Vitamin D supplementation reduces the rates of asthma exacerbations requiring treatment with systemic corticosteroids, according to a recent study. The systematic review and meta-analysis of individual participant data included 483 unique studies, 8 of which were eligible randomized controlled trials with 1,078 participants. This included double-blind, placebo-controlled, RCTs of vitamin D3, or vitamin D2 supplementation in persons with asthma that reported incidence of asthma exacerbation, published between database inception and October 26, 2016. Researchers found:
- Vitamin D supplementation reduced the rate of asthma exacerbation requiring treatment with systemic corticosteroids among all participants (adjusted incidence rate ratio, 0.74).
- There were no significant differences between vitamin D and placebo in the proportion of participants with at least 1 exacerbation or time to first exacerbation.
- Subgroup analyses of the rate of asthma exacerbations treated with systemic corticosteroids revealed that protective effects were seen in participants with baseline 25(OH)D of < 25 nmol/L (aIRR 0.33, p=0.046), but not in participants with higher baseline 25(OH)D levels.
Jolliffe DA, Greenberg L, Hooper RL, et al. Vitamin D supplementation to prevent asthma exacerbations: a systematic review and meta-analysis of individual participant data. [Published online ahead of print October 3, 2017]. Lancet Respir Med. doi:10.1016/S2213-2600(17)30306-5.
Results of this study are consistent with that of a related Cochrane review which concluded that in double-blind, placebo-controlled RCTs in both children and adults, vitamin D supplementation reduced the rate of asthma exacerbations requiring treatment with systemic corticosteroids by 36%.1 The current meta-analysis furthers that evidence by showing that the beneficial effect of vitamin D occurred in those with asthma who had low vitamin D levels prior to treatment. In that group, there was a decrease of 67% in the incidence of asthma exacerbations with vitamin D supplementation. This is information that we can use tomorrow with our patients. It makes sense to check a vitamin D level n patients with asthma who have had exacerbations; if it is low, then supplement with vitamin D. —Neil Skolnik, MD
- Martineau AR, Cates CJ, Urashima M, et al. Vitamin D for the management of asthma. Cochrane Database Syst Rev. 2016;CD011511.
This Week's Must Reads
Acute Illness and Cannabis Use in Adults, Ann Intern Med; ePub 2019 Mar 26; Monte, et al
Pregnancy History and Risk of Miscarriage, BMJ; ePub 2019 Mar 20; Magnus, et al
Firearms Mortality Among US Schoolchildren, Am J Med; ePub 2019 Mar 25; Rubenstein, et al
Rapid Point of Care Test for Influenza, J Am Board Fam Med; 2019 Mar; Dale, et al
Must Reads in Asthma
Antibiotic Therapy in Patients with Asthma, JAMA Intern Med; ePub 2019 Jan 28; Stefan, et al
Asthma Toolkit Improves Measures of Asthma Care, J Am Board Fam Med; 2019 Jan; Colborn, et al
Fractional Exhaled Nitric Oxide Testing in Asthma, Mayo Clin Proc; ePub 2017 Dec 20; Wang, et al
Pharmacologic Tx of Seasonal Allergic Rhinitis, Ann Intern Med; ePub 2017 Nov 28; Wallace, et al
FDA Approves Fasenra for Severe Eosinophilic Asthma, AstraZeneca news release; 2017 Nov 14