Best vitamins for asthma

Vitamin D supplements may reduce asthma severity

Adding vitamin D supplements to standard medication could reduce the severity of asthma attacks for individuals with the respiratory condition, suggests a new review.

Share on PinterestThe new review suggests that vitamin D supplementation may help to reduce severe asthma attacks.

Researchers found that people with asthma who took vitamin D supplements alongside their usual medication were 50 percent less likely to visit the emergency department or require hospital admission as a result of an asthma attack.

What is more, the researchers found that vitamin D supplementation was linked to a reduction in the need for steroid injections or tablets following an asthma attack.

Lead researcher Prof. Adrian Martineau, from Queen Mary University of London (QMUL) in the United Kingdom, and colleagues recently reported their findings in The Lancet Respiratory Medicine.

Asthma is one of the biggest health burdens across the globe, affecting approximately 300 million children and adults. In the United States alone, around 25 million people have asthma, and this number rises every year.

Although there is currently no cure for asthma, there are medications that can help patients to manage the condition and reduce their risk of an asthma attack.

But these medications are not always effective; each year in the U.S., there are around 1.8 million visits to the emergency department for asthma attacks, and the condition causes 10 deaths in the country every day.

As such, researchers are searching for ways to further reduce asthma severity. Could vitamin D be one such strategy?

A review of vitamin D for asthma

Vitamin D is essential for human health. Not only does the vitamin aid calcium absorption, which is vital for healthy bones, but it also helps to strengthen the immune system. It is the latter function that has led researchers to investigate vitamin D as a possible treatment for asthma.

Respiratory infections, such as the common cold or the flu, are known to trigger symptoms of asthma – including airway inflammation, which can bring on an asthma attack.

Some studies have suggested that vitamin D may help to lower the risk of respiratory infection-induced asthma attacks by boosting the immune system.

To gain a better understanding of this association, Prof. Martineau and colleagues conducted a review of seven randomized controlled trials that looked at the effects of vitamin D supplementation on asthma severity.

Asthma events, hospital visits reduced

The review included a total of 955 subjects with asthma, all of whom were receiving standard treatment for the condition.

It was found that vitamin D supplementation reduced the need for asthma-related emergency department visits and hospital admissions by 50 percent when compared with a placebo, with the rate of such events falling from 6 percent to 3 percent.

Also, among adults who did experience an asthma attack, vitamin D supplementation reduced the need for treatment with steroid tablets or injections by 30 percent, from 0.43 events per person per year to 0.30 events per person per year.

From a subgroup analysis, the researchers found that patients whose vitamin D levels were low at study baseline experienced the greatest benefit from vitamin D supplementation; their need for treatment with steroid tablets or injections fell by 55 percent.

Still, they note that the small number of participants in each subgroup makes it difficult to confirm whether or not initial vitamin D levels influence the effect of supplementation on asthma severity.

Further clinical trials underway

Importantly, it was also found that vitamin D supplementation was safe for participants at the doses used, and there were no differences in adverse effects between subjects who took vitamin D and those who took a placebo.

Overall, the researchers believe that their findings indicate that vitamin D supplementation may be an effective way to help reduce asthma severity.

“These results add to the ever growing body of evidence that vitamin D can support immune function as well as bone health.”

Prof. Adrian Martineau

“Vitamin D is safe to take and relatively inexpensive,” adds Prof. Martineau, “so supplementation represents a potentially cost-effective strategy to reduce this problem.”

First study author Dr. David Joliffe, also of QMUL, notes that because the majority of study subjects were adults with mild to moderate asthma, they are currently unable to generalize the findings to children or individuals with more severe asthma.

“Further clinical trials are ongoing internationally,” adds Dr. Joliffe, “and we hope to include data from them in a future analysis to determine whether the promise of today’s results is confirmed in an even larger and more diverse group of patients.”

Can Vitamin D Reduce Asthma Attack Risk?

British researchers say they have found a way to cut in half the risk of asthma attacks that require hospitalization.

The answer is vitamin D.

The researchers from Queen Mary University of London concluded that taking oral vitamin D supplements in addition to standard asthma medication resulted in a 50 percent reduction in the risk of experiencing at least one asthma attack that required a visit to the emergency room.

Taking the vitamin supplement also led to a 30 percent reduction in the number of asthma attacks that required treatment with steroid tablets or injections.

“Vitamin D can boost immune responses to viruses that trigger asthma attacks, while simultaneously dampening down harmful inflammatory responses,” Adrian Martineau, PhD, a clinical professor of respiratory infection and immunity at Queen Mary University and a lead researcher on the study, told Healthline.

A serious ailment

According to the U.S. Centers for Disease Control and Prevention (CDC), more than 24 million people in the United States have asthma.

About 8 percent of American adults and 8 percent of children under 18 have from the condition.

An estimated 2 million visits to the emergency room result in a primary diagnosis of asthma.

In 2014, asthma led to 3,651 deaths in the United States. Globally, asthma accounts for 400,000 deaths annually.

Death from asthma typically occurs during a period of acute worsening of asthma symptoms.

“In a true asthma flare or attack, the airways become filled with mucus and the muscles contract. They can become plugged with mucus, cutting off all airflow, and ultimately may result in death if not treated,” Tonya Winders, president and chief executive officer of the Allergy and Asthma Network, told Healthline.

Help from vitamin D

Researchers hope use of vitamin D in addition to regular asthma medications will improve the quality of life for those living with asthma.

“This is yet another example of a growing body of data to suggest vitamin D supplements may help reduce asthma flares resulting in uncontrolled symptoms and significant impact of patients’ lives,” Winders said.

