GEORGIAN MEDICAL NEWS

No 10 (283) 2018

ASTHMA CONTROL STATUS AND LUNG FUNCTION IN RELATION

TO VITAMIN D LEVEL IN CHILDREN WITH BRONCHIAL ASTHMA

Bugadze L., Manjavidze N., Jorjoliani L.

David Aghmashenebeli University of Georgia, Tbilisi, Georgia

Bronchial asthma is one of the most common chronic diseases nocturnal symptoms/awakening, lung function (PEF or FEV1),
in childhood [1]. Clinically diagnosed asthma rate in children and need for reliever/rescue treatment, asthma patients were
and adults over the last 20-30 years has increased from 9 to 17%. classified as controlled and uncontrolled.
According to the survey conducted by ISAAC (The Interna- The quantitative determination of vitamin D in blood serum.
tional Study of Asthma and Allergies in Childhood) in many (Chemiluminescensional analysis). were performed in the labo-
countries asthma frequency ranges from 1.6 to 36.8%. ratories – “Enmedici” and ‘Vistamedi”. The results were evalu-
Vitamin D plays an important role in regulating the immune sys- ated by the following criteria. Vitamin D normal level - 30-100
tem [1,10,12]. Reduced Vitamin D decreases the formation of Th1 ng/ml; Vitamin D insufficiency - 20-30 ng/ml; and vitamin D
cells and increases Th2 cell proliferation, which itself increases the deficiency - <20 ng/ml.
number of IL-4, IL-5 and IL-13 quantity. Interleukins IL-4, IL-5 Individual study map was created for each patients, which
and IL-13 are related to the number of eosinophiles in the peripheral included questions as a debut of the disease, symptoms and co-
blood and total IgE blood serum levels [3,4]. morbid conditions. The genetically predisposition of patients,
According to a research, the 25 (OH) D low level in blood allergic anamnesis and risk factors were also assessed.
serum is correlated with increased asthma prevalence and hos- The data was processed by the methods of variation statistics. We
pitalization. In patients with bronchial asthma as a result of Vi- studied median and median squared deviation. The difference be-
tamin D additives have been shown to improve the condition tween groups was stated by the student’s coefficient (t) for indepen-
[8,12]. Studies are actively underway for determining correla- dent selection and for quality coefficient – by F Fisher criterion; The
tion between vitamin D levels and etiological and trigger factors chances of the odds (OR) and the 95% reliability interval (95% Cl)
of bronchial asthma. (house dust, vegetable allergens as pollen were determined. χ2 value has been defined by the p-value. Analysis
allergen, tobacco smoke, environmental pollution, etc.). was performed using the program packet SPSS/v 20.
Various studies have estimated vitamin D’s effect on blood serum Results and their discussion. Children, involved in the study are
levels of immunoglobulin E. In particular, a significant reduction in divided according to the quality of age, sex and asthma as follows.
the formation of immunoglobulin E by B lymphocyte cells revealed
after Vitamin D. The research also found that the reduction of im-
munoglobulin E production by B lymphocyte cells resulted in the
addition of Vitamin D and VDR agonists [1,5,7].
The aim of the study - to establish the correlation between asthma
control status, lung function and vitamin D level in blood serum.
Material and methods. One centric clinical trial was per-
formed on the base of Sachkhere Medical Center. The main Fig. 1. Demographic information about patients
group was formed. Fifty patients with bronchial asthma, were
involved in the main group. Patients were given long-term The most patients (60%) were between 6 and 10 years old
control and/or quick-relief medicines, (which is provided by (n=30; p-0.01), and only 40% was between 11-15 years (n=20;
GINA guidelines) according to the asthma control status. p-0.002).
Inclusion criteria: age from 6 to 15 years; confirmed Bronchial The patients involved in the main group prevail in the male
asthma by using clinical- instrumental examines. Confirmation sex population (n=27; p-0.000), female gender was represented
consent of a parent or a guardian about the participation in the re- by 23 persons. (n=23; p-0.00).
search. Exclusion criteria: vitamin D intake within one month prior According to the GINA definition, the individuals are di-
to research; associated somatic disease; severe chronic infections. vided into two subgroups: controlled bronchial asthma 62%
The study was performed at Sachkhere Medical Center. The (n=31; p-0.00) and uncontrolled bronchial asthma 38 % (n=19;
persons were given the following types of tests: define the IgE p-0.039). The information about exams is given in the Table 1.
serum blood level; spirometry exam- (using Spirolab II) and As a result of statistical processing of the results, we have
skin prick test using Allergopharma allergens. received the following data. According to the results of the spi-
According to clinical characteristics (GINA defined asthma rometer exams, the patients had mild (n-28; p-0.001) and mod-
control), that include: daytime symptoms, limitation of activity, erate (n=22; p-0.00) obstruction.
Table 1. Statistical data of diagnostic studies
Studies Mean % F t p
Lung function reduction - mild obstruction 0.56 56% 24.09 5.73 0.001
Lung function reduction - moderate obstruction 0,44 44% 18.90 5.12 0.00
Skin prick test on ambrosia 0.04 4% 16.3 1.79 0.078
Skin prick test on dust mite 0.84 84% 36.2 12.04 0.000
Skin prick test on milk protein 0.10 10% 37.8 4.09 0.00
Serum IgE high level 1.00 100% 24.09 3.73 0.001

