Serum vitamin D levels and severe asthma exacerbations in the Childhood Asthma Management Program study.
BACKGROUND
Asthma exacerbations, most often caused by respiratory tract infections, are the leading causes of asthma morbidity and comprise a significant proportion of asthma-related costs. Vitamin D status might play a role in preventing asthma exacerbations.


OBJECTIVE
We sought to assess the relationship between serum vitamin D levels and subsequent severe asthma exacerbations.


METHODS
We measured 25-hydroxyvitamin D levels in sera collected from 1024 children with mild-to-moderate persistent asthma at the time of enrollment in a multicenter clinical trial of children randomized to receive budesonide, nedocromil, or placebo (as-needed beta-agonists): the Childhood Asthma Management Program. Using multivariable modeling, we examined the relationship between baseline vitamin D levels and the odds of any hospitalization or emergency department visit over the 4 years of the trial.


RESULTS
Thirty-five percent of all subjects were vitamin D insufficient, as defined by a level of 30 ng/mL or less 25-hydroxyvitamin D. Mean vitamin D levels were lowest in African American subjects and highest in white subjects. After adjusting for age, sex, body mass index, income, and treatment group, insufficient vitamin D status was associated with a higher odds of any hospitalization or emergency department visit (odds ratio, 1.5; 95% CI, 1.1-1.9; P = .01).


CONCLUSIONS
Vitamin D insufficiency is common in this population of North American children with mild-to-moderate persistent asthma and is associated with higher odds of severe exacerbation over a 4-year period.
Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Boston, Mass, USA.
John M
JM
Brehm
Brooke
B
Schuemann
Anne L
AL
Fuhlbrigge
Bruce W
BW
Hollis
Robert C
RC
Strunk
Robert S
RS
Zeiger
Scott T
ST
Weiss
Augusto A
AA
Litonjua
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D001249:Asthma / Q000097:blood* / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology; D016535:Bronchial Hyperreactivity / Q000503:physiopathology; D002648:Child; D004311:Double-Blind Method; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood
D000305:Adrenal Cortex Hormones; D014807:Vitamin D; C104450:25-hydroxyvitamin D