Serum micronutrients levels and clinical features of elderly asthmatics

So-Hee Lee; Woo-Jung Song; Heung-Woo Park; Sae-Hoon Kim; Hye-Kyung Park; Sang-Heon Kim; Yong Eun Kwon; Tae-Bum Kim; Byung-Jae Lee; Young-Koo Jee; Byoung Whui Choi; Sang-Heon Cho; Sun Sin Kim

doi:10.4168/aard.2017.5.4.223

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Lee, Song, Park, Kim, Park, Kim, Kwon, Kim, Lee, Jee, Choi, Cho, and Kim: Serum micronutrients levels and clinical features of elderly asthmatics

Original Article

Allergy Asthma Respir Dis 2017;5(4):223-227.

Published online: 5 July 2017

DOI: https://doi.org/10.4168/aard.2017.5.4.223

Serum micronutrients levels and clinical features of elderly asthmatics

So-Hee Lee^1,², Woo-Jung Song¹, Heung-Woo Park¹, Sae-Hoon Kim³, Hye-Kyung Park⁴, Sang-Heon Kim⁵, Yong Eun Kwon⁶, Tae-Bum Kim⁷, Byung-Jae Lee⁸, Young-Koo Jee⁹, Byoung Whui Choi¹⁰, Sang-Heon Cho¹, Sun Sin Kim^1,²

¹Departement of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea

²Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea

³Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea

⁴Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea

⁵Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea

⁶Department of Internal Medicine, Chosun University Medical School, Gwangju, Korea

⁷Department of Allergy and Clinical Immunology, Asan Medical Center, Seoul, Korea

⁸Department of Internal Medicine, Samsung Medical Center, Seoul, Korea

⁹Department of Internal Medicine, Dankook University College of Medicine, Choenan, Korea

¹⁰Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea

Correspondence to: Sun Sin Kim https://orcid.org/0000-0002-0664-3256 Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center, 152 Teheran-ro, Gangnam-gu, Seoul 06236, Korea Tel: +82-2-2112-5642, Fax: +82-2-2112-5794, E-mail: kimss@snu.ac.kr

Received 26 May 201730 May 2017 Accepted 2 June 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The prevalence of asthma in the elderly is rapidly increasing. However, we do not fully understand the pathogenesis of elderly asthma, especially for the roles of micronutrients. This study aimed to evaluate the associations between serum levels of micronutrients, including several vitamins and minerals, and clinical features of the elderly asthmatics.

Methods

A total of 317 asthmatics aged 65 or older were enrolled. Serum levels of vitamin D, vitamin B12, folate, Mg, and Se were measured and then the associations between serum micronutrient levels and clinical features of elderly asthmatics were evaluated.

Results

Positive correlations with significance among serum levels of vitamin B₁₂, vitamin D, and folate were found. Serum micronutrients levels showed no difference according to the atopic status and symptom severity. The serum folate level was significantly associated with forced expiratory volume in 1 second, and serum vitamin B₁₂ and folate levels were significantly associated with serum total IgE level. Interestingly, elderly asthmatics with exacerbation history showed significantly lower serum levels of vitamin D and Mg, but significantly higher serum levels of Se.

Conclusion

Serum levels of micronutrients, such as vitamin D, vitamin B₁₂, Mg, folate, and Se, were significantly associated with some clinical features of elderly asthmatics. Clinical meanings of these associations need to be investigated further.

Keywords: Elderly, Asthma, Micronutrients

REFERENCES

1. Hanania NA, King MJ, Braman SS, Saltoun C, Wise RA, Enright P, et al. Asthma in the elderly: current understanding and future research needs–a report of a National Institute on Aging (NIA) workshop. J Allergy Clin Immunol. 2011; 128(3 Suppl):S4–24.

2. Yáñez A, Cho SH, Soriano JB, Rosenwasser LJ, Rodrigo GJ, Rabe KF, et al. Asthma in the elderly: what we know and what we have yet to know. World Allergy Organ J. 2014; 7:8.

3. Song WJ, Cho SH. Challenges in the management of asthma in the elderly. Allergy Asthma Immunol Res. 2015; 7:431–9.

4. Park J, Kim TB, Joo H, Lee JS, Lee SD, Oh YM. Diseases concomitant with asthma in middle-aged and elderly subjects in Korea: a population-based study. Allergy Asthma Immunol Res. 2013; 5:16–25.