© GMN 115

МЕДИЦИНСКИЕ НОВОСТИ ГРУЗИИ
CFMFHSDTKJC CFVTLBWBYJ CBF[KTYB

Table 2. Serum IgE level in basic group

n Mean Std. Deviation Std. Error Mean
IgE blood serum level 50 564.26 568.68 103.82

Table 3. Vitamin D serum blood level in basic (controlled and uncontrolled asthma ) group
n Mean Std. Deviation Std. Error Mean
1 basic group 50 18.78610 6.044547 1.103578
Serum vitamin
Controlled asthma 31 20.72498 5.624890 1.023454
D level
uncontrolled asthma 19 15.04238 5.345128 1.024537

Table 4. Evaluation of the x2 and p-value indicators in the conditions of vitamin D deficiency
Chi-square - X2 Sig. (2-tailed)- p
Controlled bronchial asthma 2.11 0.01
Uncontrolled bronchial asthma 6.78 0.01
Blood serum IgE level 10.90 0.54
Decreased lung function 3.12 0.039
Skin prick test on dust mite 5.12 0.50

Fig. 4. Skin prick test results using “Allergopharma”-s al-

Fig. 2. Lung function indicators by spirometry test
Within the study, the patients were determined serum immu-
noglobulin E level. High level of immunoglobulin E has been
detected in blood serum of all patients.
Fig. 3. IgE quantitative division by age
The patients were performed skin prick tests, using “Al-
lergopharma”- allergens. The highest frequency allergy was
revealed on dust mite- “Dermatophagoides farinae” in 84%
(n=42; p-0.001). 10% of persons were allergic to ambrosia (n=5;
p-0.00), and only 6% of the patients were allergic to milk protein
(n=3; p-0.078) according skin prick test result.
In the main stage of the study, the patients were tested in
quantitative analysis of Vitamin D in blood serum. Different
cases also have been identified as sufficiency and deficiency.
lergens
We concluded, that serum vitamin D level was significantly
decreased (18.78±6.04 ng/ml).
In addition, 48% of patients in the controlled bronchial asth-
ma group (n=15), has been found with vitamin D insufficiency
in blood serum, when 52% of cases (n=16) - vitamin D defi-
ciency was revealed.
In group of uncontrolled bronchial asthma, 5% of patients
(n=1) had vitamin D insufficiency, and 95% of them revealed
vitamin D deficiency (n=18).
Mean level of serum vitamin D level in group of controlled
asthma was: mean - 20.72 ng/ml. As for serum vitamin D level
in uncontrolled asthma group, it was significantly low: mean -
15.04 ng/ml.
Using the multivariate logistic regression analysis, the pres-
ence of asthma was associated with reduced level of vitamin D
in patients with uncontrolled bronchial asthma (OR = 1.35, 95%
CI (1,14-1.58) P = 0.011; χ2=6.78; F-0.022).
Also, by statistical analysis, serum vitamin D level is strongly
associated with decreased lung function (p-0.039; χ2-3.12); Exactly,
in group of controlled asthma , presence of insufficiency and defi-
ciency was almost equal, while in uncontrolled asthma group 95%
of patients were found with vitamin D deficiency in blood serum.
Based on the statistical analysis of the results, there was not
found correlations between serum vitamin D deficiency and IgE
high level (P-0.54; χ2-10.9). Also there has not been proved any
association skin prick test results and vitamin D serum level (P-
0.50; χ2-5.12).