According to researchers, the impact from vitamin D is equivalent in size to that achieved through expensive antibody therapies.

“The fact that vitamin D is inexpensive and safe means that it is potentially a highly cost-effective intervention,” Martineau said.

Vitamin D can also be gained through sun exposure, though Martineau notes this carries a risk of skin cancer that supplements do not.

Additionally, depending on where you live in the world, sun exposure may not have sufficient ultraviolet B rays all year long to produce vitamin D in the skin.

The benefits of taking vitamin D supplements extend beyond asthma.

“In a nutshell, benefits for bone health and muscle health are pretty well accepted and noncontroversial. There is a strong body of evidence now that vitamin D supplementation can reduce risk of colds and flu, particularly in people who have low vitamin D levels to start,” Martineau said.

Taking a look at severe asthma

However, more work needs to be done for groups that were underrepresented in this study, such as children and adults with severe asthma.

More trials are ongoing, and within five years Martineau anticipates there will be more data.

“I would welcome additional data in severe asthma, where the burden is so high… Based on vitamin D’s safety record, it would be interesting to see its effects in children with asthma,” Winders said.

But the research only shows a benefit of vitamin D use in preventing asthma attacks, not in everyday symptoms.

“Around 50 percent of patients with asthma don’t suffer such attacks but are bothered by day-to-day symptoms. We have not shown a benefit of vitamin D on day-to-day asthma control,” Martineau said.

The number of asthma patients with uncontrolled symptoms is significant.

“ over 50 percent of all asthma patients not well-controlled, which results in symptoms like coughing, wheezing or shortness of breath. In fact, in a recent survey we found that over 80 percent of patients limited simple activities like household chores and exercise at least once per week due to asthma,” Winders said.

Martineau says there is enough evidence that would justify testing for vitamin D deficiency in asthma patients.

“I think the evidence is strong enough now to suggest that testing for vitamin D deficiency in people who have asthma attacks and treating it where it is found is likely to have a benefit in terms of reduced risk of colds and flu and reduced risk of asthma attack,” he said.

High quality evidence suggests Vitamin D can reduce asthma attacks

A new Cochrane Review published in the Cochrane Library has found evidence from randomized trials that taking an oral vitamin D supplement in addition to standard asthma medication is likely to reduce severe asthma attacks.

Scroll to the bottom of this article for a round-up of media coverage

Asthma is a common chronic disease, affecting about 300 million people worldwide. The symptoms of asthma include wheezing, coughing, chest tightness, and shortness of breath.

Low blood levels of vitamin D have been linked to increased risk of asthma attacks in children and adults with asthma. There has been a growing interest in the potential role of vitamin D in asthma management, because it might help to reduce upper respiratory infections (such as the common cold) that can lead to exacerbations of asthma. Several clinical trials have tested whether taking vitamin D as a supplement has an effect on asthma attacks, symptoms, and lung function in children and adults with asthma.

The team of Cochrane researchers found seven trials involving 435 children and two studies, involving 658 adults. The study participants were ethnically diverse, reflecting the broad range of global geographic settings, involving Canada, India, Japan, Poland, the UK, and the US. The majority of people recruited to the studies had mild to moderate asthma, and a minority had severe asthma. Most people continued to take their usual asthma medication while participating in the studies. The studies lasted for between six and 12 months.

The researchers found that giving an oral vitamin D supplement reduced the risk of severe asthma attacks requiring hospital admission or emergency department attendance from 6% to around 3%. They also found that vitamin D supplementation reduced the rate of asthma attacks needing treatment with steroid tablets. These results are based largely on trials in adults. They also found that vitamin D did not improve lung function or day-to-day asthma symptoms, and that it did not increase the risk of side effects at the doses that were tested.

The Cochrane Review’s lead author, Professor Adrian Martineau from the Asthma UK Centre for Applied Research, Queen Mary University of London, said, “We found that taking a vitamin D supplement in addition to standard asthma treatment significantly reduced the risk of severe asthma attacks, without causing side effects.”

He added, “This is an exciting result, but some caution is warranted. First, the findings relating to severe asthma attacks come from just three trials: most of the patients enrolled in these studies were adults with mild or moderate asthma. Further vitamin D trials in children and in adults with severe asthma are needed to find out whether these patient groups will also benefit. Second, it is not yet clear whether vitamin D supplements can reduce risk of severe asthma attacks in all patients, or whether this effect is just seen in those who have low vitamin D levels to start with. Further analyses to investigate these questions are on-going, and results should be available in the next few months.”

The findings of this Cochrane Review are to be presented at the European Respiratory Society (ERS) Congress in London on Tuesday 6 September.

Read this press release in German or Spanish.

Editor’s notes
The National Institute for Health Research (NIHR) is the largest single funder of Cochrane Airways and supported this review through Programme Grant 13/89/14. Disclaimer: The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the NIHR, the NHS or the Department of Health.

The authors set out to include both types of Vitamin D in their research, however all the trials used Vitamin D3.

For further information, please contact

Jo Anthony
Senior Media and Communications Manager, Cochrane
M +44(0) 7582 726 634 E [email protected] or [email protected]

Media spokesperson
Adrian R Martineau
Professor of Respiratory Infection and Immunity
UK Centre for Applied Research
Barts and The London School of Medicine and Dentistry
Queen Mary University of London
London, UK
E [email protected]

Professor Martineau will be presenting his finding of this Cochrane Review at the ERS Congress in London 3-7 September: http://erscongress.org/

About Cochrane
Cochrane is a global independent network of researchers, professionals, patients, carers and people interested in health.
Cochrane produces reviews which study all of the best available evidence generated through research and make it easier to inform decisions about health. These are called systematic reviews.
Cochrane is a not-for-profit organization with collaborators from more than 120 countries working together to produce credible, accessible health information that is free from commercial sponsorship and other conflicts of interest. Our work is recognized as representing an international gold standard for high quality, trusted information.

