ISSN: 1223-1533

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SELENIUM DEFICIENCY IN ADOLESCENTS WITH CHRONIC INFECTIOUS-ALLERGIC BRONCHIAL ASTHMA


Authors: D. Ana, V. Dumitrascu, Ioana Ana



Received for publication: 15th of July, 2013
Revised: 1st of August, 2013



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SUMMARY: (Hide the summary)

Previous epidemiological  studies  have revealed  that adolescent patients  with chronic bronchial asthma are selenium deficient  and have also lowered  activity  of glutathione  peroxidase  (GSH-Px). The aim of this study was to evaluate the effects of selenium supplementation on lung function in a clinical trial of adolescents with asthma from southwestern Romania. A randomized observational longitudinal prospective  and comparative  multicenter  study  was performed  on 112 nonsmoking  adolescent patients (13 to 18 years), with chronic infectious-allergic bronchial asthma during June 2012-July 2013. All the patients reported inhaled salmeterolum/fluticasolum combination use at baseline and experienced this therapy for at least two years. As a pharmacologic therapy, the patients were given 200 1g Se/day for a study period of 1 year (Selenium forte, 100 1g, two tablets daily, Walmark). Venous blood samples were withdrawn  for selenium analysis and its concentrations were measured by atomic absorbtion spectrophotometry, at baseline and at the end of the study. Exclusion criteria: adolescents with history of renal or liver disease or if they were  taken supplements containing selenium.  One revealed  a  significant  increase  of 35%  plasma  selenium  concentrations,  when compared with  baseline. When serum selenium concentrations were correlated with forced vital capacity levels, a significant correlation was found at the end of the studied period (p<0.005).  In contrast of other authors, we observed a direct correlation between serum selenium concentrations and  forced  expiratory  volume  in one  second  in the  adolescent  patients  enrolled  in the  study (p<0.005).  This study reveals a direct correlation between low selenium levels and the ventilatory lung function parameters in adolescent patients with chronic infectious and allergic asthma. Selenium supplementation certainly represents a useful adjunct to salmeterolum/fluticasolum combination therapy for this category of patients.

Abbreviations: GSH-Px = glutathione  peroxidase;  FVC = forced vital capacity;  FEV1 = forced expiratory volume in one second


Key Words:

selenium deficiency, adolescents, chronic infectious-allergic bronchial asthma, ventilatory lung function.

 


 

Adolescence is a complex and distinct period in the life of the individual, characterized by profound physical and psychological  changes (1). The changes  of  the body found in the transition between childhood and adulthood cause important and interesting pharmacotherapeutic features, difficult to manage by most of the healthcare providers. Noting the specific features of this age, Hein and Cohen initiated the pharmacotherapy teen 20 years ago, paving the way for some interesting future research (2), (3).

Chronic  infectious-allergic   bronchial   asthma is  a common  burden in the adolescent patient (4). In this context,  identifying  nutrients  that could help  reduce severity of the disease by improving the ventilatory lung function in this population is a worthy public-health aim.

Selenium is an essential component of a wide number of functional seleno-proteins required for normal health. It is specific  because it is the only trace element to be specified in the genetic  code - as selenocysteine  (5). Among these selenoproteins, the antioxidant glutathione peroxidase (GSH-Px) is definitely the most important  and well known, because it has the role to remove hydrogen peroxide  and  other damaging  lipid and  phospholipid hydroxides generated by free radicals and other oxygen derived species in airway epithelial fluid (6).

Previous epidemiological studies have revealed that adolescent patients with chronic bronchial asthma are selenium deficient and have also lowered activity of glutathione  peroxidase  (7). One has  reported  that selenium  supplementation  has  a  beneficial  effect in chronic infectious-allergic bronchial asthma, because it decreases oxidative stress, which has a very important role in the pathology of this severe disease (8).

 

The aim of this study was to evaluate the effects of selenium supplementation on lung function in a clinical trial of adolescents  with asthma  from southwestern Romania.

 

MATERIAL AND METHOD

A randomized observational, longitudinal, prospective and comparative multicenter  study was performed  on 112 nonsmoking adolescent patients (13 to 18 years), with chronic infectious-allergic bronchial asthma during June 2012-July 2013.

