الفهرس 
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Abstract
Summary
Study design
This study is observational cohort study conducted at New Cairo Police Hospital, in Chest Department from January 2016 till January 2017 including 60 Resistant Asthmatic subjects including 30 patients with serum 25OH Vitamin D3 deficiency, who will be followed up after VITAMIN D3 supplementation therapy for three month and will be compared with 30 Resistant Asthmatic subjects with normal serum 25OH Vitamin D3.
Subjects will be grouped into:
group I: 30 Resistant Asthmatic subjects with 25 OH Vitamin D3 deficiency.
group II: 30 Resistant Asthmatic subjects with normal 25 OH Vitamin D3.
All study subjects were recruited on voluntary basis and a written informed consent was obtained from adult subjects and parental consent from the parents or guardians of each minor subject enrolled in the study.
Patients were subjected to full history taking, detailed clinical examination, chest x-ray, full routine lab CBC, Liver function tests, Kidney function tests, demographic data acquisition and spirometry, Serum(25 OH VITAMIN D3) before and after VITAMIN D3 supplementation therapy for three month.
The results were analyzed and it was observed that patients were with matched age, sex, BMI and asthma severity.
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Childhood and elderly resistant Asthmatics patients with severe asthma exacerbation were treated with 40 mg/day of prednisolone for more than 14 days. The asthma patients were randomly divided into group І:30 resistant asthmatic subjects with 25 OH VITAMIN D3D3 deficiency and group П:30 resistant asthmatic subjects with normal 25 OH VITAMIN D3. The asthmatic patients with Vitamin D deficiency were orally supplemented with 1000 IU of vitamin D3 for children and 2000 IU vitamin D3 for elderly from day 1 to day 90.
Measurement of vitamin D3 in serum
At day 1 and day 90The serum vitamin D3 was determined in samples from each patient by enzyme-linked immunosorbent assay (ELISA). The ELISA kits for vitamin D3 were purchased from IBL (Germany).
Spirometry (FEV1, FVC, FEV1/FVC)
At day 1 and day 90 spirometry is measured with a Jaeger Lung Function Analyzer.
The patient must be clinically stable, should sit straight, with head erect, nose clip in place, and holding the mouthpiece tightly between the lips.
This study highlights the Effect of vitamin D3 in patients with resistant asthma among childhood and elderly asthmatics.
In this study, the Comparative spirometric analysis (change) in Elderly Resistant Asthmatics with serum 25OH Vitamin D3 deficiency ―Cases‖ and Elderly resistant Asthmatics with normal serum 25 OH VITAMIN D3 asthmatics ”Control‖ before and after were orally supplemented with 2000 IU vitamin of D3 from day 1 to day 90, The
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mean ―FEV1% change‖ of Elderly Resistant Asthmatics with normal serum 25OH Vitamin D3 ―Control‖ was 0.00 with ±SD 3.54, the mean ―Actual FEV1‖ of Elderly Resistant Asthmatics with serum 25OH Vitamin D3deficiency ―Cases‖ was 7.69 with ±SD 5.11 and the difference statistically significant, and the differences was in favor of Cases.
In this study, the Comparative spirometric analysis (change) in Childhood Resistant Asthmatics with serum 25OH Vitamin D3 deficiency ―Cases‖ and Childhood resistant Asthmatics with normal serum 25 OH VITAMIN D3 asthmatics ―Control‖ before and after were orally supplemented with 1000 IU vitamin of D3 from day 1 to day 90, The mean ―FEV1% change‖ of Childhood Resistant Asthmatics with normal serum 25OH Vitamin D3 ―Control‖ was 0.02 with ±SD 5.79, the mean ―Actual FEV1‖ of Childhood Resistant Asthmatics with deficiency serum 25 OH VITAMIN D3 ―Cases‖ was 7.71 with ±SD 3.69 and the difference was statistically significant, and the differences was in favor of Cases.
As regard a comparison in spirometric measures in asthmatic Childhood and Elderly resistant Asthmaticswith serum 25 OH VITAMIN D3D3 deficiencies before and after were orally supplemented with1000 IU vitamin D3 for children and 2000 IU vitamin D3 for elderly, the difference was statistically significant.
Conclusion
This study highlight the response to VITAMIN D3 supplementation therapy and it yielded results as vitamin D deficiency was associated with a decrease in spirometric measures in the Childhood And Elderly resistant Asthmatics a role for vitamin D induced modulation of the airway, and altering the pathogenesis of asthma through modulation of T
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cell driven immune responses, however there is still clearlya need for more work to evaluate this effect of vitamin D3 in patients with resistant asthma among childhood and elderly asthmatics.
Recommendations
There is certainly mounting evidence for a role of vitamin D in altering the pathogenesis of asthma through modulation of T cell driven immune responses; however there is still clearly a need for more work to evaluate the effect of vitamin D3 in patients with resistant asthma among childhood and elderly asthmatics.
Measurement of vitamin D must be a routine step in resistant asthma among childhood and elderly asthmatics.
Vitamin D supplementation during childhood and adolescence, in adequate doses could be among the national nutritional priorities.