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Revista alergia México

On-line version ISSN 2448-9190

Rev. alerg. Méx. vol.64 n.3 Ciudad de México Jul./Sep. 2017

https://doi.org/10.29262/ram.v64i3.325 

Letters to the editors

Vitamin D and asthma in clinical practice: the impact on asthma control

Giorgio Ciprandi1 

Fabio Gallo2 

1Hospital Policlínico San Martino. Génova, Italia

2Universidad de Génova, Departamento de Ciencias de la Salud. Génova, Italia


Bedolla-Barajas and colleagues examined vitamin D insufficiency and deficiency in 135 Mexican patients with allergic asthma.1 Vitamin D insufficiency was common in the group: 25.2 % as well as deficiency: 71.1 %. Noteworthy, there was no difference between genders.

There is a growing body of evidence that vitamin D exert a relevant immunomodulatory effect on immune cells, that may be able to explain the close link between vitamin D and respiratory disorders.2,3

On the other hand, the control of asthma is the cornerstone strategy in the management of patients with asthma as stated by the Global Initiative for Asthma (GINA) document.4 The asthma control evaluation is based on a global assessment of respiratory symptoms, lung function, bronchial inflammation, comorbidity (including obesity, upper airways disorders, gastroesophageal reflux, emotional problems, nocturnal apnea), risk factors, compliance, and adherence to treatments. Unfortunately, the study of Hall and colleagues, even though conducted on a very large population, did not addressed this issue. So, the aim of this study was to identify the impact of vitamin D serum levels on some clinical and functional characteristics in a group of 126 outpatients (85 females, mean age 56.93 ± 13.66 years) with asthma.

The informative factors and the vitamin D were selected for multivariate analysis, that it was performed using the multinomial logit regression and the model selection was done by the Akaike an Information Criterion. Differences, with a p-value less than 0.05, were selected as significant and data were acquired and analyzed in R v3.3.3 software environment.5

Table 1A reports clinical and functional data of outpatients. Regarding vitamin D categorization, 16 subjects (12.7 %) had sufficient serum level, 54 (42.86 %) had insufficient serum level, and 56 (44.44 %) had deficient serum level. More in detail, subjects with sufficient vitamin D serum level showed a mean of 38.34 ng/mL (SD = 9.79) ng/mL, while patients classified in insufficient and deficient vitamin D group had a mean value of 24.43 ng/mL (SD = 2.64) and 13.01 ng/mL (SD = 4.29), respectively.

Table 1A Características demográficas y clínicas de los participantes del estudio  

Características   Vitamina D
Suficiente≥ 30 ng/mL Insuficiente20-30 ng/mL Deficiente≤ 20 ng/mL
  Grupo general 16 (12.70 %) 54 (42.86 %) 56 (44.44 %)
Sexo
    Hombres 85 (67.46 %) 10 (11.76 %) 33 (38.82 %) 42 (49.41 %)
    Mujeres 41 (32.54 %) 6 (14.63 %) 23 (56.1 %) 12 (29.27 %)
Tabaquismo actual
    No 121 (96.03 %) 15 (12.4 %) 54 (44.63 %) 52 (42.98 %)
    Sí 5 (3.97 %) 1 (20 %) 2 (40 %) 2 (40 %)
Tabaquismo en el pasado
    No 88 (69.84 %) 11 (12.5 %) 37 (42.05 %) 40 (45.45 %)
    Sí 38 (30.16 %) 5 (13.16 %) 19 (50 %) 14 (36.84 %)
Control del asma (GINA)
    Bien controlado 32 (25.4 %) 6 (18.75 %) 18 (56.25 %) 8 (25 %)
    Parcialmente controlado 11 (8.73 %) 1 (9.09 %) 6 (54.55 %) 4 (36.36 %)
    No controlado 83 (65.87 %) 9 (10.84 %) 32 (38.55 %) 42 (50.6 %)
Síntoma
    Ninguno 17 (13.49 %) 4 (23.53 %) 8 (47.06 %) 5 (29.41 %)
    Bronquial 47 (37.3 %) 4 (8.51 %) 21 (44.68 %) 22 (46.81 %)
    Nasal 25 (19.84 %) 3 (12 %) 12 (48 %) 10 (40 %)
    Bronquial y nasal 37 (29.37 %) 5 (13.51 %) 15 (40.54 %) 17 (45.95 %)
Inicio temprano
    No 106 (84.13 %) 12 (11.32 %) 45 (42.45 %) 49 (46.23 %)
    Sí 20 (15.87 %) 4 (20 %) 11 (55 %) 5 (25 %)
Comorbilidad por rinitis
    No 108 (85.71 %) 13 (12.04 %) 49 (45.37 %) 46 (42.59 %)
    Sí 18 (14.29 %) 3 (16.67 %) 7 (38.89 %) 8 (44.44 %)
Edad 56.93 (13.66) 54.47 (13.74) 58.06 (13.57) 56.48 (13.86)
Índice de masa corporal 26.82 (7.13) 26.41 (5.72) 27.62 (9.33) 26.11 (4.38)
FVC 93.73 (19.61) 92.39 (17.03) 90.83 (19.91) 97.14 (19.79)
FEV1 75.15 (23.23) 75.54 (26.77) 73.68 (22.67) 76.55 (23.06)
FEV1/FVC 73.36 (17.69) 74.4 (22.44) 73.87 (15.74) 72.53 (18.37)

