Is Vitamin C supplementation beneficial in asthmatic patients?
More details
Hide details
Pneumonology Department, “G. Papanikolaou” General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
Corresponding author
Konstantinos Porpodis   

Pulmonary University Clinic, Aristotle University of Thessaloniki, “G. Papanikolaou” General Hospital, Thessaloniki, Greece
Pneumon 2017;30(3):151-156
As asthma prevails worldwide, nutritional hypotheses appear to suggestthat vitamin C supplementation may have a positive effect inasthma management. However, scientific community has not reachedan agreement concerning the association between vitamin C andasthma. In this review, we provide evidence of several in vitro andin vivo studies in mouse, rat and pig models that implicate vitaminC in immune response and also as an anti-inflammatory agent withantiviral properties. Finally, whether vitamin C supplementation inasthmatics is beneficial or not, a number of systematic reviews andmeta-analyses have tried to shed more light in this controversy,but no robust assessment concerning the use of vitamin C in themanagement of asthma is available.
Chihara J, Kakazu T, Higashimoto I, et al. RANTES augments eosinophil lucigenin-dependent chemiluminescence. International Αrchives of Αllergy and Ιmmunology 1998; 117(Suppl 1):40-3.
Rochelle LG, Fischer BM, Adler KB. Concurrent production of reactive oxygen and nitrogen species by airway epithelial cells in vitro. Free Radical Biology and Μedicine 1998; 24:863-8.
Ochs-Balcom HM, Grant BJ, Muti P, et al. Antioxidants, oxidative stress, and pulmonary function in individuals diagnosed with asthma or COPD. European Journal of Clinical Nutrition 2006; 60:991-9.
Global Initiative for Asthma (GINA). GINA Report, Global Strategy for Asthma Management and Prevention. 2017. Available from: Accessed 2017.
Mannino DM, Homa DM, Pertowski CA, et al. Surveillance for asthma--United States, 1960-1995. MMWR. CDC surveillance summaries: Morbidity and mortality weekly report. CDC Surveillance Summaries 1998; 47:1-27.
Nakazawsa T, Kawakami Y, Sudo M, et al. Trends of asthma death among adults in Japan 1992-1994. Analysis of 313 cases reported questionnaires sent to hospitals with more than 100 beds. Arerugi = [Allergy] 1998; 47:41-7.
Wood LG, Shivappa N, Berthon BS, Gibson PG, Hebert JR. Dietary inflammatory index is related to asthma risk, lung function and systemic inflammation in asthma. Clinical and experimental allergy: Journal of the British Society for Allergy and Clinical Immunology 2015; 45:177-83.
Misso NL, Brooks-Wildhaber J, Ray S, Vally H, Thompson PJ. Plasma concentrations of dietary and nondietary antioxidants are low in severe asthma. ERJ 2005; 26:257-64.
Patel BD, Welch AA, Bingham SA, et al. Dietary antioxidants and asthma in adults. Thorax 2006; 61:388-93.
Han YY, Blatter J, Brehm JM, Forno E, Litonjua AA, Celedon JC. Diet and asthma: vitamins and methyl donors. The Lancet. Respiratory Medicine 2013; 1:813-22.
Thorburn AN, Macia L, Mackay CR. Diet, metabolites, and “western-lifestyle” inflammatory diseases. Immunity 2014; 40:833-42.
Riccioni G, Bucciarelli T, Mancini B, Di Ilio C, D’Orazio N. Plasma lycopene concentration is low in subjects with stable asthma. Allergy 2006; 61:1371-2.
Shrader WA, Jr. Short and long term treatment of asthma with intravenous nutrients. Nutrition Journal 2004; 3:6.
Naidu KA. Vitamin C in human health and disease is still a mystery? An overview. Nutrition Journal 2003; 2:7.
Sly RM, O’Donnell R. Stabilization of asthma mortality. Annals of allergy, asthma & immunology: Official publication of the American College of Allergy, Asthma and Immunology 1997; 78:347-54.
Ertle AR, London MR. Insights into asthma prevalence in Oregon. The Journal of asthma: Official Journal of the Association for the Care of Asthma 1998; 35:281-9.
Bowler RP, Crapo JD. Oxidative stress in allergic respiratory diseases. The Journal of Allergy and Clinical Immunology 2002; 110:349-56.
Arab L, Steck-Scott S, Fleishauer AT. Lycopene and the lung. Experimental Biology and Medicine 2002; 227:894-9.
Kirkham P, Rahman I. Oxidative stress in asthma and COPD: antioxidants as a therapeutic strategy. Pharmacology and Therapeutics 2006; 111:476-94.
Nadeem A, Chhabra SK, Masood A, Raj HG. Increased oxidative stress and altered levels of antioxidants in asthma. The Journal of Allergy and Clinical Immunology 2003; 111:72-8.
Li N, Nel AE. Role of the Nrf2-mediated signaling pathway as a negative regulator of inflammation: implications for the impact of particulate pollutants on asthma. Antioxidants and Redox Signaling 2006; 8:88-98.