5. Ban GY, Trinh TH, Ye YM, Park HS. Predictors of asthma control in elderly patients. Curr Opin Allergy Clin Immunol. 2016; 16:237–43.

6. Battaglia S, Benfante A, Spatafora M, Scichilone N. Asthma in the elderly: a different disease? Breathe (Sheff). 2016; 12:18–28.

7. Park HW, Song WJ, Kim SH, Park HK, Kim SH, Kwon YE, et al. Classification and implementation of asthma phenotypes in elderly patients. Ann Allergy Asthma Immunol. 2015; 114:18–22.

8. Lavoie KL, Bacon SL, Barone S, Cartier A, Ditto B, Labrecque M. What is worse for asthma control and quality of life: depressive disorders, anxiety disorders, or both? Chest. 2006; 130:1039–47.

9. Carvalho NS, Ribeiro PR, Ribeiro M, Nunes Mdo P, Cukier A, Stelmach R. Comparing asthma and chronic obstructive pulmonary disease in terms of symptoms of anxiety and depression. J Bras Pneumol. 2007; 33:1–6.

10. Lee JA, L Reed P, Berg JP. Asthma characteristics among older adults: using the California health interview survey to examine asthma incidence, morbidity and ethnic differences. J Asthma. 2014; 51:399–404.

11. Hall SC, Agrawal DK. Vitamin D and bronchial asthma: an overview of data from the past 5 years. Clin Ther. 2017; 39:917–29.

12. Korn S, Hübner M, Jung M, Blettner M, Buhl R. Severe and uncontrolled adult asthma is associated with vitamin D insufficiency and deficiency. Respir Res. 2013; 14:25.

13. Columbo M, Panettieri RA Jr, Rohr AS. Asthma in the elderly: a study of the role of vitamin D. Allergy Asthma Clin Immunol. 2014; 10:48.

14. Jolliffe DA, Kilpin K, MacLaughlin BD, Greiller CL, Hooper RL, Barnes NC, et al. Prevalence, determinants and clinical correlates of vitamin D deficiency in adults with inhaled corticosteroid-treated asthma in Lon-don, UK. J Steroid Biochem Mol Biol 2016 Nov 5 [Epub]. pii: S0960-0760(16)30300-4.https://doi.org/10.1016/j.jsbmb.2016.11.004.

15. Brumpton BM, Langhammer A, Henriksen AH, Camargo CA Jr, Chen Y, Romundstad PR, et al. Vitamin D and lung function decline in adults with asthma: The HUNT Study. Am J Epidemiol. 2016; 183:739–46.

16. Salas NM, Luo L, Harkins MS. Vitamin D deficiency and adult asthma exacerbations. J Asthma. 2014; 51:950–5.

17. Shaikh MN, Malapati BR, Gokani R, Patel B, Chatriwala M. Serum mag-nesium and vitamin D levels as indicators of asthma severity. Pulm Med. 2016; 2016:1643717.

18. Fabian E, Pölöskey P, Kósa L, Elmadfa I, Réthy LA. Nutritional supplements and plasma antioxidants in childhood asthma. Wien Klin Wochen-schr. 2013; 125:309–15.

19. Rubin RN, Navon L, Cassano PA. Relationship of serum antioxidants to asthma prevalence in youth. Am J Respir Crit Care Med. 2004; 169:393–8.

20. Kocyigit A, Armutcu F, Gurel A, Ermis B. Alterations in plasma essential trace elements selenium, manganese, zinc, copper, and iron concentrations and the possible role of these elements on oxidative status in patients with childhood asthma. Biol Trace Elem Res. 2004; 97:31–41.

21. Qujeq D, Hidari B, Bijani K, Shirdel H. Glutathione peroxidase activity and serum selenium concentration in intrinsic asthmatic patients. Clin Chem Lab Med. 2003; 41:200–2.

22. Bishopp A, Sathyamurthy R, Manney S, Webbster C, Krishna MT, Man-sur AH. Biomarkers of oxidative stress and antioxidants in severe asthma: A Prospective Case-Control Study. Ann Allergy Asthma Immunol. 2017; 118:445–51.

23. Sharma S, Litonjua A. Asthma, allergy, and responses to methyl donor supplements and nutrients. J Allergy Clin Immunol. 2014; 133:1246–54.

