title: Vitamin d insufficiency and asthma severity in adults from costa rica.
abstract: OBJECTIVE
  Non-classical actions of vitamin D as a cytokine are related to the immunopathology of asthma. Few studies have examined vitamin D levels and asthma severity in adults. The aim of this research was to assess the relationship between vitamin D levels, atopy markers, pulmonary function, and asthma severity.
  
  
  METHODS
  We analyzed 25-hydroxyvitamin D levels in serum collected from 121 asthmatic adults from Costa Rica to investigate the association between vitamin D levels (categorized as sufficient, ≥30 ng/mL, or insufficient, <30 ng/mL), allergic rhinitis, total IgE and peripheral blood eosinophils (as markers of atopy), asthma severity, baseline forced expiratory volume in 1 second (FEV1), and forced vital capacity (FVC). Univariate and multivariate analyses were performed to assess these relationships.
  
  
  RESULTS
  When the population was stratified by vitamin D status, 91% of asthmatic patients with vitamin D levels below 20 ng/mL (n=36) and 74% of patients with vitamin D levels between 20 and 30 ng/mL (n=73) had severe asthma versus 50% of those with vitamin D sufficiency (n=12; P=0.02). Vitamin D insufficiency was associated with a higher risk of severe asthma (odds ratio [OR], 5.04; 95% Confidence interval [CI], 1.23-20.72; P=0.02). High vitamin D levels were associated with a lower risk of hospitalization or emergency department visit during the last year (OR, 0.90; 95% CI, 0.84-0.98; P=0.04). Although there appeared to be a direct relationship between vitamin D levels and FEV1 (regression coefficient=0.48; r(2)=0.03), it did not reach statistical significance (P=0.07).
  
  
  CONCLUSIONS
  Our findings suggest that vitamin D insufficiency is common among our cohort of asthmatic adults. Lower vitamin D levels are associated with asthma severity.
authors.affiliation: Department of Pneumology, Hospital San Juan de Dios, San José, Costa Rica.
authors.forename: Felicia
authors.initials: F
authors.lastname: Montero-Arias
authors.forename: Giovanni
authors.initials: G
authors.lastname: Sedó-Mejía
authors.forename: Allan
authors.initials: A
authors.lastname: Ramos-Esquivel
keywords: Adult; asthma; vitamin D