|
OJHAS Vol. 9, Issue 4:
(Oct-Dec, 2010) |
|
|
| Study of Plasma Ascorbic
Acid Levels in Wheezing Children |
|
Nagdeote AN, Department of Biochemistry,
ESI Post Graduate Institute of Medical Sciences and Research, Andheri
east, Mumbai,
Paunipagar PV, Department of Biochemistry,
Raichur Institute of Medical Sciences (RIMS), Raichur,
Muddeshwar MG, Department of Biochemistry,
Indira Gandhi Govt. Medical College, Nagpur,
Suryawanshi NP, Department of Biochemistry,
Indira Gandhi Govt. Medical College, Nagpur, |
|
|
| |
|
|
|
|
|
|
Address For Correspondence |
Associate Professor in
Biochemistry,
ESI Post Graduate Institute
of Medical Sciences and Research,
Andheri east, Mumbai.
400093.
E-mail:
abhayanuaru@rediffmail.com |
|
|
|
|
|
Nagdeote AN, Paunipagar PV, Muddeshwar MG, Suryawanshi NP. Study of Plasma Ascorbic
acid levels in Wheezing Children. Online J Health Allied Scs.
2010;9(4):10 |
|
|
|
|
Submitted: Aug 27, 2010; Suggested revision: Oct 8, 2010; Revised: Oct 10, 2010;
Accepted: Oct 18, 2010; Published: Jan 20, 2011 |
|
|
|
|
|
|
|
| |
|
| Abstract: |
|
Background: Reactive
Oxygen species induced bronchial abnormalities may have important consequences
in asthma, the main symptom being wheezing specially in children. Vitamin
C is an important antioxidant known to quench the reactive oxygen species.
A beneficial effect of fresh fruit consumption on lung function has
been observed in several studies. Plasma levels Vitamin C was determined
in relation to wheezing symptoms in cross sectional study. Methods: In a cross sectional
blood samples of 50 patients attending pediatrics OPD, having
wheezing and shortness of breath were analyzed for plasma Ascorbic
acid level and compared with healthy controls of same age and
sex. Results: The total number of 50 wheezing children
were in the age group of 2 to 12 years with similar age matched controls. It was observed that the plasma ascorbic acid concentration in the wheezing
children (0.43 – 0.12 mg/dl) was significantly decreased as compared
to the normal controls ( 0.75 – 0.18 mg/dl ) P< 0.001. The highly
significant low levels of plasma ascorbic acid level in wheezing children
was irrespective of sex and severity of symptoms. However the ascorbic
acid levels were at the lower side in female and with severe symptoms. Conclusions: Plasma Ascorbic
acid levels were significantly, decreased in the process of scavenging the
reactive oxygen species. Ascorbic acid directly neutralizes free radical and
protects the bronchial tissue from oxidative injury, so it can be concluded that
the consumption of fruit rich in vitamin C may reduce wheezing symptoms in
children.
Key Words: Wheezing; Asthma;
Reactive oxygen species; Ascorbic acid
|
|
Wheezing, the most common
symptom of Asthma is usually described as a musical sound that is usually
heard when child takes a breath out and sometimes also when he breaths
in. This sound is caused by an obstruction to the regular flow of air
from the lungs and is usually caused by inflammation resulting due to
free radicals. Airway inflammation is important characteristics of asthma
and the metabolism of oxygen radical is enhanced in symptomatic asthma
in relation to clinical disease activity.1 Eosinophils,
alveolar macrophages and neutrophils from asthmatic patients produce
more oxygen species than do those from normal subject.2
Vitamin
C is a potent antioxidant known to protect from oxidative injury. Loading
cells with vitamin C reduces oxidative cell death, inhibits Fas ligand
induced apoptosis and confers genomic protection through the quenching
of intracellular reactive oxygen species.3
Consuming
fruits rich in Vitamin C may reduce wheezing symptoms in childhood.4 Ascorbic acid is the most abundant water soluble antioxidant
in lung tissue that directly neutralizes free radicals and is a part
of Glutathione peroxidase pathway for repairing oxidative damage to
the lipid membrane.5 In our present study we tried
to find out plasma Ascorbic acid level in wheezing children which reflect
their alveolar level.6
Present study was carried
out in Dept. of Biochemistry. Blood samples of 50 (26 males, 24 females)
children who came to pediatrics OPD with wheezing and shortness of breath
were included in the study. Blood sample was collected and analyzed
for plasma Ascorbic acid level photometrically using Backeman’s spectrophotometer.7 Out of total 50 children 18 were having severe symptoms.
Equal number of healthy age and sex matched controls (28 males, 22 females)
were selected for comparison.
The total number of 50
wheezing children were in the age group of 2 to 12 years with similar
age matched controls. It was observed that the plasma ascorbic acid concentration
in the wheezing children (0.43 ± 0.12 mg/dl) was significantly low as
compared to the normal controls (0.75 ± 0.18 mg/dl) P< 0.001. The
highly significant low levels of plasma ascorbic acid level in wheezing
children was irrespective of sex and severity of symptoms.
|
Table 1: Plasma Ascorbic
level in wheezing children (in mean ± SD) in mg/dl
|
|
Normal controls (n=50) |
Wheezing children(n=50) |
|
0.75±0.18 |
0.43±0.12* |
|
*p<0.001
|
|
Table 2: Sex wise distribution
of plasma Ascorbic acid level in wheezing children in mg/dl
|
|
Sex |
Normal control |
Wheezing children |
|
Male |
0.78±0.21 |
0.44±0.10* |
|
Female |
0.73±0.19 |
0.42±0.13* |
*p<0.001 |
|
Table 3: Severity
wise Distribution of Plasma ascorbic acid level in wheezing children
in mg/dl.
