Vitamin D and Asthma

Jun 10, 2014

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Okay. Im only going to say it once. Here is goes. Pat is a better fisherman than me. Last Thursday night, Pat and our co-worker Joleene threw out a couple of spoons at the Bayduza development on Lake Dauphin. They limited out on pickerel in an hour and had to throw back plenty of over sized fish. Pat told Kevin. Kevin and his kids went to the same area on the Saturday and hauled in a bunch of fish. So that Monday, I took my kids out. Now granted, we were on Crescent Cove, but youd think wed get something. Within the first five minutes, Emily cast her spoon into a tree, Sheldon the dog jumped into the lake and then covered himself with sand and Eric lost my favorite 5 of diamonds into the lake. I dis-entangled Emily from the tree and got Eric re-tied. Then Eric cast his line into 3 different trees on three different casts, each of which I had to untangle. Emily got mad because she didnt like the casting mechanism to lift the bale on the rod I gave her. Then I got nominated for father of the year as I yelled at Eric. You see on his third cast into his third tree he started to giggle uncontrollably. The little bugger was enjoying casting into trees!

Sometimes a good idea like taking you kids fishing goes off the rails. Medical researchers have days like that too. Dr. Mario Castro, professor of medicine and pediatrics at Washington University in St. Louis, Missouri had the thought that Vitamin D might help people with asthma.

What is Vitamin D? There isnt a simple answer. There are different forms of Vitamin D, but the most potent form is called calcitriol. The type of Vitamin D your body makes is called Vitamin D3 (or cholecalciferol). Its formation is complicated. A Pre- Vitamin D3 is converted to Vitamin D3 in the skin with the help of sunlight (UV Radiation). Vitamin D3 is converted to a second form in the liver called calcidiol. The calcidiol is converted to calcitriol by the kidney. Again calcitriol is the most active form. You can get Vitamin D3 from taking pills, having your skin make it from sunshine or eating things like fish. Then you hope your kidneys are healthy enough to convert the Vitamin D3 to calcitriol. There is another form of Vitamin D called Vitamin D2 . It is formed by plants and it can be converted to calcitriol in your body as well. There are those that argue that Vitamin D2 doesnt form calcitriol as well at Vitamin D3.

Why do we care about Vitamin D? The most important thing about Vitamin D is still that it helps your gut absorb calcium. We know this because young children who dont get enough Vitamin D develop rickets. Rickets is a condition characterized by bone deformities and soft bones which dont have enough calcium. If we treat these children with Vitamin D and/or sunlight, their bones get better. This is why we give breast fed babies a Vitamin D supplement. We assume that the newborns arent put in the sun (mostly because we told the mothers not too) and the mothers arent in the sun either. Once the babies go onto formula or milk, they dont need the Vitamin D supplement anymore.

We need Vitamin D to absorb calcium. That isnt a new recommendation. We used to say 400 IU per day of Vitamin D was fine. Now we dont think 400 IU of Vitamin D will prevent fractures in adults. The recommendations are for at least 400 IU if you are healthy and less than 50. If you are over 50, you should consider 800 to 1000 IU. Vitamin D is generally considered safe up to 2000 IU. Lately people arent talking about Vitamin D just for bone strength. Vitamin D has been looked at for cancer, heart disease, MS, fall prevention in the elderly and now asthma.

Dr. Castro and his colleagues knew that previous studies had shown people with low Vitamin D levels had airway hyper responsiveness or twitchy airways. That means if any dust, cold air, pollen, or other irritants got inhaled, the patients are more likely to have an asthma attack. So Dr. Castro and his colleagues decided to give Vitamin D to asthmatics who were Vitamin D deficient. They got together a test group of 408 adults with asthma and low Vitamin D levels. They gave a big dose of oral Vitamin D3 (100?000 IU) to the patients on the first day and then 4000 IU per day for 28 weeks. The test group had 201 people and the placebo group had 207 people. Both groups were also on normal asthma treatment which in this case was the inhaled steroid ciclesonide. The results were presented in May at the American Thoracic Society 2014 International Conference and published online in JAMA.

Unfortunately, the Vitamin D supplementation didnt work in this trial. It had no significant effect on the overall rate of first treatment failure or exacerbation in patients with asthma and low vitamin D levels, according to the Vitamin D Add-on Therapy Enhances Corticosteroid Responsiveness in Asthma (VIDA) trial. However, there were a few glimmers of hope. The group which had Vitamin D given to them used less of their steroid inhalers than the placebo group. This wasnt one of the main results the researchers were looking for, but it is interesting. The researchers think that their next trial should be on people with more severe Vitamin D deficiency.

Just like the VIDA researchers, my fishing evening with the children ended with a glimmer of hope. Yes, the night after the kids and I went out, Pat and Murray went for a boat ride and limited out again, but I dont want to talk about that. On the kids fishing evening, after a little instruction, Emily got the hang of the new casting mechanism on her reel. Eric started casting into the lake and not into the trees. Emily even had an honest to goodness bite before we left for home. After reeling up Emilys fish jumped a few times where she lost him. Emily said he was waving good-bye. Eric told his mom that Emily got the first bite of the year and everyone seemed to go to bed happy. I still would have rather come home with a fish or two.

As always if you have any questions or concerns about these products, ask your pharmacist.

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

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VIDA Study in JAMA -


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