Effectiveness of correction of hypovitaminosis D against the background of standard step therapy of bronchial asthma in children
S. V. Dolbnya,
V. R. Ponamaryova,
I. N. Zakharova,
L. Ya. Klimov,
A. A. Tolkunova,
L. Yu. Barycheva,
V. V. Kuznetsova,
E. A. Enina,
N. N. Zaritovskaya https://doi.org/10.21518/ms2025-279
Abstract
Introduction. The close interest of a wide range of pediatricians in the problems of bronchial asthma (BA) is due to its prevalence, difficulties in selecting basic therapy, and the high frequency of hypovitaminosis D.
Aim. To analyze the frequency of vitamin D deficiency and the effectiveness of its correction by including cholecalciferol preparations in the standard step therapy regimen for bronchial asthma in children.
Materials and methods. The study involved 75 children and adolescents from the Stavropol Territory suffering from BA, aged
12.4 [9.5; 14.8] years. From 2018 to 2021, a two-stage study of vitamin D status was conducted in patients – initially and after completion of a 3-month intake of cholecalciferol aqueous solution (CCF).
Results. At the 1st stage of treatment, all 3 (100%) patients were over 12 years old and received low doses of ICS each time they used SABA without constant basic therapy. At the 2nd stage of therapy, all 9 (100%) patients used LRA drugs in age-appropriate dosages. At the 3rd stage, 1 (5.3%) child received treatment with medium doses of ICS, 10 (52.6%) children used a fixed combination of ICS-LABA, and 8 (42.1%) a combination of ICS + LRA.
The vitamin D status after taking cholecalciferol preparations increased from 18.3 ng/ml to 35.4 ng/ml. Vitamin D deficiency was initially detected in 44 (58.7%) children, and after the correction course – only in 3 (4.0%) people (p < 0.001).
Initially, the median AST was 16.0 [12.0; 20.5] points, and at the end of the study 20.0 [16.0; 24.0] points (p < 0.004).
Conclusion. Step therapy for asthma should be prescribed in according to current clinical guidelines. ICS should be used more widely as initial basic therapy for asthma, reducing the number of people receiving monotherapy with ALR.
Keywords
bronchial asthma,
step therapy,
vitamin D,
cholecalciferol,
25(OH)D,
inhaled glucocorticosteroids,
children
Supporting agencies: The article was published as part of the state assignment “Development of a personalized scheme for the prevention and correction of hypovitaminosis D in various phenotypes and endotypes of bronchial asthma in children” (state number 1023022000021-3-3.2.3).
About the Authors
S. V. Dolbnya
Stavropol State Medical University; Regional Children’s Clinical Hospital
Russian Federation
Russian Federation
Svetlana V. Dolbnya - Cand. Sci. (Med.), Assistant Professor of the Department of Faculty Pediatrics, Stavropol State Medical University; Pulmonologist, Regional Children’s Clinical Hospital.
310, Mira St., Stavropol, 355017; 3, Semashko St., Stavropol, 355029
V. R. Ponamaryova
Stavropol State Medical University
Russian Federation
Russian Federation
Viktoriya R. Ponamaryova - Student of the Faculty of Pediatrics, Stavropol State Medical University.
310, Mira St., Stavropol, 355017
I. N. Zakharova
Russian Medical Academy of Continuing Professional Education
Russian Federation
Russian Federation
Irina N. Zakharova - Dr. Sci. (Med.), Professor, Head of the Department of Pediatrics named after Academician G.N. Speransky, Russian Medical Academy of Continuing Professional Education.
2/1, Вldg. 1, Barrikadnaya St., Moscow, 125993
L. Ya. Klimov
Stavropol State Medical University
Russian Federation
Russian Federation
Leonid Ya. Klimov - Dr. Sci. (Med.), Professor, Head of the Department of Faculty Pediatrics, Stavropol State Medical University.
310, Mira St., Stavropol, 355017
A. A. Tolkunova
Stavropol State Medical University; Regional Children’s Clinical Hospital
Russian Federation
Russian Federation
Anna А. Tolkunova - Assistant of the Department of Faculty Pediatrics, Stavropol State Medical University; Pulmonologist, Regional Children’s Clinical Hospital.