Find out more at cochrane.org | Follow us on twitter @cochranecollab

If you are a journalist or member of the press and wish to receive news alerts before their online publication or if you wish to arrange an interview with an author, please contact the Cochrane press office: [email protected]

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About Queen Mary University of London
Queen Mary University of London (QMUL) is one of the UK’s leading universities, and one of the largest institutions in the University of London, with 20,260 students from more than 150 countries.

A member of the Russell Group, we work across the humanities and social sciences, medicine and dentistry, and science and engineering, with inspirational teaching directly informed by our research – in the most recent national assessment of the quality of research, we were placed ninth in the UK (REF 2014).

We also offer something no other university can: a stunning self-contained residential campus in London’s East End. As well as our home at Mile End, we have campuses at Whitechapel, Charterhouse Square, and West Smithfield dedicated to the study of medicine, and a base for legal studies at Lincoln’s Inn Fields.

We have a rich history in London with roots in Europe’s first public hospital, St Barts; England’s first medical school, The London; one of the first colleges to provide higher education to women, Westfield College; and the Victorian philanthropic project, the People’s Palace based at Mile End.

Selected coverage

Promising developments but still more research needed into asthma, says RCGP on the Royal College of General Physicians website

Vitamin D – Can the sunshine vitamin help reduce asthma attacks? on Evidently Cochrane.

Vitamin D ‘significantly reduces severe asthma attacks’ on the BBC.

Lynda Ware: Can vitamin D help reduce asthma attacks? on BMJ Blog.

Vitamin D may protect against severe asthma attacks and hospitalisation on The Conversation.

Vitamin D may cut risk of severe asthma attacks on WEbMD.

Study: Vitamin D may reduce incidence of asthma attacks on United Press International.

High quality evidence suggests Vitamin D can reduce asthma attacks on Science Daily.

Vitamin D could prove to be cheap, over-the-counter alternative to inhalers on CBS New York.

Vitamin D can help treat severe asthma if taken daily, according to new study on The Telegraph.

Vitamin D supplements could halve risk of serious asthma attacks on The Guardian.

Vitamin D can prevent asthma attacks, study finds on the UK Independent.

Vitamin D pill cuts asthma attack threat: Supplements can reduce chance by half in patients on Daily Mail UK.

Vitamin D tablets may help reduce asthma attacks, review finds on Reuters.

Vitamin D supplements may reduce asthma attacks on Nursing Times.

Can asthma be controlled with a vitamin supplement?

Obstruction of the lumen of a bronchiole by mucoid exudate, goblet cell metaplasia, and epithelial basement membrane thickening in a person with asthma. Credit: Yale Rosen/Wikipedia/CC BY-SA 2.0

The shortness of breath experienced by the nearly 26 million Americans who suffer from asthma is usually the result of inflammation of the airways. People with asthma typically use albuterol for acute attacks and inhaled steroids to limit chronic inflammation. Both medications come with side effects.

But what if it was possible to keep asthma under control by changing one’s diet or taking a vitamin supplement? It may happen sooner than you think.

Preliminary research results from the UNC School of Medicine indicate that a type of vitamin E known as gamma tocopherol may reduce eosinophilic inflammation – a kind of airway inflammation common in asthma patients. The results were published in the Journal of Allergy & Clinical Immunology.

“We started looking into vitamin E because epidemiologic data suggested that people with high amounts of vitamin E in their diet were less prone to asthma and allergic disease,” said Michelle Hernandez, MD, professor of pediatrics and senior author of the study.

There are several different isoforms of vitamin E. The type commonly found in vitamin supplements – alpha tocopherol – has been studied previously, but the results suggested that alpha tocopherol was not particularly effective. Even worse, the alpha isoform seemed to be associated with an increased risk for hemorrhagic stroke.

So UNC researchers took a different tack and asked whether the kind of vitamin E being used might have an effect on the outcome. They began looking more closely at gamma tocopherol, the type of vitamin E commonly found in a diet rich in nuts and nut oil. According to study first author Allison Burbank, MD, assistant professor of pediatrics, the gamma isoform has properties that the alpha doesn’t.

“While the alpha isoform does have antioxidant activities, gamma tocopherol has both an antioxidant and a very unique anti-inflammatory action as well,” she said “That anti-inflammatory effect is what we think made the difference in this study.”

Participants in the study were randomized into two groups that received either gamma tocopherol supplement or a placebo for two weeks. At the end of that period, they were asked to cough up sputum. They also underwent an LPS challenge – inhaling a substance that causes inflammation in the lung and then coughing up more sputum, allowing researchers to measure how they responded to the substance used in the challenge.

After a three week “washout period” where they took nothing, subjects were placed in the other group: if they took the supplement for the first two weeks, they took a placebo for the second period.

“The advantage of a cross-over design like this is that we are able to compare the subjects to themselves,” said Burbank. “And what we found is that when people were taking the vitamin E supplement, they had less eosinophilic inflammation.”

In addition to decreased inflammation, those who were taking vitamin E were also found to have lower levels of proteins called mucins, which affect the stickiness of mucus. Mucins are often elevated in asthmatics.