|
|
Severity |
Normal controls |
Wheezing children |
|
Mild |
0.75±0.18 |
0.44±0.17* |
|
Severe |
|
0.42±0.09* |
|
*p<0.001 |
Wheezing and shortness
of breath are main symptoms of bronchial asthma.8
Asthmatics showed increased superoxide generation from leucocytes, as
well as increased lipid peroxidation product, indicating
increased oxidative stress.2 Ascorbic acid an important
antioxidant which directly neutralizes free radical, thus it is continuously
utilized to maintain the redox state of lung in asthma.5
Hatch et al9 suggested that ascorbic acid is the major
antioxidant substance present in the airway surface lining of the lung,
and may protect against endogenous as well as exogenous oxidants. Our
present finding of low ascorbic acid in wheezing children could be attributed
to its normal physiological function, elevated utilization to overcome
continuous generation of oxidant radical and also to neutralize the
exogenous oxidant. It has been suggested that ascorbic acid deficiency
may be either an underlying factor in the pathophysiology of asthma
or a response to asthmatic airways inflammation.10 Our findings
of low ascorbic acid in wheezing children is in agreement with the earlier
reports of Akinkube et al11 who attributed such kind
of lowering in ascorbic acid level in plasma to its normal physiological
function i.e., its utilization in the maintenance of defense mechanism,
tissue integrity and replacement and healing process. Destruction of
respiratory mucous membrane during common cold and resulting reduction
of the tissue ascorbic acid, may further delay in the healing of mucous
membrane surface leading to prolonged symptoms of asthma.12 The
study of Kalayci O et al13 shows that antioxidant
vitamins are decreased in the sera of asthmatic patients even during
the asymptomatic periods of the disease, and thus this decrease is not
totally dependent on the increased oxidative stress as reflected by
lipid peroxidation products. Based on this findings, it can be suggested
that to some extent decrease in the level of ascorbic acid may be due
to increase utilization for the formation of Prostaglandin E2, a
bronchodilator and not solely due to scavenging of free radicals.14 Vitamin C may have protective effect on the airway hyper
reactivity in some patients with exercise induced asthma. Important
role of ascorbic acid in the maintenance of pulmonary function has been
reported by McNally et al15 who showed that administration
of ascorbic acid caused pulmonary dilation and urinary excretion of
the vitamin during the acute episode of asthma was significantly reduced. This would suggest that, during the asthmatic episodes, ascorbic acid
was being actively metabolized probably at the bronchial mucosal surface,
thus reducing the plasma ascorbic acid content. It has been also found
that consumption of citrus fruit rich in vitamin C has a protective role
in wheezing children.4 Thus the continuous supply
of vitamin C to the wheezing children might be considered helpful.
- Jarjour MJ, Busse
WW, Calnoun WJ. Enhanced production of oxygen radical in nocturnal asthma.
Am Rev Resp Dis 1992;146:905.
- Branes PJ.
Reactive oxygen species and airway inflammation. Free radic Biol Med 1990;9:235.
- Shagun KC, Carcamo JM, Golde
DW. Vitamin C entersmitochondria via facilitative
glucose transporter 1 (glut 1) and confers mitochondrial protection
against oxidative injury. The FASEB Journal 2005;19:1657.
- Forastiere
F, Pistelli R, Sestini P, Fortes C, Renozoni E, Rusconi F et al. Consumption
of fresh fruit rich in vitamin C and wheezing symptoms in children. Thorax 2000
April;44(4):283.
- Johnson FC, Sinclair
HM. The antioxidant Vitamin C. R C Crit Rev food sci Nutr 1979;11:217.
- Bui MH, Sauty
A, Collet
F, Leuenberger
P. Dietary vitamin C intake and
concentrations in the body fluids and cells of male smokers and nonsmokers. J
Nutr 1992 Feb;122(2):312.
- Kyaw A. A
Simple colorimetric method for Ascorbic acid determination in blood
plasma. Clinical chemica acta 1978;86:153.
- Barnes PJ. Asthma. Fauci AS,
Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, et al, editors.
Harrison’s principles of internal medicine. 17th ed. New York: McGraw
Hill; 2008. p. 1596.
- Hatch GE.
Asthma, Inhaled oxidants, and dietary antioxidants. Am J Clini Nutr 1995;61(suppl):625.
- Kongerud
J, Crissman K, Hatch G, Alexis N. Ascorbic acid is decreased in induced
sputum of mild asthmatic children. Inhal Toxicol 2003 Feb;15(2);101.
- Akinkughe
FM, Ette SI. Role of zinc, copper and ascorbicacid in some common clinical
pediatric problem. J Trop Peds 1987;33:337.
- Priest RE.
Formation of epithelial basement membrane is restricted by scurvy in
vitro and stimulated by vitamin C. Nature 1970;225:74 4.
- Kalayci O,
Besler T, Kiline BE, Saraclar Y. Serum levels of antioxidants vitamins
( alpha tocoferol , beta carotene ,and ascorbic acid) in children with
bronchial asthma. Turk J Pediatr 2000;42(1):17.
- Mohsenin
V, Dabois AB, Douglas JS.Effect of ascorbic acid in response to methacholine
challenge in asthmatic subjects. Am Rev Resp Dis 1983;127:143.
- McNally N.
Preliminary report on use of vitamin C in asthma. J Irish Med Asso 1953;33:175.
|
