Does vitamin D administered to children with asthma treated with inhaled glucocorticoids affect short‐term growth or bone turnover?

Abstract

Our objective was to assess whether administration of 25-OH-vitamin D to children with asthma treated with inhaled dry-powder budesonide 400 microg daily affects short-term growth or markers of bone turnover. We utilized a randomized, double-blind, two-period crossover trial with run-in and washout periods of 2 weeks and treatment periods of 4 weeks duration. The setting was an Outpatient clinic in a secondary referral center. Subjects included 14 boys and 3 girls with a mean age of 11.7 (range, 6.1-14.4) years. Interventions included 15 microg (600 IU) 25-OH-vitamin D (cholecalciferol) in one tablet ABCDin(R) once daily in the morning. Primary outcome measures were: lower leg growth rate, serum osteocalcin, and serum markers of type I collagen turnover, i.e., the amino terminal propeptide of type I procollagen (PINP), the carboxy terminal propeptide of type I procollagen (PICP) (formation markers), and the carboxy terminal pyridinoline cross-linked telopeptide of type I collagen (ICTP) (degradation markers). Secondary outcome measures were parameters of asthma control and serum 25-OH-vitamin D. Lower leg growth rate was 0.22 mm/week during vitamin D and 0.25 mm/week during placebo treatment (NS). Osteocalcin was 59.9 and 57.8 microg/l during vitamin D and placebo treatment, respectively, PINP 574 and 565 microg/l, PICP 381 and 382 microg/l, and ICTP 11.5 and 11.1 microg/l, respectively (NS). Serum 25-OH-vitamin D was 76.3 nmol/l and 48.2 nmol/l, respectively (P < 0.001). There were no statistically significant differences in measures of pulmonary function. In conclusion, administration of 25-OH-vitamin D does not affect short-term growth or markers of bone turnover in children with asthma treated with inhaled dry-powder budesonide 400 microg daily.

Vitamin D supplementation during pregnancy and infancy reduces aeroallergen sensitization: a randomized controlled trial

“…Although no studies to date have reported the effect of vitamin D supplementation during pregnancy and early infancy on asthma during childhood, placebo‐controlled clinical trials have shown efficacy of vitamin D supplementation in children with asthma. A meta‐analysis, published in 2015 , that included data from five clinical trials, which used a vitamin D doses ranging from 500 to 2000 IU/day in children aged 5–18 years, showed a statistically significant reduction in asthma exacerbations . One further trial published since this meta‐analysis, which enrolled 130 individuals aged 10–50 years and randomly assigned them to vitamin D or placebo, showed a significant improvement in lung function after 24 weeks of the intervention .…”

Vitamin D with asthma and COPD: not a false hope? A systematic review and meta-analysis

“…Asthma (Schou et al, 2003) COPD (Lehouck et al, 2012) Patients Children with asthma treated with inhaled dry-powder 182 patients with moderate to very severe COPD and a history of recent budesonide 400 mg daily exacerbations Interventions 15 mg (600 IU) 25-OH-vitamin D once daily in the 100,000 IU vitamin D supplementation or placebo every 4 weeks for morning with run-in and washout periods of 2 weeks 1 year and treatment periods of 4-week duration. Table 2.…”

“…There were 2 randomized, placebo-controlled trials that showed the effects of vitamin D on asthma and COPD (Schou et al, 2003;Lehouck et al, 2012) (Table 2). The exacerbations did not significantly differ between the groups (including the median time to first exacerbation, exacerbation rates), nor did FEV1 and PEF (peak expiratory flow).…”

Knemometry for Assessment of Growth Suppressive Effects of Exogenous Glucocorticoids

“…400 µg budesonide or beclomethasone from a dry powder inhaler), at which no other methods have been able to detect any systemic effects [5;62;67]. The method allows precise and direct comparisons of the systemic activity of different compounds [26;35;37;39], doses [27-29;35-37;40], dose intervals [30] and adjunctive [36] or modifying [51] treatments. Reduced lower leg growth has been attributed mainly to reduced linear bone growth [21].…”