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GEORGIAN MEDICAL NEWS
No 10 (283) 2018
Conclusion. By using multivariable logistical regression analy-
sis, bronchial asthma is strongly associated with low level of vita-
min D in blood serum in children with uncontrolled bronchial asth-
ma. (OR = 1.35, 95% CI (1,14-1.58) P = 0.011; χ2=6.78; F-0.022).
Also, decreased pulmonary function (p - 0.039; χ2 - 3.12 ) is
strongly associated with low level of vitamin D; but neither se-
rum IgE level (p - 0.54; χ2 - 10.9) nor skin prick test result on
dust mite (p - 0.50, χ2 - 5.12 ) was in correlations with serum
vitamin D low level.
The presence of vitamin D deficiency effectively predict in-
creased risk of uncontrolled bronchial asthma in children. Serum
vitamin D level is related to lung function, Therefore, the nor-
malization of the serum levels of Vitamin D may have benefi-
cial effect on improvement of asthma control in the complex of
asthma management and preventive measures.
REFERENCES
1. Batmaz SB, Arıkoğlu T, Tamer L, Eskandari G, Kuyucu S.
Seasonal variation of asthma control, lung function tests and al-
lergic inflammation in relation to vitamin D levels: a prospective
annual stud // Postepy Dermatol Alergol. 2018;35(1):99-105.
2. Hou C, Zhu X, Chang X. Correlation of vitamin D recep-
tor with bronchial asthma in children. // Exp Ther Med. 2018
Mar;15(3):2773-2776.
3. Bai YJ, Dai RJ. Serum levels of vitamin A and 25-hydroxyvi-
tamin D3 (25OHD3) as reflectors of pulmonary function and
quality of life (QOL) in children with stable asthma: A case-
control study. Medicine (Baltimore). 2018 Feb;97(7):e9830.
4. Hall SC, Agrawal DK Vitamin D and Bronchial Asthma:
An Overview of Data From the Past 5 Years. //Clin Ther. 2017
May;39(5):917-929
5. Dabbah H, Bar Yoseph R, Livnat G, Hakim F, Bentur L Bron-
chial Reactivity, Inflammatory and Allergic Parameters, and Vi-
tamin D Levels in Children With Asthma. // Respir Care. 2015
Aug;60(8):1157-63.
6. Checkley W, Robinson CL, Baumann LM, et al. 25-hydroxy
vitamin D levels are associated with childhood asthma in a popu-
lation-based study in Peru // Clin Exp Allergy. 2015;45:273–82.
7. Alyasin S, Momen T, Kashef S, Alipour A, Amin R. The rela-
tionship between serum 25 hydroxyvitamin D levels and asthma
in children //Allergy Asthma Immunol Res 2011;3(4):251–255.
8. Hollams EM, Hart PH, Holt BJ, Serralha M, Parsons F,
de Klerk NH, et al. Vitamin D and atopy and asthma pheno-
types in children: a longitudinal cohort study // Eur Respir J
2011;38(6):1320–1327.
9. Szymczak I, Pawliczak R. Can vitamin D help in achieving
asthma control? Vitamin D “revisited’’: an updated insight. //
Adv Respir Med. 2018;86(2):103-109.
10. Konstantinopoulou S, Tapia IE. Vitamin D and the lung //
Paediatr Respir Rev. 2017; 24: 39–43.
11. Hall SC, Fischer KD, Agrawal DK. The impact of vitamin D
on asthmatic human airway smooth muscle // Expert Rev Respir
Med. 2016; 10(2):127-135.
12. Wolsk HM, Chawes BL, Litonjua AA, Hollis BW, Waage J,
Stokholm J, Bønnelykke K, Bisgaard H, Weiss ST. Prenatal vita-
min D supplementation reduces risk of asthma/recurrent wheeze
in early childhood: A combined analysis of two randomized con-
trolled trials // PLoS One. 2017; 12(10): e0186657.
13. Igde M, Baran P, Oksuz BG, Topcuoglu S, Karatekin G.Niger
Association between the oxidative status, Vitamin D levels and
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Jan;21(1):63-68.
© GMN
SUMMARY
ASTHMA CONTROL STATUS AND LUNG FUNCTION
IN RELATION TO VITAMIN D LEVEL IN CHILDREN
WITH BRONCHIAL ASTHMA
Bugadze L., Manjavidze N., Jorjoliani L.
David Aghmashenebeli University of Georgia, Tbilisi, Georgia
The aim of the study - low circulating vitamin D level maybe
related to poor asthma control status and decreased lung func-
tion. The aim of our research is to establish correlation between
serum vitamin D level, asthma control status and lung function.
The study was performed in children aged 6-15 years old, in-
cluding patients with asthma (n=50), who referred to Sachkhere
medical center for a visit. The status of asthma control in the
basic group was classified as controlled (n=31) and uncontrolled
(n=19). The children underwent serum vitamin D and IgE level,
spirometry and skin prick tests for the study.
Using the multivariate logistic regression analysis, the pres-
ence of asthma was associated with the reduced level of vitamin
D (OR = 1.35, 95% CI (1,14-1.58) P = 0.011; χ2=6.78; F-0.022)
in children with uncontrolled bronchial asthma. 48% of the pa-
tients in the group- controlled asthma (n=15) had vitamin D defi-
cit, and in 52% of the cases (n=16) was confirmed with vitamin
D insufficient. In the group –uncontrolled asthma - 5% of the
patients (n=1) had Vitamin D insufficiency in blood serum. In
95% (n=18) of the patients vitamin D level was significantly
low <20 ng/ml.
According the results, decreased pulmonary function (p-
0.039; χ2-3.12) is strongly associated with low level of vitamin
D; but neither serum IgE level (p-0.54; χ2-10.9), nor skin prick
test result on dust mite (p-0.50, χ2-5.12 ) was correlations with
serum vitamin D low level.
The presence of vitamin D deficiency effectively predict in-
creased risk of uncontrolled bronchial asthma in children. Serum
vitamin D level is related to lung function too. Therefore, the
normalization of the serum levels of Vitamin D may have ben-
eficial effect on improvement of asthma control in the complex
of asthma management and preventive measures.
Keywords: vitamin D, children, uncontrolled asthma, prick-
test, spirometry, IgE.
РЕЗЮМЕ
СТАТУС КОНТРОЛЯ АСТМЫ И ФУНКЦИИ ЛЕГКИХ
В ОТНОШЕНИИ УРОВНЯ ВИТАМИНА D У ДЕТЕЙ С
БРОНХИАЛЬНОЙ АСТМОЙ
Бугадзе Л.Дж., Манджавидзе Н.Ш., Жоржолиани Л.Д.
Грузинский университет им. Давида Агмашенебели,
Тбилиси, Грузия
Низкий уровень витамина D в циркулирующей крови мо-
жет быть связан с риском развития неконтролируемой аст-
мы и с уменьшением функции легких.
Целью исследования явилось определение корреляции
между показателями витамина D, статусом контроля астмы
и функцией легки.
Исследованы дети с бронхиальной астмой в возрасте 6-15
лет (n=50), которые посещали Медицинский центр в Сачхере.
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МЕДИЦИНСКИЕ НОВОСТИ ГРУЗИИ
CFMFHSDTKJC CFVTLBWBYJ CBF[KTYB