Powers SK, Jackson MJ. Exercise-induced oxidative stress: cellular mechanisms and impact on muscle force production. Physiological Reviews 2008; 88:1243-76.
Ashton T, Young IS, Peters JR, et al. Electron spin resonance spectroscopy, exercise, and oxidative stress: an ascorbic acid intervention study. Journal of Applied Physiology 1999; 87:2032- 6.
Cohen HA, Neuman I, Nahum H. Blocking effect of vitamin C in exercise-induced asthma. Archives of Pediatrics and Adolescent Medicine 1997; 151:367-70.
Anah CO, Jarike LN, Baig HA. High dose ascorbic acid in Nigerian asthmatics. Tropical and Geographical Medicine 1980; 32:132-7.
Misso NL, Thompson PJ. Oxidative stress and antioxidant deficiencies in asthma: potential modification by diet. Redox report: Communications in Free Radical Research 2005;10:247- 55.
Kelly FJ, Mudway I, Blomberg A, Frew A, Sandstrom T. Altered lung antioxidant status in patients with mild asthma. Lancet 1999; 354:482-3.
Jeong YJ, Kim JH, Kang JS, Lee WJ, Hwang YI. Mega-dose vitamin C attenuated lung inflammation in mouse asthma model. Anatomy and Cell Biology 2010;43:294-302.
Carcamo JM, Pedraza A, Borquez-Ojeda O, Golde DW. Vitamin C suppresses TNF alpha-induced NF kappa B activation by inhibiting I kappa B alpha phosphorylation. Biochemistry 2002;41:12995-13002.
Bansal P, Saw S, Govindaraj D, Arora N. Intranasal administration of a combination of choline chloride, vitamin C, and selenium attenuates the allergic effect in a mouse model of airway disease. Free Radical Biology and Medicine 2014; 73:358-65.
Nounou HA, Deif MM, Arafah M. The influence of dexamethasone and the role of some antioxidant vitamins in the pathogenesis of experimental bronchial asthma. Journal of Experimental Pharmacology 2010; 2:93-103.
Langlois M, Duprez D, Delanghe J, De Buyzere M, Clement DL. Serum vitamin C concentration is low in peripheral arterial disease and is associated with inflammation and severity of atherosclerosis. Circulation 2001; 103:1863-8.
Wannamethee SG, Lowe GD, Rumley A, Bruckdorfer KR, Whincup PH. Associations of vitamin C status, fruit and vegetable intakes, and markers of inflammation and hemostasis. The American Journal of Clinical Nutrition 2006; 83:567-74; quiz 726-567.
Rizzo MR, Abbatecola AM, Barbieri M, et al. Evidence for antiinflammatory effects of combined administration of vitamin E and C in older persons with impaired fasting glucose: impact on insulin action. Journal of the American College of Nutrition 2008; 27:505-11.
Scott DA, Poston RN, Wilson RF, Coward PY, Palmer RM. The influence of vitamin C on systemic markers of endothelial and inflammatory cell activation in smokers and non-smokers. Inflammation research: Official Journal of the European Histamine Research Society ... [et al] 2005; 54:138-44.
Hernandez M, Zhou H, Zhou B, et al. Combination treatment with high-dose vitamin C and alpha-tocopherol does not enhance respiratory-tract lining fluid vitamin C levels in asthmatics. Inhalation Toxicology 2009; 21:173-81.
Kamgar M, Zaldivar F, Vaziri ND, Pahl MV. Antioxidant therapy does not ameliorate oxidative stress and inflammation in patients with end-stage renal disease. Journal of the National Medical Association 2009;101:336-44.
Puglisi L, Berti F, Bosisio E, Longiave D, Nicosia S. Ascorbic acid and PGF2alpha antagonism on tracheal smooth muscle. Advances in Prostaglandin and Thromboxane Research 1976; 1:503-6.
Rothberg KG, Hitchcock M. Effects of ascorbic acid deficiency on the in vitro biosynthesis of cyclooxygenase metabolites in guinea pig lungs. Prostaglandins, Leukotrienes, and Medicine 1983; 12:137-47.
Mohsenin V, Tremml PG, Rothberg KG, Souhrada M, Douglas JS. Airway responsiveness and prostaglandin generation in scorbutic guinea pigs. Prostaglandins, Leukotrienes, and Essential Fatty Acids 1988; 33:149-55.
Zuskin E, Lewis AJ, Bouhuys A. Inhibition of histamine-induced airway constriction by ascorbic acid. The Journal of Allergy and Clinical Immunology 1973; 51:218-26.
Sipahi E, Ercan ZS. The mechanism of the relaxing effect of ascorbic acid in guinea pig isolated tracheal muscle. General Pharmacology 1997; 28:757-60.
Tecklenburg SL, Mickleborough TD, Fly AD, Bai Y, Stager JM. Ascorbic acid supplementation attenuates exercise-induced bronchoconstriction in patients with asthma. Respiratory Medicine 2007; 101:1770-8.
Maeng HG, Lim H, Jeong YJ, et al. Vitamin C enters mouse T cells as dehydroascorbic acid in vitro and does not recapitulate in vivo vitamin C effects. Immunobiology 2009; 214:311-20.
