The impact of vitamin D3 supplementation on the course of acute obstructive bronchitis in young children
Background. Acute obstructive bronchitis (AOB) ranks second among the respiratory diseases in children. In recent years, the results of clinical studies demonstrate a correlation between the low level of vitamin D (VD) and the risk of recurrent respiratory infections in adults and children. At the same time, the impact of VD insufficiency/deficiency and timely compensation of these changes on the frequency and severity of broncho-obstructive syndrome (BOS) in young children remains poorly understood. Thus, the purpose of the research was to study the features of VD level in young children with recurrent BOS and the efficacy of vitamin D3 supplementation on incidence and severity of the disease. Materials and methods. We examined 120 children with acute obstructive bronchitis. Group I included 60 patients with episodic BOS (up to 3 episodes per year), group II consisted of 60 children with recurrent BOS (3 or more episodes per year). The control group represented 30 healthy children of the corresponding age. We evaluated the severity of BOS and determined the serum level of 25-hydroxyvitamin D (25(OH)D) using an electrochemiluminescence method. Subsequently, the group of children with recurrent BOS was divided into two subgroups: IIa subgroup included 30 children who received vitamin D3 1000 IU daily throughout the year, IIb included 30 patients who were not supplemented with VD. The effectiveness of vitamin D3 supplementation was determined by the changes in the blood level of 25(OH)D, frequency and severity of BOS episodes. We used non-parametric methods for statistical analysis of data. For all types of analysis, the critical value of the significance level (p) was taken to be < 0.05. Results. The analysis of the clinical features of BOS episode showed that in the group of children with recurrent BOS compared to patients with episodic BOS the disease was characterized by a more severe course (23.3 % vs. 10.0 %, respectively; p = 0.034). We found that the mean VD level in children with recurrent BOS was 13.68 (7.96; 19.51) ng/ml and in children with episodic BOS 33.0 (28.19, 41.97) ng/ml (p < 0.001). The VD supplementation in the group with recurrent BOS was significantly lower than in children who were ill episodically (5 % vs. 60 %; p < 0.001). We showed that the risk of severe episode (OR = 3.06; 95% CI: 1.19–7.84; p = 0.019) and recurrent BOS (OR = 4.35; 95% CI: 2.75–6.86; p < 0.001) is higher in case of 25(OH)D level in serum less than 20 ng/ml. According to our data, VD supplementation in children for one year improves VD level (25.11 (12.14, 42.47) ng/ml vs. 14.48 (10.58, 23.47) ng/ml; p = 0.012) and reduces frequency of BOS episodes (1.0 (0.0; 2.0) in IIa subgroup vs. 2.0 (1.0; 3.0) in IIb subgroup; p < 0.001). On the background of vitamin D3 intake the severe course of BOS was not noticed, unlike the patients who did not receive it (0 % vs. 20 %, respectively; p = 0.031). Conclusions. VD deficiency occurs in 75 % of children with recurrent BOS. Moreover, the serum level of 25(OH)D below 20 ng/ml is associated with an increased risk of recurrent and severe episodes of BOS. Thus, supplementation with vitamin D3 1000 IU per day helps to increase the content of 25(OH)D in serum, to reduce the frequency and severity of BOS.
Full Text:PDF (Українська)
Mallol J, Solé D, Garcia-Marcos L, et al. Prevalence, severity, and treatment of recurrent wheezing during the first year of life: a cross-sectional study of 12,405 Latin American infants. Allergy Asthma Immunol Res. 2016;8(1):22-31. doi: 10.4168/aair.2016.8.1.22.
Taylor-Robinson DC, Pearce A, Whitehead M, Smyth R, Law C. Social inequalities in wheezing in children: findings from the UK Millennium Cohort Study. Eur Respir J. 2016;47(3): 818-828. doi: 10.1183/13993003.01117-2015.
Burke H, Leonardi-Bee J, Hashim A, et al. Prenatal and passive smoke exposure and incidence of asthma and wheeze: Systematic review and meta-analysis. Pediatrics. 2012;129(4):735-744. doi: 10.1542/peds.2011-2196.
Bergman P, Lindh ÅU, Björkhem-Bergman L, Lindh JD. Vitamin D and respiratory tract infections: A systematic review and meta-analysis of randomized controlled trials. Plos One. 2013;8(6):e65835. doi: 10.1371/journal.pone.0065835.
Povoroznyuk VV, Pludowski P. Vitamin D deficiency and insufficiency: epidemiology, diagnosis, prophylaxis, treatment. Donetsk: Publishing House Zaslavsky; 2014. 262 p. (in Ukrainian).
Kvashnina LV, Makovska YA, Rodionov VP. D-vitamin content of the organism in different age periods of childhood. In: Antypkin JG, Maidannyk VG,eds. Current problems of pediatrics: Abstracs of the XI Congress of Рediatriсs of Ukraine, October, 7-9th, 2015, Kiev. International Journal of Pediatrics, Obstetrics and Gynecology. 2015;8(1):40-41. (in Ukrainian).