Inclusion  criteria:  all  the patients  reported  inhaled salmeterolum/fluticasolum  combination use at baseline and experienced this therapy for at least two years for mild or  moderate  chronic  infectious-allergic  bronchial asthma.

 

Participants gave informed written consent.

Exclusion  criteria:  adolescents with history of renal or liver disease  or  if  they were   taken  previously supplements containing selenium.

As a pharmacologic therapy, the patients were given 200 1g Se/day for a study  period of 1 year (Selenium forte, 100 1g, Walmark).

Venous blood samples were withdrawn  for selenium analysis and the plasma concentrations were measured by atomic absorbtion spectrophotometry, at baseline and at the end of the study.  Serum selenium levels were evaluated  by electrothermal  atomic absorption spectrophotometry,  using an  AA1 -  Shimadzu  2001 spectrophotometer,  with  control and  computed processed  data.  The  standardized  zinc  curve had  a coefficient r = 0,9939. Blood samples were previously mineralized with nitrogenous acid at a temperature  of 160oC,  for 15 minutes,  on  a  microwaves   mineralizer MARS - 5, CEM 2001.

 

Table 1. Serum levels of selenium in the study group at baseline and after 1 year of selenium supplementation.

 

Click on the image to zoom in

 

 

Results were expressed as mean and standard deviation.

In order to reveal forced vital capacity and the forced expiratory volume in one second, comparative results were recorded baseline and after one-year of selenium therapy, using an electronic portable peak flow meter, as well as spirometry tests.

 

RESULTS AND DISCUSSIONS

Mean age of enrolled adolescent patients was 14.7 ± 11.37 years.

Distribution  by sex revealed  53.11%  females  and 46.89% males.

At baseline, all 112 adolescent patients taken in the study were  selenium-deficient.  Serum  selenium concentrations were found to be significantly lower than normal ranges (Table 1).

One revealed  a significant  increase  of 35% plasma selenium concentrations,    after    one-year   selenium supplementation, when compared with baseline.

According with data from literature, we observed that all the investigated subjects had different degrees of selenium deficiency, like in other developing countries (9), (10), (11). The  most decreased  variations  were revealed in 5 adolescents (4.46%), diagnosed HIV positive,  and  these  results are  in  accordance  with previous researches (12).

Correlations  with   the  duration of  the  chronic infectious-allergic bronchial asthma were set up, pointing out that adolescents having a disease duration more than two years had a significant lower selenium concentration level,  than those with a  duration  under  two years (p<0.005).

When serum selenium concentrations were correlated with forced vital capacity levels, a significant correlation was found at the end of the studied period (p<0.005).

In contrast of other authors (13), we observed a direct correlation between serum selenium concentrations and forced expiratory volume in one second in the adolescent patients enrolled in the study (p<0.005).  Measurements of lung function were used to determine asthma severity with <60%,  60-80%, and >80%  predicted FEV1 values representing   severe,   moderate and   mild  asthma, respectively (14).

The most representative results concerned FEV1/FVC ratio, as fallowing: a ratio of <70% implies obstructive disease, and was  revealed in 75% of the enrolled patients. After 1-year of selenium supplementation, the FEV1/FVC  ratio became  >70%, therefore obstruction was effectively excluded (15), (16).

Further  research  is needed in  order to  reveal the correlation between the plasma selenium levels and the duration   and   severity of  chronic infectious-allergic bronchial asthma in adolescent patients. The good compliance   of  selenium supplements   reveals   the clinically important improvements  in the analyzed patient setting, in accordance with literature data (17).

 

CONCLUSION

This study reveals a direct correlation between  low selenium   levels and   the   ventilatory   lung function parameters   in  adolescent   patients with  chronic infectious and   allergic asthma. Selenium supplementation certainly represents a useful adjunct to salmeterolum/fluticasolum combination therapy for this category of patients.

 

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Correspondence to:
Dorin Ana, M.D. (anadorin@yahoo.com) Department of Pharmacology