RESUMO
Introduction Asthma is a clinical syndrome characterized by reversible and recurrent airway obstruction leading to the symptoms of wheezing, cough, shortness of breath, fatigue, and respiratory distress. It is one of the most common lung pathologies worldwide. Its incidence is on the rise in Pakistan, which may be due to overt environmental pollution or improving screening protocols. Irrespective more and more patients are now being diagnosed as cases of asthma and this has led to renewed interest in research for the subject locally. Vitamin D plays a key component of the immune system and its deficiency has been associated with diseases, such as inflammatory bowel disease, celiac disease, rheumatoid arthritis, depression, sepsis, and coronavirus disease 2019 (COVID-19) pneumonia. The role of vitamin D in exacerbation, prevention, causation, and treatment of asthma is still up for debate. However, as more data emerges, it is becoming evident that vitamin D in one way or another is linked to outcomes in asthma. Especially the deficiency of vitamin D in asthma and its supplementation has garnered great attention in scientific trials. Our research is just one small step in this direction. This study aims to evaluate the frequency of vitamin D deficiency in patients with asthma. Methods This was a retrospective cross-sectional cohort conducted at the Department of Medicine of Abbasi Shaheed Hospital Karachi (ASHK) during March 2019 to August 2019. Patients of either gender aged ≥18 years that were diagnosed with cases of asthma were eligible to be included in the study. Asthma was defined in accordance with the latest guidelines issued by the Pakistan Chest Society. A vitamin D level of <20 ng/dl was considered deficient. Patient confidentiality was made certain. Results A total of 97 (62.98%) of the 154 patients included in the study had <20 ng/ml of vitamin D level. The mean vitamin D level recorded in this study was 15.34±4.21 ng/dl. The male-to-female ratio was 1:5. The mean age of our cohort was 42.78±4.56 years. The mean duration of disease, i.e., asthma was 6.7±3.68 years. Both the age of the patients and duration of the disease were found to be statistically significant with respect to vitamin D levels in asthmatics. Conclusions The frequency of vitamin D deficiency is very high in patients with asthma. These suboptimal levels are significantly influenced by the age of the patient and the duration of the disease.
RESUMO
Introduction The most important function of vitamin D is to maintain normal calcium homeostasis. Various factors play an important role but the most significant aspect of its normal physiological functioning is exposure to sunlight, therefore, it is also known as the sunshine vitamin. In adults, a prolonged deficiency of vitamin D (calcitriol) can lead to osteomalacia while a lower deficiency (insufficiency) is associated with various non-specific symptoms. Vitamin D deficiency has been observed in developed and developing countries, including the Middle East and the subcontinent. Vitamin D is mandatory for the maintenance of health due to the presence of its highly specific receptors, Vitamin D receptors, in all body tissues and its regulatory role in the encoding of more than 200 genes. The deficiency of Vitamin D, therefore, could affect any tissue or body system. Most interventions for this are done through outpatient departments (OPDs). The burden of vitamin D deficiency is affected by seasonal variation in our part of the world as well as internationally; data show a marked variation, however. Generalized body ache is a vague symptom. It is one of the most common complaints seen at the OPD and can be a manifestation of many a disease. But a correlation with low vitamin D levels has been observed previously. Whether this relation is affected by seasonal variation remains unascertained and data on the above-mentioned relationship for Pakistan are scarce. Objective We aim to evaluate the incidence of vitamin D deficiency in different seasons in the adult Karachi population presenting in medical OPDs with a generalized body ache. Materials and methods This study was conducted at Medical Ward 5, Jinnah Postgraduate Medical Center, Karachi, from January 2016 to December 2016. Data were collected from the OPD that was held twice-weekly (Mondays and Fridays). Only patients who exclusively complained of "generalized body ache" were inducted into the study. Patients with minor complaints, such as headache, backache, fatigue, and lethargy, were also seen only if there were no comorbidity at all. Meticulous lab and clinical workup were done to rule out potentially not-so-benign causes of the symptoms. Patients 18 years or older were inducted into the study. Once written consent was taken, Vitamin D levels were carried out via the COBAS (Roche Diagnostics, Mannheim, Germany) method. A vitamin D level of ≤30 ng/ml was considered deficient. Results were obtained within a week, and data were recorded and analyzed. Summer was defined as three months either side of the summer solstice (June 21) and winter was defined as three months either side of the winter solstice (December 21). Results A total of 577 patients were inducted into the study. The mean age of the patients was 39.33 ± 10.23 years. The patients were predominantly female (72.7%) and housewives. Of these, 298 (51.64%) had a vitamin D deficiency; in summer, the incidence was 44.23% and in winter, it was 60.37%. The mean level of vitamin D in deficient patients was 25.06±8.74 ng/dl. Conclusion Vitamin D levels are significantly decreased in patients complaining of generalized body ache even without any comorbidity. These affect predominantly the middle-aged female population. Seasonal variation occurs with most patients presenting during the winter months, along with lower means.
