THE ASSESSMENT OF VITAMIN D LEVELS OF PATIENTS WITH ASTHMA AND MULTIMORBIDITY

ABSTRACT Vitamin D deficiency is associated with increased systemic inflammation, oxidative stress and negatively affects disease control of patients with asthma, obesity and multimorbidity.

Material and methods. The study included 237 patients with asthma, they were divided into 3 groups (normal body weight, overweight and obesity). Levels of vitamin D, interleukin-6 (IL-6), tumor necrosis factor (TNF-α), degree of oxidative damage to biomolecules (PerOx), asthma control and the multimorbidity index were assessed.

Results. 57.8% of patients with obesity had vitamin D insufficiency and 35.8% had deficiency. Vitamin D levels decreased with increasing comorbidities, with the most pronounced deficiency seen in those with ≥5 comorbidities (p<0.05). Patients with obesity had lower vitamin D levels than those with normal body weight, irrespective of comorbidity count (p<0.05). Inverse correlation was found between level vitamin D and asthma control by ACQ-5 (r = -0.3593), BMI (r = -0.3036), IL-6 (r=-0.1644 ), TNF-α (r=-0.2596), PerOx ( r=-0.2129), leptin ( r= -0.2756). Patients with obesity and uncontrolled asthma had significantly lower vitamin D levels (median (21,7[18,8;24,5]) In patients with normal body weight and vitamin D deficiency, oxidative stress levels were twofold higher (p<0·05). Patients with obesity had statistically significantly higher levels of IL-6, TNF-α, and PerOx independent of vitamin D status (p<0-05).

Conclusion. In patients with asthma and multimorbidity, low vitamin D levels may be associated with elevated proinflammatory cytokines and worse asthma control. Vitamin D deficiency in those with asthma, obesity, and multimorbidity represents a clinically important modifiable factor that warrants attention.

Vitamin D supplementation may be considered as part of a comprehensive treatment and rehabilitation strategy for these patients.