowen JR, Lain SL, Allen HD, Vivian-Taylor JM, Roberts CL. Pregnancy exposures and risk of childhood asthma admission in a population birth cohort. Pediatr Allergy Immunol. 2011 Sep 19. doi: 10.1111/j.1399-3038.2011.01206.x. [Epub ahead of print]
    Alyasin S, Momen T, Kashef S, Alipour A, Amin R. The relationship between serum 25 hydroxy vitamin d levels and asthma in children. Allergy Asthma Immunol Res. 2011 Oct;3(4):251-5.
    Bener A, Ehlayel MS, Tulic MK, Hamid Q. Vitamin D Deficiency as a Strong Predictor of Asthma in Children. Int Arch Allergy Immunol. 2011 Oct 6;157(2):168-175.
    Bozzetto S, Carraro S, Giordano G, Boner A, Baraldi E. Asthma, allergy and respiratory infections: the vitamin D hypothesis. Allergy. 2011 Sep 21. doi: 10.1111/j.1398-9995.2011.02711.x. [Epub ahead of print]
    Carroll KN, Gebretsadik T, Larkin EK, Dupont WD, Liu Z, Van Driest S, Hartert TV. Relationship of maternal vitamin D level with maternal and infant respiratory disease. Am J Obstet Gynecol. 2011 Apr 13. [Epub ahead of print]
    Ehlayel MS, Bener A, Sabbah A. Is high prevalence of vitamin D deficiency evidence for asthma and allergy risks? Eur Ann Allergy Clin Immunol. 2011 Jun;43(3):81-8.
    Gupta A, Sjoukes A, Richards D, Banya W, Hawrylowicz C, Bush A, Saglani S. Relationship Between Serum Vitamin D, Disease Severity and Airway Remodeling in Children with Asthma. Am J Respir Crit Care Med. 2011 Sep 15. [Epub ahead of print]
    Hollams EM, Hart PH, Holt BJ, Serralha M, Parsons F, de Klerk NH, Zhang G, Sly PD, Holt PG. Vitamin d and atopy and asthma phenotypes in children: a longitudinal cohort study. Eur Respir J. 2011 May 12. [Epub ahead of print]
    Keet CA, McCormack MC, Peng RD, Matsui EC. Age- and atopy-dependent effects of vitamin D on wheeze and asthma. J Allergy Clin Immunol. 2011 Aug;128(2):414-16.e5.
    Krstić G. Asthma prevalence associated with geographical latitude and regional insolation in the United States of America and Australia. PLoS One. 2011 Apr 8;6(4):e18492.
    Staple LE, Teach SJ. Evidence for the Role of Inadequate Vitamin D in Asthma Severity Among Children. J Investig Med. 2011 Jul 27. [Epub ahead of print]
    van Oeffelen AA, Bekkers MB, Smit HA, Kerkhof M, Koppelman GH, Haveman-Nies A, van der A DL, Jansen EH, Wijga AH. Serum micronutrient concentrations and childhood asthma: the PIAMA birth cohort study. Pediatr Allergy Immunol. 2011 Sep 19. doi: 10.1111/j.1399-3038.2011.01190.x. [Epub ahead of print]
    Zosky GR, Berry LJ, Elliot JG, James AL, Gorman S, Hart PH. Vitamin D deficiency causes deficits in lung function and alters lung structure. Am J Respir Crit Care Med. 2011 May 15;183(10):1336-43.

  5. [email protected]

    Are we not guilty of “compartmentalising”, i.e. looking at the issue as a single issue; should we not be taking into consideration the likes of concurrent Magnesium and calcium deficiencies to help explain the discrepency of the results from the study in question? Even if gestational levels of D3 are adequate, if tey drop off in the infant and the other factors are not addressed then asthma will still occur, n’est pas? (I speak from a veterinary and agriculture consultant background but for various reasons I have studied this issue for some time now). Frank Rowson.

    • Brant Cebulla

      Great comment. I think so. The problem with research is that nobody likes doing RCTs with a bunch of drugs and nutrients working together, as that makes it difficult to really pick out what’s beneficial and what is not. For instance, if you are a researcher and you were trying to discover a breakthrough, would you be more apt to research outcomes vitamin D vs placebo, or vitamin D, magnesium, zinc and calcium vs placebo? Definitely the former.

  6. [email protected]

    See “Crescendo of papers on Asthma, Allergy, and Vitamin D ”
    @ http://www.vitamindwiki.com/tiki-index.php?page_id=2032
    which has a graph of the number of allergy and asthma with vitamin D papers annually for the past 12 years.
    That web page has links to “Overview of Asthma and Vitamin D” as well as 71 other papers concerning breathing and vitamin D.

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