Surve S, Begum S, Chauhan S, Khatkhatay I, Joshi B. Discrepancy between the recommended and functional cut offs of vitamin D among under-five children: experiences from a pilot study. Indian J Endocrinol Metab. 2018;22(4):473-478. doi: 10.4103/ijem.IJEM_574_17.
Povoroznyuk VV, Balatska NI, Docenko VF, Sineok LL, Gavrish AV, Bortnichuk OV. The role of fortified products in the correction of vitamin D deficiency states (review of literature and results of the first studies). Pain. Joints. Spine. 2014;(15):24-31. (in Ukrainian).
Pavlyshyn HA, Shulhai AMA. Vitamin D status in the pathogenesis of child diseases development. Actual Problems of Pediatry, Obstetrics and Gynecology. 2018;1:25-31. doi: 10.11603/24116-4944.2018.1.8800. (in Ukrainian).
Majdanny`k VG, Demchuk SM. Modern approaches to the prevention and treatment of vitamin D-deficient rickets from the standpoint of evidence-based medicine. International Journal of Pediatrics, Obstetrics and Gynecology. 2015;8(1):133-143. (in Russian).
Charan J, Goyal JP, Saxena D, Yadav P. Vitamin D for prevention of respiratory tract infections: A systematic review and meta-analysis. J Pharmacol Pharmacother. 2012;3(4):300–303. doi: 10.4103/0976-500X.103685.
Ralston SL, Lieberthal AS, Meissner HC, et al. Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis. Pediatrics. 2014 November;134(5):1474-1502. doi: 10.1542/peds.2014-2742.
Płudowski P, Karczmarewicz E, Bayer M, et al. Practical guidelines for the supplementation of vitamin D and the treatment of deficits in Central Europe – recommended vitamin D intakes in the general population and groups at risk of vitamin D deficiency. Endokrynologia Polska. 2013;64(4):319-27. doi: 10.5603/EP.2013.0012.
Bener A, Ehlayel MS, Bener Z, Hamid Q. The impact of vitamin D deficiency on asthma, allergic rhinitis and wheezing in children: An emerging public health problem. J Family Community Med. 2014;21(3):154-161. doi: 10.4103/2230-8229.142967.
Prasad S, Rana RK, Sheth R, Mauskar AV. A Hospital Based Study to Establish the Correlation between Recurrent Wheeze and Vitamin D Deficiency Among Children of Age Group Less than 3 Years in Indian Scenario. J Clin Diagn Res. 2016 Feb;10(2):18-21. doi: 10.7860/JCDR/2016/17318.7287.
Peçanha MB, Freitas RB, Moreira TR, Silva LS, Oliveira LL, Cardoso SA. Prevalence of vitamin D deficiency and its relationship with factors associated with recurrent wheezing. J Bras Pneumol. 2019 Feb 11;45(1):e20170431. doi: 10.1590/1806-3713/e20170431.
Di Mauro A, Baldassarre ME, Capozza M, et al. The impact of vitamin D supplementation in paediatric primary care on recurrent respiratory infections: A randomized controlled trial. EuroMediterranean Biomedical Journal. 2018;13(44):194-199. doi: 10.3269/1970-5492.2018.13.44.
Martineau AR, Jolliffe DA, Hooper RL, et al. Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data. BMJ. 2017 Feb 15;356:i6583. doi: 10.1136/bmj.i6583.
Grant WB, Boucher BJ, Bhattoa HP, Lahore H. Why vitamin D clinical trials should be based on 25-hydroxyvitamin D concentrations. J Steroid Biochem Mol Biol. 2018;177:266-269. doi: 10.1016/j.jsbmb.2017.08.009.
Aglipay M, Birken CS, Parkin PC, et al. Effect of high-dose vs standard-dose wintertime vitamin D supplementation on viral upper respiratory tract infections in young healthy children. JAMA. 2017;318(3):245-254. doi:10.1001/jama.2017.8708.
Rosendahl J, Valkama S, Holmlund-Suila E, et al. Effect of higher vs standard dosage of vitamin D3 supplementation on bone strength and infection in healthy infants. JAMA Pediatr. 2018 Jul 1;172(7):646-654. doi: 10.1001/jamapediatrics.2018.0602.
Hibbs AM, Ross K, Kerns LA, et al. Effect of vitamin D supplementation on recurrent wheezing in black infants who were born preterm: The D-wheeze randomized clinical trial. JAMA. 2018 May 22;319(20):2086-2094. doi: 10.1001/jama.2018.5729.
Yakoob MY, Salam RA, Khan FR, Bhutta ZA. Vitamin D supplementation for preventing infections in children under five years of age. Cochrane Database of Systematic Reviews. 2016;11. doi: 10.1002/14651858.CD008824.pub2.
Copyright (c) 2019 CHILD`S HEALTH
This work is licensed under a Creative Commons Attribution 4.0 International License.
© Publishing House Zaslavsky, 1997-2020