310, Mira St., Stavropol, 355017; 3, Semashko St., Stavropol, 355029
L. Yu. Barycheva
Stavropol State Medical University; Regional Children’s Clinical Hospital
Russian Federation
Russian Federation
Liudmila Yu. Barycheva - Dr. Sci. (Med.), Professor, Head of the Department Immunology with a Course of Additional Professional Education, Stavropol State Medical University.
310, Mira St., Stavropol, 355017
V. V. Kuznetsova
Stavropol State Medical University; Regional Children’s Clinical Hospital
Russian Federation
Russian Federation
Vera V. Kuznetsova - Assistant of the Department of Immunology with a Course of Additional Professional Education, Stavropol State Medical University; Allergist-Immunologist, Regional Children’s Clinical Hospital.
310, Mira St., Stavropol, 355017; 3, Semashko St., Stavropol, 355029
E. A. Enina
Stavropol State Medical University; Regional Children’s Clinical Hospital
Russian Federation
Russian Federation
Elena A. Enina - Cand. Sci. (Med.), Associate Professor, Department of Hospital Pediatrics, Stavropol State Medical University; Head of the Pulmonology Department, Regional Children’s Clinical Hospital.
310, Mira St., Stavropol, 355017; 3, Semashko St., Stavropol, 355029
N. N. Zaritovskaya
Stavropol State Medical University
Russian Federation
Russian Federation
Natalia V. Zaritovskaya - Dr. Sci. (Med.), Professor of the Department of Propaedeutics of Childhood Diseases with a Course of Additional Professional Education, Stavropol State Medical University.
310, Mira St., Stavropol, 355017
References
1. Bystritskaya EV, Bilichenko TN. The review of the bronchial asthma morbidity in the population of the Russian Federation. Pulmonologiya. 2022;32(5): 651–660. (In Russ.) https://doi.org/10.18093/0869-0189-2022-32-5-651-660.
2. Volerman A, Balachandran U, Zhu M, Akel M, Hull A, Siros M et al. Evaluating inhaler education interventions for hospitalized children with asthma: A randomized controlled trial. Ann Allergy Asthma Immunol. 2023;131(2):217–223.e1. http://doi.org/10.1016/j.anai.2023.02.023.
3. Reddel HK, Bacharier LB, Bateman ED, Bonini M, Bourdin A, Brightling C et al. Global Initiative of Asthma. Global strategy for asthma management and prevention. Updated 2024. 261 p. Available at: https://ginasthma.org/wp-content/uploads/2024/05/GINA-2024-Strategy-Report-24_05_22_WMS.pdf.
4. Авдеев СН, Айсанов ЗР, Астафьева НГ, Баранов АА, Белевский АС, Бухтияров ИВ и др. Бронхиальная астма: клинические рекомендации. М.; 2024. 204 с. Режим доступа: https://raaci.ru/dat/pdf/clin_BA.pdf.
5. Hatter L, Bruce P, Holliday M, Anderson AJ, Braithwaite I, Corin A et al. The Children’s Anti-inflammatory Reliever (CARE) study: a protocol for a randomised controlled trial of budesonide-formoterol as sole reliever therapy in children with mild asthma. ERJ Open Res. 2021;7(4):00271–2021. https://doi.org/10.1183/23120541.00271-2021.
6. Reddel HK, Foxley GJ, Davis SR. How to step down asthma preventer treatment in patients with well-controlled asthma – more is not always better. Aust Prescr. 2022;45(4):125–129. http://doi.org/10.18773/austprescr.2022.033.
7. Tashkin DP, Lipworth B, Brattsand R. Benefit: risk profile of budesonide in obstructive airways disease. Drugs. 2019;79(16):1757–1775. http://doi.org/10.1007/s40265-019-01198-7.
8. Yu Y, Cao W, Xiao Y, Li A, Huang H, Liu K et al. Budesonide/formoterol maintenance and reliever therapy in childhood asthma: Real-world effectiveness and economic assessment. Pediatr Pulmonol. 2023;58(12):3406–3415. https://doi.org/10.1002/ppul.26647.
