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J Allergy Clin Immunol. 2010 Jul;126(1):52-8.e5. doi: 10.1016/j.jaci.2010.03.043. Epub 2010 Jun 9.

Serum vitamin D levels and severe asthma exacerbations in the Childhood Asthma Management Program study.

Collaborators (258)

Shapiro GG, DuHamel TR, Lasley MV, Chinn T, Hinatsu M, Furukawa CT, Altman LC, Virant FS, Williams PV, Kennedy MS, Becker JW, White G, Bierman CW, Crawford D, Eliassen H, Hammond B, Minotti DA, Reagan C, Sharpe M, Wighton TG, Weiss S, Fuhlbrigge A, Plunkett A, Madden N, Barrant P, Darcy C, Thompson K, Torda W, Tata M, Babigian S, Benson L, Caicedo J, Calder T, DeFilippo A, Dorsainvil C, Erickson J, Fulton P, Grace M, Gilbert J, Greineder D, Haynes S, Higham M, Jakubowski D, Kelleher S, Koslof J, Mandel D, Martin P, Martinez A, McAuliffe J, Nakamoto E, Pacella P, Parks P, Sagarin J, Seligsohn K, Swords S, Syring M, Traylor J, Van Horn M, Wells C, Whitman A, MacLusky I, Reisman J, Levison H, Hall A, Chay J, Sananes R, Benedet Y, Carpenter S, Collinson M, Finlayson-Kulchin J, Gore K, Holmes N, Klassen S, Quenneville J, Wasson C, Adkinson F Jr, Eggleston P, Aylward EH, Huss K, Plotnick L, Pulsifer M, Rand C, Bollers N, Bull D, Hamilton R, Hyatt K, Limb S, Pessaro M, Philips S, Wheeler B, Szefler S, Nelson HS, Bender B, Covar R, Liu A, Spahn J, Sundström D, Phillips M, White MP, Brelsford K, Bridges J, Ciacco J, Eltz M, Feeley J, Flynn M, Gleason M, Junk-Blanchard T, Hassell J, Hefner M, Hendrickson C, Hettleman D, Irvin CG, Jacobs J, Kamada A, Nimmagadda S, Sandoval K, Sheridan J, Washington T, Willcutt E, Carel K, Jain N, Leo H, Macomber B, Mjaanes C, Stewart L, Song B, Zeiger RS, Friedman N, Mellon MH, Schatz M, Harden K, Jenson EM, Panzlau S, Rodriguez E, Easton JG, Feinberg M, Galbreath LL, Gulczynski J, Hansen E, Jalowayski A, Lincoln A, Kaufman J, King S, Lopez B, Magiari-Ene M, Mostafa K, Moscona A, Nelle CA, Powers J, Sandoval K, Wilson NW, Kelly HW, Jacobs A, Spicher M, Raissy HH, Annett R, Archibeque T, Bashir N, Bereket HS, Braun M, Bush S, Clayton M, Colon-Semidey A, Devault S, Grad R, Hunt D, Larsson J, McClelland S, McWilliams B, Montoya E, Moreshead M, Murphy S, Ortega B, Weers D, Zayas J, Strunk RC, Bacharier L, Bloomberg GR, Corry JM, Rodgers D, Kertz L, Morgan V, Oliver-Welker T, White DK, Cherniack R, Tonascia J, Meinert C, Belt P, Collins K, Collison B, Colvin R, Dodge J, Donithan M, Harle J, Jackson R, Livingston H, Meinert J, Owens K, Smith M, Sternberg A, Van Natta M, Wild M, Wilson L, Wise R, Yates K, Taggart V, Eggers L, Kiley J, Zheng G, Albert P, Hurd S, Parker S, Randall P, Wu M, Eigen H, Cloutier M, Connett J, Cuttler L, Evans D, Kattan M, Menendez R, Simons FE, Davis CE, Leikin S, Cherniack R, Strunk R, Szefler S, Taggart V, Tonascia J, Meinert C, Cherniack R, Strunk R, Adkinson NF, Annett R, Bender B, Caesar M, DuHamel TR, Kelly HW, Levison H, Lincoln A, MacLusky I, McWilliams B, Meinert CL, Parker S, Reisman J, Rodgers D, Seligsohn K, Shapiro GG, Sharpe M, Sundström D, Szefler S, Taggart V, Tata M, Tonascia J, Weiss S, Wheeler B, Wise R, Zeiger R.



Asthma exacerbations, most often caused by respiratory tract infections, are the leading causes of asthma morbidity and comprise a significant proportion of asthma-related costs. Vitamin D status might play a role in preventing asthma exacerbations.


We sought to assess the relationship between serum vitamin D levels and subsequent severe asthma exacerbations.


We measured 25-hydroxyvitamin D levels in sera collected from 1024 children with mild-to-moderate persistent asthma at the time of enrollment in a multicenter clinical trial of children randomized to receive budesonide, nedocromil, or placebo (as-needed beta-agonists): the Childhood Asthma Management Program. Using multivariable modeling, we examined the relationship between baseline vitamin D levels and the odds of any hospitalization or emergency department visit over the 4 years of the trial.


Thirty-five percent of all subjects were vitamin D insufficient, as defined by a level of 30 ng/mL or less 25-hydroxyvitamin D. Mean vitamin D levels were lowest in African American subjects and highest in white subjects. After adjusting for age, sex, body mass index, income, and treatment group, insufficient vitamin D status was associated with a higher odds of any hospitalization or emergency department visit (odds ratio, 1.5; 95% CI, 1.1-1.9; P = .01).


Vitamin D insufficiency is common in this population of North American children with mild-to-moderate persistent asthma and is associated with higher odds of severe exacerbation over a 4-year period.

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