Efficacy of Vitamin D on the Clinical Management of Pediatric Patients With Asthma
Efficacy of Vitamin D on the Clinical Management of Pediatric Patients With Asthma
Asthma is a disease that represents a public health problem worldwide, there are several
 barriers, especially in pediatric patients with this disease, them, prevent the adequate
 control of their condition, in addition every day there are new processing aids for this
 entity; within these novel research we founded the relationship between decreased vitamin D
 serum levels and his role in the regulating of the immune response, also this relationship in
 the pathophysiology of this disease and responses in the event of infectious diseases of the
 respiratory tract which can exacerbate symptoms in pediatric patients. We have been some of
 clinical trials with the aim of improving serum levels of vitamin D in asthmatic patients,
 however, these studies have different sources of bias and thus far there is no solid evidence
 that favors or denies the relationship between asthma and vitamin D, this paper aims to help
 generate this evidence to improve clinical management of these patients and their lung
 function and increase the free time crisis.

 In this trial two study groups which are divided for each of the interventions described
 below:

 Group low supplementation dose: 1 tablet of 400 IU was administered every 24 hours via oral,
 regardless of time or if it is before or after food, preferably in the morning to improve
 adherence to treatment, will be completed one year of treatment without suspension.

 Group high supplementation dose: 1 tablet of 1600 IU should be administered every 24 hours
 via oral, regardless of time or if it is before or after food, preferably in the morning to
 improve adherence to treatment, will be completed one year of treatment without suspension
 thereof.
There are several potential mechanisms that have been described both in vitro models and in
 vivo models in which has been linked to asthma control with elevated levels of vitamin D in
 serum. These mechanisms include structural effects in the lungs, immunomodulation, modulation
 of smooth muscle response to level and effect on bronchial response to inhaled medicines to
 treat asthma.

 -  Structural mechanisms Studies were conducted in rats of 50 days old, lung compliance was
 measured and decreased it in rats whose mothers had a diet of deprivation of vitamin D
 compared to those rats whose mothers received vitamin supplementation was observed. In
 human groups, pulmonary function tests at age 6 were carried out, and there was a
 significant difference between children with mothers with vitamin D deficiency during
 pregnancy and children whose mothers had normal levels during pregnancy. These findings
 suggest that there is a strong relationship between lung embryonic development serum
 level of vitamin D and therefore this plays a key role in the structural development of
 the airways

 -  Anti-inflammatory Mechanisms Within these mechanisms, they are significantly inhibiting
 pro-inflammatory cytokines such as interleukin-6 and tumor necrosis factor alpha (TNF-A)
 by way of inhibition of MAP 38 produced by monocytes. Another such mechanism is the
 inhibition of transcription factor (necrosis factor kappa-beta). We observed a decrease
 in the phosphorylation and production of reactive oxygen species with the addition of
 1-25 dihydroxyvitamin D levels which leads to less inflammatory damage in the
 respiratory epithelium.

 -  Immunomodulation Effects occur in both innate immunity and adaptive, innate immunity in
 the effect of 1,25 hydroxyvitamin D has an effect on the reduction of inflammatory
 cytokines and in the decreased expression of Toll-like receptors monocytes. Also active
 antimicrobial peptides such as defensin 2 and 4 and the human defensin cathecidina 18,
 studies where low levels of vitamin D are associated and low levels of this peptide

 -  Effects on helper T lymphocytes Molecular effects, vitamin D levels are associated with
 decreased circulating IgE as well as decreasing the TH1 response and therefore TH2,
 however the role of vitamin D on these cells is unclear, and some studies have shown the
 prevalence of TH2 response in patients with adequate levels of Vitamin D, however the
 decrease in the inflammatory response and the production of cytokines such as IL 12 has
 shown that vitamin D it modulates the response that causes pathogenesis Asthma

 -  Decrease in early infections or severity The previously mentioned effects on adaptive
 and innate immunity may decrease the risk of early respiratory tract infections, which
 have been associated in the first years of life with a high incidence of wheezing. In
 Hawaiian children under age 5 suffering from rickets incidence of respiratory tract
 diseases and wheezing it was higher than that of the population without vitamin D
 deficiency
Inclusion Criteria:

 -  Pediatric patients 7 to 15 years regardless of sex diagnosed with asthma by clinical
 suspicion and accurate diagnosis by spirometry positive flow limitation with
 bronchodilator reversibility

 -  Controlled pediatric Pneumology service Patients

 -  Patients whose parents accept the child's participation by signing the informed
 consent. For children over 12 years the least sign the informed consent personally

 Exclusion Criteria:

 -  Patients with hypocalcemia or hypercalcemia

 -  Patients with kidney diseases such as kidney stones, hypercalciuria, renal tubular
 acidosis

 -  Patients with moderate to severe malnutrition