9. Reddel HK, Bateman ED, Schatz M, Krishnan JA, Cloutier MM. A Practical Guide to Implementing SMART in Asthma Management. J Allergy Clin Immunol Pract. 2022;10(1S):S31–S38. https://doi.org/10.1016/j.jaip.2021.10.011.
10. de Benedictis FM, Carloni I, Guidi R. Safety of anti-inflammatory drugs in children with asthma. Curr Opin Allergy Clin Immunol. 2021;21(2):144–150. http://doi.org/10.1097/ACI.0000000000000730.
11. Barry T, Holliday M, Sparks J, Biggs R, Colman A, Lamb R et al. START CARE: a protocol for a randomised controlled trial of step-wise budesonideformoterol reliever-based treatment in children. ERJ Open Res. 2024;10(2):00897-2023. http://doi.org/10.1183/23120541.00897-2023.
12. Surovenko TN, Zhukalina EF, Krasnova IN. Features of the treatment of children with mild asthma in the context of the COVID-19 pandemic. Meditsinskiy Sovet. 2023;17(1):138–146. (In Russ.) https://doi.org/10.21518/ms2022-037.
13. Geppe NA, Kondiurina EG, Reviakina VA, Malakhov AB, Kolosova NG. Therapy of bronchial asthma in children: age-related aspects. Pediatrics. Consilium Medicum. 2021;(2):113–122. (In Russ.) https://doi.org/10.26442/26586630.2021.2.200928.
14. Kolosova NG, Grebeneva IV, Denisova VD. Tiotropium: efficacy and safety in pediatric bronchial asthma. Meditsinskiy Sovet. 2021;(1):175–180. (In Russ.) https://doi.org/10.21518/2079-701X-2021-1-175-180.
15. Papi A, Blasi F, Canonica GW, Morandi L, Richeldi L, Rossi A. Treatment strategies for asthma: reshaping the concept of asthma management. Allergy Asthma Clin Immunol. 2020;16:75. https://doi.org/10.1186/s13223-020-00472-8.
16. Selmanoglu A, Celik HI, Genis C, Kockuzu E, Emeksiz ZS, Misirlioglu ED. Evaluation of asthma course in patients hospitalized in pediatric intensive care unit due to severe asthma exacerbation. Medicina. 2025;61(2):341. https://doi.org/10.3390/medicina61020341.
17. Gaffin JM, Castro M, Bacharier LB, Fuhlbrigge AL. the role of comorbidities in difficult-to-control asthma in adults and children. J Allergy Clin Immunol Pract. 2022;10(2):397–408. https://doi.org/10.1016/j.jaip.2021.11.016.
18. Ferraro VA, Spaggiari S, Zanconato S, Traversaro L, Carraro S, Di Riso D. psychological well-being of children with asthma and their parents. J Clin Med. 2024;13(17):5100. https://doi.org/10.3390/jcm13175100.
19. Kondratyeva EI, Klimov LYa, Ilenkova NA, Melyanovskaya YuL, Stepanova LV, Dolbnya SV et al. The influence of exogenous and genetic factors on the level of vitamin D in children with bronchial asthma in three regions of the Russian Federation. Clinical Practice in Pediatrics. 2024;19(2):104–114. (In Russ.) https://doi.org/10.20953/1817-7646-2024-2-104-114.
20. Mohammadzadeh I, Darvish S, Qujeq D, Hajiahmadi M, Vaghari-Tabari M. Association of serum 25-OH vitamin D3 with serum IgE and the Pediatric Asthma Severity Score in patients with pediatric asthma. Allergy Asthma Proc. 2020;41(2):126–133. https://doi.org/10.2500/aap.2020.41.190025.
21. Kondratyeva EI, Loshkova EV, Ilenkova NA, Mizernitsky YuL, Klimov LYa, Melyanovskaya YuL et al. The role of the VDR gene in the formation of clinical manifestations, complications and response to therapy in bronchial asthma. Clinical Practice in Pediatrics. 2023;18(1):43–54. (In Russ.) https://doi.org/10.20953/1817-7646-2023-1-43-54.