“The fact that the supplement targeted the eosinophils – the main cells we worry most about in asthma treatment – was really telling,” said Hernandez. “And we were also excited to see that the supplement had an effect on how mucus moves through the airway. When there are fewer mucins, the mucus is less sticky and patients are able to clear it better, which means there isn’t as much pro-inflammatory mucus staying in the lungs.”

Hernandez said that the next step is to expand the scope of the study.

“We’d like to do this over a longer time frame and establish whether it’s safe, in less healthy adults,” Hernandez said. “We want to look more closely at how it affects things like lung function and coagulations markers, because of that risk of hemorrhagic stroke associated with alpha tocopherol. We want to see if there are any unanticipated effects of the supplementation regimen.”

For Burbank, the goal is ultimately to improve outcomes for patients.

“We want to know if people with asthma increase intake of vitamin E, did they have fewer asthma attacks? Did they use their rescue inhalers less? Did they go to the hospital or the emergency room fewer times because? I think that’s the goal of any asthma treatment. These are the things we care about and what patients care about.”

Explore further

AAAAI: low vitamin E in mothers can up asthma risk in offspring More information: Allison J. Burbank et al. Gamma tocopherol-enriched supplement reduces sputum eosinophilia and endotoxin-induced sputum neutrophilia in volunteers with asthma, Journal of Allergy and Clinical Immunology (2017). DOI: 10.1016/j.jaci.2017.06.029 Journal information: Journal of Allergy and Clinical Immunology Provided by University of North Carolina at Chapel Hill School of Medicine Citation: Can asthma be controlled with a vitamin supplement? (2017, November 16) retrieved 2 February 2020 from https://medicalxpress.com/news/2017-11-asthma-vitamin-supplement.html This document is subject to copyright. Apart from any fair dealing for the purpose of private study or research, no part may be reproduced without the written permission. The content is provided for information purposes only.nanantachoke/iStock/Getty Images

A balanced diet is key to maintaining a healthy lifestyle, and this is especially true in people with asthma. While no single vitamin, mineral or supplement can treat or cure asthma, research shows that adequate nutrition may relate to the number of asthma attacks and frequency of symptoms experienced. More specifically, ensuring adequate levels of the vitamins C, D, E and the mineral magnesium may be especially important, since links between low levels of these vitamins and asthma symptoms have been reported.

Vitamin C

In people with asthma, constriction of the airways causes wheezing and difficulty breathing. Wheezing and coughing are often prominent symptoms. A January 2000 article from the “Thorax” journal reported an association between vitamin C and asthma attacks. This study found that people with asthma who had a low intake of vitamin C-rich fruits like oranges also had higher risks of wheezing. A February 2006 article from the same journal reported that people with controlled asthma and no wheezing had higher levels of vitamin C in their blood than those who had uncontrolled asthma and wheezing.

Vitamin D

Vitamin D is important for the immune system, strong bones and lung health. Unfortunately, it’s present naturally in very few commonly consumed foods, and many people are deficient. Vitamin D seems to improve the lungs’ response to steroids — medications used to reduce airway inflammation in asthma. According to an April 2010 article in the “American Journal of Respiratory and Critical Care Medicine,” adequate vitamin D levels correlated with less severe asthma and less sensitivity of the airways to asthma triggers. An October 2012 article from the same journal found that asthmatic children who needed more steroid treatments had lower vitamin D levels than children whose asthma was better controlled.

Vitamin E

Vitamin E is important for a healthy immune system and function of organs such as the eyes and skin. It naturally occurs in a variety of foods as different forms, or isomers. There is some evidence from animal studies that the alpha isomer, known as α-tocopherol, has anti-inflammatory properties that might help with airway inflammation in the lungs of mice. According to an August 2013 article in the “American Journal of Respiratory and Critical Care Medicine,” some studies in humans have reported a small beneficial effect associated with higher alpha-tocopherol, but others have not.

Magnesium

In asthma, it’s not just airway inflammation but also smooth muscle contraction that leads to the narrowing of the airways, wheezing and shortness of breath. When given intravenously, magnesium dilates and relaxes the smooth muscles of the bronchi and is sometimes used in this way for severe asthma attacks. Adequate magnesium levels are important, and magnesium intake may also have helpful effects when taken orally. According to a June 2006 article from the “European Journal of Clinical Nutrition,” magnesium might work to amplify the effects of inhaled steroids, reduce bronchial sensitivity to allergens and potentially reduce the use of albuterol. Further research is ongoing.

Warning and Precautions

Vitamin and mineral supplements can help maintain adequate nutrition. Although they can be purchased without prescription, vitamins and minerals should be used in accordance with their labels. Some vitamins may lead to dangerous side effects when used in excess. Interactions with medications and adverse effects in those with specific illnesses are also possible, so it’s important to inform your doctor about all supplements.

Vitamin D ‘protects against severe asthma attacks’

“Vitamin D supplements could halve risk of serious asthma attacks,” The Guardian reports. A review of previous data found that vitamin D supplements could have a protective effect against serious asthma attacks when taken alongside normal asthma treatment.

Vitamin D is made in the skin when it’s exposed to sunlight. Many people in the UK have low levels of vitamin D, especially during the winter when sunlight is weak. People with low levels of vitamin D seem to be more likely to have asthma attacks. The researchers wanted to pool data to get a clearer picture of whether vitamin D supplements could help.