По качеству контроля над астмой пациенты были раз-
делены на две группы: Контролируемая астма (n=31) и не-
контролируемая астма (n=19). Пациенты проходили иссле-
дования: определение иммуноглобулина E и витамина D в
сыворотке крови, спирометрия и кожный тест на аллергены.
Согласно многовариантному логистическому регрессион-
ному анализу, наличие неконтролируемой астмы связано с
низким уровнем витамина D в сыворотке крови (OR = 1.35,
95% CI (1,14-1.58) P = 0.011; χ2=6.78; F-0.022). В группе с
контролируемой астмой у 15 (48%) пациентов выявлен де-
фицит витамина D в сыворотке крови, у 16 (52%) - недо-
статок витамина D. В группе, не контролируемой астмой,
у 1 (5%) больного - недостаток витамина D, у остальных
reziume
содержание витамина D в сыворотке крови было низким -
<20 нг/мл.
Согласно проведенным исследованиям, низкий уровень ви-
тамина D коррелирует с нарушением функции легких. (p-0.039;
χ2 - 3.12). Кроме того, ни уровень иммуноглобулина E (p-0.54; χ2
- 10.9) в сыворотке крови, ни результат кожных тестов (p-0.50,
χ2 - 5.12) не коррелируют с дефицитом витамина D.
Дефицит витамина D эффективно прогнозирует риск раз-
вития неконтролируемой астмы у детей. Уровень витамина
D тесно связан с снижением функции легких. Нормализа-
ция уровня витамина D в сыворотке в комплексе лечения
астмы и профилактических мер, может оказать благотвор-
ное влияние на улучшение контроля астмы.