Los resultados se expresan como media con desviación estándar o como número de sujetos con porcentaje. FVC, capacidad vital forzada; FEV1, volumen espiratorio forzado en el primer segundo

At multivariate analysis, a significant effect of the GINA asthma control grade and the FVC on vitamin D was observed (p-values < 0.05). In particular, the FVC were positively associated with insufficient vitamin D values (OR = 1.04; p-value = 0.04), while having insufficient vitamin D among patients with partially controlled asthma was been about 73 % less likely than that in patients with controlled asthma level (OR = 0.27; p-value = 0.03), as reported in Table 1B.

Table 1B Análisis multivariado  

Características Insuficiente versus suficiente Deficiente versus suficiente
OR (95 % CI) p RM (IC 95 %) p
Intercepto 0.09 (0.01-2.69) 0.1640 4.23 (0.19-95.51) 0.3650
FVC 1.04 (1.01-1.07) 0.0430 1 (0.97-1.03) 0.9715
Control del asma (GINA)
Bien controlada 1   1  
Parcialmente controlada 0.27 (0.08-0.90) 0.0330 0.76 (0.25-2.32) 0.6272
No controlada 2.09 (0.77-5.68) 0.1475 0.88 (0.34-2.29) 0.8005

RM (IC 95 %), razón de momios con un intervalo de confianza de 95%

The present experience, although performed on a limited group of outpatients, underlines the impact of vitamin D insufficiency/deficiency on the asthma control grade and is consistent with studies supporting a pathogenic role of vitamin D in asthma.

Referencias

1.  Bedolla-Barajas M, López-Hernández JC, García-Padilla LF, Morales-Romero J, Velarde-Rivera FA, Robles-Figueroa M, Ortiz-Peregrina JR. Prevalencia de insuficiencia y deficiencia de vitamina D en adultos mexicanos con asma alérgica. Rev Alerg Mex 2017;64:178-187. Disponible en: http://revistaalergia.mx/ojs/index.php/ram/article/view/255Links ]

2.  Hall SC, Fischer KD, Agrawal DK. The impact of vitamin D on asthmatic human airway smooth muscle. Expert Rev Resp Med 2016;10(2):127-135. DOI: http://dx.doi.org/10.1586/17476348.2016.1128326Links ]

3.  Hall SC, Agrawal DK. Vitamin D and bronchial asthma: An overview of data from the past 5 years. Clin Ther 2017;39(5):917-929. DOI: http://dx.doi.org/10.1016/j.clinthera.2017.04.002Links ]

4.  Global Initiative for Asthma. GINA guidelines. Global strategy for Asthma Management and Prevention. Disponible en: htpp://www.ginasthma.org/Links ]

5.  R Foundation for Statistical Computing. [Sitio web]. R: A language and environment for statistical computing. Viena, Austria: R Foundation for Statistical Computing; 2017. Disponible en https://www.R-project.org/Links ]

*Corresponding author: E-mail address:Giorgio Ciprandi. gio.cip@libero.it

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