Any review of this sort is only as good as the studies fed into it. While the studies were judged to be of a good quality, the reviews’ authors warn that there were “relatively few” studies included; seven in total. But the main conclusions were based on just three studies which mainly involved adults with mild or moderate asthma. This means the results may not apply to people with severe asthma, or to children.

Unfortunately, the review can’t tell us whether everyone with asthma would benefit from taking vitamin D, or only people whose vitamin D levels are low. Also, it doesn’t give us a recommended dose.

Public Health England recently recommended everyone in the UK considers taking a 10microgram dose of vitamin D daily, especially in winter. However doses in some of these asthma studies were much higher.

So it is unclear whether there is such a thing as an optimal dose, and even if there was, what that would be.

Where did the story come from?

The study was carried out by researchers from several different universities, all of whom are part of the Cochrane Collaboration, an international network of researchers who review medical evidence according to high quality rules. It had no external funding. The study was published in the peer-reviewed journal Cochrane Database of Systematic Reviews. As with all Cochrane publications, the study is open-access, so you can read it for free online.

The UK media covered the study reasonably accurately. The Guardian and BBC News gave clear summaries of the research, pointing out the limitations of the study as well as the top findings.

The Mail Online stated that “as long as patients do not take a huge dose, there is no risk of side effects,” which is not entirely true. Some people in one study of low-dose vitamin D were found to have too much calcium in their urine, which over time can damage the kidneys.

What kind of research was this?

This was a systematic review and meta-analysis of double-blind, randomised, placebo-controlled trials. These are the most reliable types of studies – the gold standard – when seeing if a drug or other treatment works. However, the researchers only found seven studies that met their criteria for inclusion, and only three studies (one including 22 children and two including 685 adults) contributed to the main findings.

What did the research involve?

The authors did searches for completed randomised controlled studies of people with clinically-diagnosed asthma, which tested the effects of vitamin D supplements. They were mainly interested in the effects on asthma attacks, defined as an attack needing to be treated with steroid pills, but they looked at other outcomes too, including emergency hospital visits, day-to-day asthma symptoms, lung function tests and time off school or work. They pooled the results to see how vitamin D affected the chances of having any of these outcomes.

They also examined the studies for anything that might have biased the results, and graded their findings as based on high-quality, moderate-quality or low-quality evidence. The studies were chosen by two researchers working independently, which helps reduce the risk of bias.

The researchers then used standard statistical methods to calculate the risk of having each outcome measured, with and without vitamin D, and tested their results for reliability and over-reliance on one study or another.

What were the basic results?

People with asthma who took vitamin D supplements had on average 0.22 attacks needing treatment with steroid pills each year (approximately one every four years), compared to 0.44 attacks (approximately one every two years) for those people taking placebo supplements (rate ratio 0.63, 95% confidence interval (CI) 0.45 to 0.88).

People taking vitamin D were also less likely to need to go to hospital at any time with an asthma attack. Three people in every 100 who took vitamin D in the studies had to go to hospital with an asthma attack, compared to six in every 100 who took placebo supplements (odds ratio 0.39, 95% CI 0.19 to 0.78).

However, vitamin D did not seem to have any effect on people’s day-to-day asthma symptoms, tests of lung function, or time taken off school or work. No-one in the studies died of an asthma attack, so it’s not possible to say whether vitamin D reduces the risk of a fatal asthma attack.

How did the researchers interpret the results?

The researchers said: “Vitamin D is likely to offer protection against severe asthma attacks.” However, they add that they need to see more research done on children and people who get severe asthma attacks, before they can give “definitive clinical recommendations” about who should take vitamin D.

In interviews given to journalists, they suggest people consider taking vitamin D, and one researcher said people should request a test to see if they have low vitamin D levels, then ask their GP or pharmacist for advice.

Conclusion

Asthma attacks are frightening for adults and children alike, and can be fatal. A treatment that can help people avoid having an asthma attack, especially a severe attack that needs hospital treatment, has long been an aim of asthma research. If a simple vitamin supplement, already recommended for use, can help reduce the risk of attacks, that’s excellent news.

There are a few important points to remember, however:

  • People with asthma should not stop taking their normal asthma medication. Everyone in the studies took vitamin D as well as their asthma treatment, not instead of it.
  • The information for reducing numbers of childhood asthma attacks relies on one study of just 22 children. We need better information from a bigger study to be sure it helps children.
  • We don’t know whether everyone with asthma would benefit, or just people already low in vitamin D.
  • We don’t know the best dose to take for people wanting to reduce their risk of asthma attacks.

It’s unlikely that taking the Public Health England recommended dose of 10 micrograms of vitamin D daily will cause any harm, although we don’t know if it’s enough to help prevent asthma attacks. More than 100 micrograms could be harmful. Vitamin D can encourage the body to absorb more calcium than it needs, which over time could damage the kidneys, heart and bones.

If you are considering adding vitamin D supplementation to your, or your child’s, asthma medication then it is a good idea to discuss it with the doctor in charge of your care.

Analysis by Bazian
Edited by NHS Website

Links to the headlines

Vitamin D supplements could halve risk of serious asthma attacks

The Guardian, 5 September 2016

Vitamin D ‘significantly reduces severe asthma attacks’

BBC News, 5 September 2016

Vitamin D can help treat severe asthma if taken daily, according to new study

The Daily Telegraph, 5 September 2016

Vitamin D pill cuts asthma attack threat: Supplements can reduce chance by half in patients

Mail Online, 6 September 2016

Links to the science

Martineau AR, Cates CJ, Urashima M, et al.