filtvis funqciisa da asTmis kontrolis statusis kavSiri

vitamin D-s donesTan bronquli asTmis dros bavSvebSi

l. buRaZe. n. manjaviZe. l. JorJoliani

saqarTvelos daviT aRmaSeneblis saxelobis universiteti, Tbilisi, saqarTvelo

kvlevis mizania davadginoT korelaciuri ka-
vSiri vitamin D, asTmis kontrolis statuss da
filtvis funqciis maCveneblebs Soris.
kvleva moicavs 6-dan 15 wlamde asakis bron-
quli asTmiT daavadebul bavSvebs (n=50), romle-
bic iyvnen vizitze saCxeris samedicino centrSi.
asTmis kontrolis xarisxis mixedviT moxda
pacientebis dayofa or qvejgufad; kontroli-
rebadi asTma (n=31) da arakontrolirebadi asTma
(n=19). pacientebs CautardaT kvlevebi: sisxlis
SratSi IgE da vitamin D-s raodenobrivi gansaz-
Rvra, spirometriuli gamokvleva da kanis prik-
testi alerenebze.
multivariaciuli lojistikuri regresiuli
analizis mixedviT, arakontrolirebad bronquli
asTmis arseboba dakavSirebulia sisxlis Srat-
Si vitamin D-s dabal donesTan (OR = 1.35, 95% CI
(1,14-1.58) P = 0.011; X²=6.78; F-0.022). 15 (48%) pacientTs
kontrolirebadi asTmis jgufidan aReniSneboda
sisxlis SratSi vitamin D-s deficiti, xolo 16
(52%) gamouvlinda vitamin D-s nakleboba. arakon-
rolirebadi asTmis jgufSi mxolod 1 (5%) pa-
cients aReniSna vitamin D-s nakleboba, maSin roca
18 (95%) gamouvlinda sisxlis SratSi vitamin D-s
mniSvnelovnad dabali done <20 ng/ml.
miRebuli Sedegebis mixedviT, vitamin D-s daba-
li done korelaciaSia aseve filtvis funqciis
daqveiTebasTan (p-0.039; χ2-3.12). amasTan arc sisxlis
SratSi IgE done (p-0.54; χ2-10.9), da arc kanis prik-
testis Sedegi mtvris tkipaze (p-0.50, χ2-5.12) araa
sarwmuno korelaciaSi vitamin D -s deficitTan.
vitamin D-s deficiti efeqturad prog-
nozirebs arakontrolirebad bronquli asTmis
gazrdil risks bavSvTa asakSi. aseve sisxlis
SratSi vitamin D-s done mWidrodaa dakavSire-
buli filtvis funqciis daqveiTebasTan. Aaqe-
dan gamomdinare, sisxlis SratSi vitamin D-s
donis normalizebiTa da asTmis marTvisa da
profilaqtikuri RonisZiebebis kompleqsuri
CatarebiT, SesaZloa gaumjobesdes daavadebis
kontrolis statusi bronquli asTmiT daavade-
bul bavSvebSi.

ПРОБЛЕМЫ СОВЕРШЕНСТВОВАНИЯ АНТЕНАТАЛЬНОГО НАБЛЮДЕНИЯ

ЗА БЕРЕМЕННЫМИ В СИСТЕМЕ ПЕРВИЧНОГО ЗДРАВООХРАНЕНИЯ ГРУЗИИ

¹Джинчарадзе Н.Г., 2Казахашвили Н.А., 3Сакварелидзе И.В.

¹Университет Грузии; ²Тбилисский государственный университет;

³Тбилисский гуманитарный учебный университет, Грузия
Защита репродуктивного здоровья женщин и предложе- избежать 54% случаев материнской смертности ежегодно
ние антенатального сервиса являются значимыми функция- [2,6]. Однако, взаимосвязь частых визитов с хорошим ис-
ми первичного здравоохранения [11]. ходом беременности не подтверждается. Часть исследо-
Доказано, что адекватным, качественным, интегриро- вателей предполагает, что излишнее количество визитов в
ванным медицинским уходом до беременности, в процессе процессе физиологической беременности не рекомендовано
беременности, при родах и в послеродовом периоде можно [10].

118
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