22. Tibrewal C, Modi NS, Bajoria PS, Dave PA, Rohit RK, Patel P et al. Therapeutic potential of vitamin D in management of asthma: a literature review. Cureus. 2023;15(7):e41956. https://doi.org/10.7759/cureus.41956.
23. Dolbnya SV, Tolkunova AA, Zakharova IN, Ponamaryova VR, Klimov LYa, Barycheva LYu et al. The effect of cholecalciferol subsidies on the level of pro-inflammatory cytokines in children with bronchial asthma. Meditsinskiy Sovet. 2024;18(11):119–129. (In Russ.) https://doi.org/10.21518/ms2024-267.
24. Dolbnya SV, Dyatlova AA, Klimov LYa, Kondratyeva EI, Zakharova IN, Enina EA. Relationship between vitamin D sufficiency and interferon-γ levels in children with chronic lung diseases. Meditsinskiy Sovet. 2023;17(12):231–239. (In Russ.) https://doi.org/10.21518/ms2023-221.
25. Buendía JA, Patiño DG, Lindarte EF. Vitamin D supplementation for children with mild to moderate asthma: an economic evaluation. J Asthma. 2023;60(9):1668–1676. http://doi.org/10.1080/02770903.2023.2178007.
26. Loshkova EV, Kondratyeva EI, Dmitriev NS, Yankina GN. Current understanding of vitamin D and genetic regulation of inflammation on the example of bronchial asthma. Clinical Practice in Pediatrics. 2022;17(3):147–155. (In Russ.) https://doi.org/10.20953/1817-7646-2022-3-147-155.
27. Dolbnya SV, Ponamareva VR, Zakharova IN, Klimov LYa, Tolkunova AA, Zarytovskaya NV et al. Bone metabolism status in children with chronic respiratory diseases. Medical News of North Caucasus. 2024;19(2):190–197. https://doi.org/10.14300/mnnc.2024.19044
28. Чучалин АГ, Геппе НА, Колосова НГ, Кондюрина ЕГ, Малахов АБ, Мизерницкий ЮЛ и др. Бронхиальная астма у детей. Стратегия лечения и профилактика: национальная программа. 5-е изд., перераб. и доп. М.: Оригинал-макет; 2017. 160 с.
29. Боровик ТЭ, Громова ОА, Захарова ИН, Мальцев СВ, Мошетова ЛК, Намазова-Баранова ЛС и др. Недостаточность витамина D у детей и подростков Российской Федерации: современные подходы к коррекции: национальная программа. 2-е изд. М.: Педиатръ; 2021. 116 с.
30. Sarıoglu N, Yalcın AD, Sahin F, Soyyigit S, Tepetam FM, Erel F. Does vitamin D deficiency in asthma affect clinical and functional parameters? A Turkish multicenter study. Allergy Asthma Proc. 2021;42(5):e152–e158. https://doi.org/10.2500/aap.2021.42.210056.
31. Niu H, He H, Zhao Z, Lu X, Zhao G. Asthmatic patients with vitamin D deficiency: Can vitamin D supplementation make a difference. Technol Health Care. 2024;32(6):3985–4008. http://doi.org/10.3233/THC-231462.
32. Fedora K, Setyoningrum RA, Aina Q, Rosyidah LN, Ni’mah NL, Titiharja FF. Vitamin D supplementation decrease asthma exacerbations in children: a systematic review and meta-analysis of randomized controlled trials. Ann Med. 2024;56(1):2400313. http://doi.org/10.1080/07853890.2024.2400313.
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Dolbnya SV, Ponamaryova VR, Zakharova IN, Klimov LY, Tolkunova AA, Barycheva LY, Kuznetsova VV, Enina EA, Zaritovskaya NN. Effectiveness of correction of hypovitaminosis D against the background of standard step therapy of bronchial asthma in children. Meditsinskiy sovet = Medical Council. 2025;(11):188-196. (In Russ.) https://doi.org/10.21518/ms2025-279
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