Vitamin D for the management of asthma

Cochrane Database of Systematic Reviews. Published online September 5 2016

PMC

Throughout history, clinical observation and clinical trials have identified links between nutritional deficiency and disease. For example, scurvy was described by Hippocrates over 2000 years ago, and native cultures have known its cause and cure for centuries. The first intervention study to demonstrate the successful treatment of scurvy with citrus fruits was published in 1753 by Captain James Lind in “A Treatise of the Scurvy”. Moving forward to the 20th century, one of the resounding achievements in this field has been identification of the importance of folic acid supplements in the prevention of spina bifida, leading to an overall reduction in incidence in the Western world. The possibility that nutritional factors may play a similarly important role in the aetiology of chronic respiratory disease is therefore intriguing and has recently attracted a great deal of interest.

The aetiology of asthma remains unclear, but it is widely accepted that environmental factors play a major role and, of these, diet is a potentially important contender. Evidence for this arises from the observations that the prevalence of asthma increases as societies move from a rural subsistence towards a more Western lifestyle; this is associated, among other factors, with a change in dietary pattern including adoption of a more processed and “convenience‐orientated” diet. The result of this dietary change is an overall increase in the intake of refined sugars, fats and additives, and a relative reduction in the intake of complex carbohydrates and micronutrients. This change is a relatively modern phenomenon, occurring in the UK since the end of wartime rationing and also resulting from increased industrialisation of the food supply chain.

There is now an extensive literature on the relationship between diet and respiratory disease.1,2,3 In asthma, observational studies have shown encouraging evidence of a protective effect of several nutrients on disease prevalence and symptoms, including vitamin C,4,5 vitamin E,6 selenium7 and magnesium.8 However, and disappointingly in view of early promise with vitamin C,9 these findings have not generally translated into consistently positive outcomes in intervention studies. For example, in a recent randomised placebo‐controlled trial of vitamin C, magnesium or placebo in 300 patients, we found no effect of either supplement on clinical asthma control.10 Similarly, an intervention study of vitamin E in adults with asthma also showed no evidence of a benefit.11 While fish oil supplements have been shown to reduce exercise‐induced bronchoconstriction in asthma,12 other studies have not shown convincing evidence of an effect on asthma symptoms or medication usage.13 The Heart Protection Study which randomised over 20 000 adults at high risk of heart disease to receive antioxidant vitamin supplementation or placebo looked at respiratory disease as a secondary outcome. No difference was found in spirometry or in admission to hospital for chronic obstructive pulmonary disease (COPD), asthma or any non‐neoplastic respiratory disease between the two groups.14 The Cochrane collaboration reviews of a range of dietary interventions in asthma (including vitamin C supplements, sodium restriction and fish oil supplementation) all report negative or, at best, inconclusive findings.15,16,17

Of the many potentially relevant nutrients identified to date, selenium is of interest because case‐control studies in both New Zealand18,19,20 and the UK7 have found a relation between low dietary selenium and an increased risk of asthma. However, the only intervention study of selenium supplementation in asthma published to date included only 24 patients with asthma and found no effect on objective markers of disease.21 In this issue of Thorax, Shaheen et al22 report the results of a definitive randomised controlled trial of selenium supplementation in asthma performed in 197 people living in London (see p 483). No effect of selenium supplementation was found either on quality of life or objective measures of asthma symptoms and control.

So why have observational epidemiological study findings of dietary benefit failed to translate into a positive clinical trial result? Confounding is always a potentially major problem in observational studies, and although the effects of smoking, socioeconomic status and other factors have been allowed for in many of the observational study analyses, it is always possible that these or other effects have still influenced the results. There is also the difficulty of isolating the effects of specific nutrients, given the close correlation that exists between nutrients in individual diets. For example, diets low in fruit and vegetables provide low intakes of both vitamins C and E, making it difficult to determine which, if either, single nutrient is important, and may lead to erroneous identification of nutrient effects in the observational studies. Further, the tendency for diet to track throughout life means that exposure to (or lack of) certain important nutrients identified in observational studies might also reflect effects of exposures occurring over a very long period of time, including childhood and even the prenatal period.23 In contrast, intervention studies have mostly been performed in adults and typically last for a few weeks or, at most, months. The intervention studies may therefore be delivering too little too late in the natural history of disease to have an effect.

Another consideration is that many intervention studies have focused on single nutrient supplements, when it is plausible that a combination of factors is more likely to be effective. This argument is supported by the results of trials showing protection against ozone‐induced bronchoconstriction by a combination of vitamins C and E relative to placebo in adults with asthma,24 and by a combination of vitamins C, E and β‐carotene in subjects without asthma.25 These studies did not, however, include single nutrient supplement groups, so it is not clear whether the effect is indeed due to the combination or whether the results are specific to the ozone challenge exposure and have relatively less relevance to the clinical control of typical asthma.

Another possibility is that other as yet uninvestigated micronutrients or co‐factors are more important. Taking a step further, it could be that entire foods rather than nutrients are important, the most obvious candidates being fruits, vegetables or oily fish; for example, in one case‐control study the intake of apples was negatively associated with the prevalence of asthma.7 To date, however, there is no evidence that individual food or food group supplements are effective in improving or preventing the disease. Furthermore, it may be that dietary supplementation only works in nutritionally deplete populations and that no additional beneficial effect will occur in well‐fed and consequently over‐supplemented individuals. This does not account for the findings in the study by Shaheen et al,22 however, as restriction of analyses to subjects with low plasma selenium levels did not change any of the study outcomes and also did not explain the negative findings in our study of vitamin C and magnesium.10

These and other potential problems may account for the failure to find a clinically useful dietary intervention for asthma, but what are the implications for future work in this area? The optimists among us may continue to pursue the increasingly elusive missing link, exploring the roles of other possible candidate single or multi‐ micronutrients or even try whole food supplements. They may also hope that future improvements in understanding the scientific basis of nutrition and potential roles in airways diseases may lead to the development of new hypotheses that can be tested in interventional studies. However, the pragmatists may take the view that, since single nutrient supplements appear to be ineffective and a balanced diet which includes a range of fresh fruit and vegetables is beneficial in so many other aspects of health, the best approach, at least for the time being, is simply to recommend people with asthma to eat a healthy balanced diet.