24. Blatter J, Brehm JM, Sordillo J, Forno E, Boutaoui N, Acosta-Pérez E, et al. Folate deficiency, atopy, and severe asthma exacerbations in puerto ri-can children. Ann Am Thorac Soc. 2016; 13:223–30.

Table 1.

Baseline characteristics of the study population (n=317)

Characteristic	Value
Age (yr)	73.8±4.9 (66–94)
Male sex	170 (53.6)
Body mass index (kg/m²)	24.3±3.3
Atopy	77 (24.3)
Onset of asthma symptom (≥65 yr)	142 (44.8)
Duration of asthma (yr)	7.9±10.9
Chronic rhinosinusitis	79 (24.9)
Current or ex-smoker	141 (44.5)
Previous exacerbation	46 (14.5)
Postbronchodilator % predicted FEV₁	79.4±23.8
Postbronchodilator FEV1/FVC	70.8±14.7
Serum total IgE (IU/mL)	417.8±988.5
Serum Na (mmol/L)	142.5±2.9
Serum vitamin B₁₂ (pg/mL)	626.1±342.9
Serum folate (ng/mL)	8.63±8.0
Serum vitamin D₃ (ng/mL)	35.5±17.3
Serum Mg (mg/dL)	3.1±8.0
Serum Se (μg/L)	98.0±20.5
KMMSE∗	27.3±3.0
GDSSFK^†	20.0±3.9
ACT score	20.5±4.0

Values are presented as mean±standard deviation (range), number (%), or mean± standard deviation.

FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity; KMMSE, Korean version of the Mini-Mental State Examination; GDSSFK, Korean version of the Geriatric Depression Scale Short Form; ACT, asthma control test.

Reference value of micronutrients: Na (135–145 mmol/L), vitamin B₁₂ (160–970 pg/ mL), folate (>1.5 ng/mL), vitamin D₃ (7.6–75.0 ng/mL), Mg (1.5–2.5 mg/dL), Se (75–205 μg/L).

^∗ 24≤KMMSE: normal, 20≤KMMSE<24: mild dementia, 10≤KMMSE<20: moderate dementia, 10>KMMSE: severe dementia.

^† Maximal score: 30, higher means more depressed.

Table 2.

Correlation amon ng micronutrients

Variable	r∗	P-value
Vitamin B12 (pg/mL)
Folate	0.197	<0.001
Se (μg/L)	0.197	<0.001
Folate (ng/mL)
Mg (mg/dL)	0.265	<0.001
Se	0.289	<0.001
Vitamin D₃ (ng/mL)
Se	0.126	0.024

^∗ Pearson correlation.

Table 3.

Association between lung function/total IgE/ACT score and micronutrients

Variable	Vitamin B₁₂ (pg/mL)		Folate (ng/mL)		Vitamin D₃ (ng/mL)		Mg (mg/dL)		Se (μg/L)
Variable	Estimate	P-value	Estimate	P-value	Estimate	P-value	Estimate	P-value	Estimate	P-value
FEV1 (%)	<0.001	0.453	0.009	0.044	-0.002	0.225	<0.001	0.957	<0.001	0.780
FVC (%)	0.000	0.311	0.004	0.435	-0.002	0.372	-0.003	0.681	-0.002	0.411
FEV₁/FVC	-0.001	0.714	0.170	0.115	-0.057	0.208	0.065	0.641	0.065	0.131
ACT score	<0.001	0.131	-0.008	0.109	-0.001	0.807	0.001	0.917	0.001	0.780
Total IgE (IU/mL)	0.747	0.047	37.575	0.021	5.961	0.243	-12.328	0.526	-4.815	0.131

ACT, asthma control test; FEV₁, forced expiratory volume in 1 second; FVC, forced expiratory capacity.

Table 4.

Difference in micronutrients according to previous exacerbation history 1 year prior to the enrollment

Variable	AE (+) (n=46)	AE (-) (n=271)	P-value
Vitamin B₁₂ (pg/mL)	707.8±317.2	600.9±294.9	0.498
Folate (ng/mL)	9.12±8.07	8.70±8.36	0.8085
Vitamin D3 (ng/mL)	34.74±13.58	35.27±18.04	0.031
Mg (mg/dL)	2.15±0.153	3.32±9.01	<0.001
Se (μg/L)	100.5±13.20	97.29±19.59	0.003

AE, acute exacerbation history.

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