Khassaf M, McArdle A, Esanu C, et al. Effect of vitamin C supplements on antioxidant defence and stress proteins in human lymphocytes and skeletal muscle. The Journal of Physiology 2003; 549:645-52.
Noh K, Lim H, Moon SK, et al. Mega-dose Vitamin C modulates T cell functions in Balb/c mice only when administered during T cell activation. Immunology Letters 2005; 98:63-72.
Lee CW, Wang XD, Chien KL, et al. Vitamin C supplementation does not protect L-gulono-gamma-lactone oxidase-deficient mice from Helicobacter pylori-induced gastritis and gastric premalignancy. International Journal of Cancer 2008; 122:1068- 76.
Fogarty A, Lewis SA, Scrivener SL, et al. Corticosteroid sparing effects of vitamin C and magnesium in asthma: a randomised trial. Respiratory Medicine 2006;100:174-9.
Kaur B, Rowe BH, Arnold E. Vitamin C supplementation for asthma. The Cochrane Database of Systematic Reviews 2009:CD000993.
McEvoy CT, Schilling D, Clay N, et al. Vitamin C supplementation for pregnant smoking women and pulmonary function in their newborn infants: a randomized clinical trial. JAMA 2014; 311:2074-82.
Shorey-Kendrick LE, McEvoy CT, Ferguson B, et al. Vitamin C Prevents Offspring DNA Methylation Changes Associated with Maternal Smoking in Pregnancy. American Journal of Respiratory and Critical Care Medicine 2017; 196:745-55.
Juraschek SP, Guallar E, Appel LJ, Miller ER, 3rd. Effects of vitamin C supplementation on blood pressure: a meta-analysis of randomized controlled trials. The American Journal of Clinical Nutrition 2012; 95:1079-88.
Basili S, Tanzilli G, Mangieri E, et al. Intravenous ascorbic acid infusion improves myocardial perfusion grade during elective percutaneous coronary intervention: relationship with oxidative stress markers. JACC. Cardiovascular Interventions 2010; 3:221-9.
Oktar GL, Sinci V, Kalaycioglu S, et al. Biochemical and hemodynamic effects of ascorbic acid and alpha-tocopherol in coronary artery surgery. Scandinavian Journal of Clinical and Laboratory Investigation 2001; 61:621-9.
Ashor AW, Lara J, Mathers JC, Siervo M. Effect of vitamin C on endothelial function in health and disease: a systematic review and meta-analysis of randomised controlled trials. Atherosclerosis 2014; 235:9-20.
Wang ZJ, Hu WK, Liu YY, et al. The effect of intravenous vitamin C infusion on periprocedural myocardial injury for patients undergoing elective percutaneous coronary intervention. The Canadian Journal of Cardiology 2014; 30:96-101.
Sadat U, Usman A, Gillard JH, Boyle JR. Does ascorbic acid protect against contrast-induced acute kidney injury in patients undergoing coronary angiography: a systematic review with meta-analysis of randomized, controlled trials. Journal of the American College of Cardiology 2013; 62:2167-75.
Douglas RM, Hemila H, Chalker E, Treacy B. Vitamin C for preventing and treating the common cold. The Cochrane Database of Systematic Reviews 2007:CD000980.
Hemila H, Chalker E. Vitamin C for preventing and treating the common cold. The Cochrane Database of Systematic Reviews 2013:CD000980.
Hemila H, Louhiala P. Vitamin C for preventing and treating pneumonia. The Cochrane Database of Systematic Reviews 2007:CD005532.
Hemila H. Vitamin C may alleviate exercise-induced bronchoconstriction: a meta-analysis. BMJ open 2013; 3.
Allen S, Britton JR, Leonardi-Bee JA. Association between antioxidant vitamins and asthma outcome measures: systematic review and meta-analysis. Thorax 2009; 64:610-9.
Gao J, Gao X, Li W, Zhu Y, Thompson PJ. Observational studies on the effect of dietary antioxidants on asthma: a meta-analysis. Respirology 2008;13:528-36.
Milan SJ, Hart A, Wilkinson M. Vitamin C for asthma and exercise-induced bronchoconstriction. The Cochrane Database of Systematic Reviews 2013:CD010391.
Hemila H. The effect of vitamin C on bronchoconstriction and respiratory symptoms caused by exercise: a review and statistical analysis. Allergy, asthma, and clinical immunology: Official Journal of the Canadian Society of Allergy and Clinical Immunology 2014;10:58.
Nurmatov U, Devereux G, Sheikh A. Nutrients and foods for the primary prevention of asthma and allergy: systematic review and meta-analysis. The Journal of Allergy and Clinical Immunology 2011;127:724-733 e721-30.
Parsons JP, Hallstrand TS, Mastronarde JG, et al. An official American Thoracic Society clinical practice guideline: exerciseinduced bronchoconstriction. American Journal of Respiratory and Critical Care Medicine 2013; 187:1016-27.
Journals System - logo
Scroll to top