Top Recommended Supplements for Asthma

Vitamin Supplements

We love Dr. Berkowitz’s guide, Asthma: Relax, You’re Not Going to Die, in part because Dr. Berkowitz has asthma himself. He offers simple and medically-sound advice for getting your asthma symptoms under control. He wants evidence-based research, but he also knows that the most important thing for asthmatics is how we feel.

And to feel better, he has one word: antioxidants.

Dr. Berkowitz points to a growing body of literature that suggests vitamins can help alleviate asthma symptoms. People with asthma are often antioxidant deficient, and our environments are increasingly toxic.

For this reason, while diet should be our main source of antioxidants, Dr. Berkowitz suggests taking two antioxidants and a multivitamin as part of your routine. He says this can help your asthma and your overall health.

(Learn more about a healthy diet for asthma management here).

You need to research which unique combination is best for your unique body and family history. Dr. Berkowitz says he takes Vitamin C and Coenzyme Q10. Other options include Vitamin A, Vitamin B1, Vitamin B3, Vitamin B6, folic acid, Vitamin B12, Vitamin C, Vitamin D, and Vitamin E.

Finally, a note of caution. Each of these vitamins has specific functions and side effects. Make sure you do your research and talk to your doctor before taking any new supplements.

Buteyko Approved Supplements for Asthma

If you follow our blog (or better yet, if you’re on our mailing list!), you know that we’ve integrated parts of the Buteyko method into our treatment for asthma. It’s got its detractors, but its simple breathing techniques are a main reason I’m no longer dependent on my asthma medication. So, I should point out that Buteyko practitioners are have some go-to recommended supplements for asthma.

First, some Buteyko practitioners believe that chronic hyperventilation can lead to loss of magnesium in the body. And loss of magnesium leads to more hyperventilation (similar to how using too much ventolin can make you need more ventolin). Magnesium also naturally opens the airways.

So, they recommend a liquid magnesium supplement to treat your asthma. Also note that magnesium is found in whole grains, nuts, avocado, beans and dark green vegetables. So make sure you’re getting lots of these in your asthma diet.

Taking Vitamin B5 is also recommended, as it affects stress hormones in the body and can become deficient when the adrenal glands are week. You can also find Vitamin B5 in whole grains, peanuts, eggs and watermelon.

Because it’s a common remedy for colds and the flu, and because those illnesses can have such a negative impact on our breathing, Echinacea is also recommended.

And Everyone Loves Omega Three

Omega 3 is vital to everyone’s health, not just those with asthma. It can help repair damaged lung tissue, and Dr. Berkowitz points to several studies that suggest omega three and six are both beneficial to asthma.

This supplement for asthma is so critical that Buteyko, Dr. Berkowitz and Dr. Weil ALL insist we get enough in our diet.

As I’ve already mentioned, an omega supplemen is the only actual supplement for asthma that I’ve taken. I like the Dr. Tobias fish oil, which is well reviewed on Amazon and moderately priced (win, win).

I can’t tell you if Omega 3 had a specific impact on my symptoms, but a healthy diet high in good fats and low in bad ones definitely makes me feel better (see my complete diet for asthma here).

Final Thoughts On Asthma Supplements

Supplements will work best when you keep track. Hopefully you’re actively recording your asthma symptoms anytime you try a new home remedy. Do the same thing when you start supplements for asthma. Give each new supplement a 4-6 week trial period and see if your symptoms improve. Everyone is unique, so just because it worked for someone else doesn’t mean it will work for you.

And now, like always, please reach out in the comments below. Have you tried any of these supplements for asthma? Any luck? We hope you’ll share that we can all start to manage our symptoms better.

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What is asthma?

Asthma is an episodic constriction of the bronchial tubes. It is a common disorder of both children and adults, often regarded as mysterious and frustrating to treat.

What are some asthma symptoms?

Asthma symptoms can include wheezing (especially on expiration), coughing, and difficulty in breathing. Asthma can appear and disappear without warning. If an attack is severe enough, it can kill.

What are the causes of asthma?

The immediate cause of an asthmatic attack is tightening of the muscular bands that regulate the size of the bronchial tubes. These muscles are controlled by nerves, but what triggers the nerves to make airways constrict inappropriately is not clear. The triggers for asthma can be primarily allergic or primarily emotional or induced by exercise or respiratory infection, or it can occur with no obvious causes. It is now being considered an inflammatory disorder.

The “hygiene hypothesis” is a proposed explanation for why allergies and asthma are now epidemic, especially in developed countries. The hypothesis holds that children who grow up in crowded and dirtier environments are less likely to develop these ailments than youngsters raised in cleaner, more protected environments. The idea is that the developing immune systems of less privileged kids are exposed to lots of germs from an early age and so become stronger and more protective of health. The hypothesis recently got a big boost in credibility. Researchers at Duke University Medical Center compared the antibodies in the blood of laboratory rats and mice, which grow in a virtually germ-free environment, with those of wild rats and mice. All of the wild rodents had higher levels of IgG and IgE, classes of antibodies associated with immune and allergic diseases, but the wild rodents’ antibodies did not tend to bind to the rat’s own cells, as did the antibodies produced by the hygienically raised rodents. Instead, the wild rodents’ antibodies efficiently and effectively attacked invading organisms. The research was written up in the August, 2006, Scandinavian Journal of Immunology.

