Pediatric Pulmonology-C
Vitamin D Levels in the Evaluation of Children with Asthma
In their recent JAMA paper entitled “Effect of Vitamin
D3 Supplementation on Severe Asthma Exacerbations in
Children With Asthma and Low Vitamin D Levels,” Forno et
al.1 reported that oral supplementation with vitamin
D3, in a dose of 4000 International Units per day, did
not significantly improve the time to a severe asthmatic exacerbation
when compared to placebo, as assessed in this double-blind, prospective
study.
However, per their Figure 1, 43 of 376 Forno’s subjects (11.4%) were
excluded for a vitamin D level less than 14 ng/mL. In addition, these
investigators reported that 23% of their participants had vitamin D
levels less than 20 ng/mL at the baseline visit.
The Global Consensus Recommendations2 and the American
Academy of Pediatrics3,4 state that a
serum 25OHD level of ≥ 20 ng/mL
should be considered sufficient for bone health in children. Thus, 23%
of Forno’s participants had 25OHD levels that were insufficient for
pediatric bone health at the baseline visit.
Commercial assays for
25OHD are readily available, as
are inexpensive dietary supplements with oral vitamin D. Given the above
findings, a serum 25OHD level should be included in the initial
evaluation of children with asthma, with subsequent correction of
insufficient levels to a 25OHD level of at least 20 ng/mL, as part of
the appropriate pediatric care of these children.
1. Forno E, Bacharier LB, Phipatanakul W, et al. Effect of Vitamin D3
Supplementation on Severe Asthma Exacerbations in Children With Asthma
and Low Vitamin D Levels: The VDKA Randomized Clinical Trial.JAMA. 2020;324(8):752-760.
2. Munns CF, Shaw N, Kiely M, et al. Global Consensus Recommendations on
Prevention and Management of Nutritional Rickets. The Journal of
Clinical Endocrinology & Metabolism. 2016;101(2):394-415.
3. Wagner CL, Greer FR. Prevention of rickets and vitamin D deficiency
in infants, children, and adolescents. Pediatrics.2008;122(5):1142-1152.
4. Golden NH, Abrams SA. Optimizing Bone Health in Children and
Adolescents. Pediatrics. 2014;134(4):e1229-e1243.
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Linda A. Linday, MD
Assistant Clinical Professor of Pediatrics
Icahn School of Medicine at Mount Sinai
E-mail:
lal14@caa.columbia.edu