Despite this intriguing evidence, we need a lot more proof from human studies before the hygiene hypothesis makes the leap from theory to fact, and I wouldn’t worry about a home being “too clean.” In fact, random pollution of the home environment has its own drawbacks. Children who breathe secondhand smoke are more likely to develop asthma, and among all youngsters with asthma, those who breathe secondhand smoke have more frequent attacks).

What are the conventional asthma treatments?

Asthma treatment has two aspects: management of acute attacks and long-term control or prevention. Conventional treatments are sometimes the best choices for acute attacks, where immediate relief can be a life-and-death matter.

For allergic asthma, one of the safest and best drugs is inhaled cromolyn sodium. Most bronchodilating drugs are stimulants that increase sympathetic tone and anxiety. Theophylline, derived from tea, has a long history of use, but may not be as safe as doctors used to think. It can cause dramatic personality changes. Other drugs of this class can be inhaled to relieve and prevent attacks. These inhalers work, but they are often addictive, since the bronchial tubes are likely to become constricted again when one dose wears off (the same pattern occurs when these drugs are sprayed into the nose to relieve nasal congestion). Newer drugs – the leukotriene inhibitors are useful for some patients and less toxic.

Other inhalers contain steroids. If the steroids are not absorbed into the system, they can be safe and effective. Different products vary greatly in efficacy and absorbability. At this writing the best are Flovent (fluticasone) and Pulmocort (budesonide), both safer than older versions. Steroid inhalers should always be used immediately following inhalation of a bronchodilator.

In my view, conventional protocols for long-term control are more problematic. Oral steroids (prednisone is the commonest) are very dangerous for asthmatics, because it is too easy to become addicted to them, and toxicity from long-term steroid use is devastating. Try to avoid ever going on oral steroids. If you do have to take them, get off as soon as possible. In general, the less medication you can take, the better. Allopathic drugs, being suppressive in nature, tend to perpetuate asthma and may reduce the chance that it will disappear on its own.

What therapies for asthma does Dr. Weil recommend?

For acute attacks, this is one of the home remedies for asthma recommended by Dr. Weil: try lobelia, or Indian tobacco (Lobelia inflate). Mix three parts tincture of lobelia with one part tincture of capsicum (red pepper, cayenne pepper). Take twenty drops of the mixture in water at the start of an asthmatic attack. Repeat every thirty minutes for a total of three or four doses.

For long term control and prevention:

  • Decrease protein to 10 percent of daily caloric intake. Replace animal protein as much as possible with plant protein
  • Eliminate milk and milk products, substituting other calcium sources.
  • Eat organically grown fruits and vegetables as much as possible.
  • Eliminate polyunsaturated vegetable oils, margarine, vegetable shortening, all partially hydrogenated oils that might contain trans-fatty acids, all foods that might contain trans-fatty acids (such as deep-fried foods).
  • Use extra-virgin olive oil as your main fat.
  • Increase intake of omega-3 fatty acids.
  • Always drink plenty of water to keep your respiratory tract secretions more fluid.
  • Experiment with eliminating (one at a time) wheat, corn, soy and sugar for six to eight weeks to see if the condition improves.
  • Eat ginger and turmeric regularly for their anti-inflammatory effects.
  • Have some manipulative work done on the chest to break up restrictive patterns in nerves and muscles that develop in chronic asthma. The best systems I know for this are osteopathic manipulation, especially from a practitioner of cranial therapy, and Rolfing, a form of deep-tissue massage.
  • Minimize contact with respiratory irritants, such as smoke, dust, molds, and volatile chemicals. Remove sources of offending materials from your home, install a good air filtration system, or consider moving if the air is generally bad where you live. Experiment with living in other locations: in high mountains, the desert, or near the seacoast. Asthma may improve greatly with a change of climate.
  • In adults, GERD (acid reflux disease) may be an underlying cause of asthma. In such cases, successful treatment of the digestive problem will often clear up the asthma.
  • Experiment with traditional Chinese medicine and Ayurvedic medicine (the traditional healing system of India). These systems are sometimes able to offer significant help through more specific dietary adjustments and herbal treatments.

Here are some specific recommendations for exercise-induced asthma:

  1. Warm up very slowly to the point where you almost feel the “tightness” associated with exercise-induced asthma. Then stop and stretch or, if you’re exercising vigorously, slow down. By taking this break, you often can block the development of asthmatic symptoms. You can then go back to your normal pace. This may take some getting used to, but can sometimes eliminate the need for medication.
  2. Try breath work. The most effective approaches are pranayama techniques (breath control exercises taught in some yoga classes). You can do these after the initial warm-up when symptoms are almost felt. For beginners, start with “The Relaxing Breath,” a technique I describe in my books and on this website.
  3. Find a form of physical activity that minimizes your exercise-induced symptoms. Sports or activities that have intermittent rest periods (such as tennis, softball, and golf) can allow you to regain control of your breathing. Swimming may be better than running outdoors in cold weather, but no type of exercise is off-limits with proper treatment. In fact, some of the world’s top athletes have exercise-induced asthma, and they’re still able to compete successfully in Olympic-level events.

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