Vitamin D for the management of asthma
Martineau AR, Cates CJ, Urashima M, Jensen M, Griffiths AP, Nurmatov U, Sheikh A, Griffiths CJ
The Cochrane database of systematic reviews · 114 citations
How it was studied
- Design
- Meta-analysis (classified by our AI screen)
- Studied in
- People
- Main outcome
- Clinical events such as disease or death
Who paid for it
- Funding
- Independent funding
- Government
- National Institute for Health and Care Research
- Unclassified
- Creations of Advanced Catalytic Transformation for the Sustainable Manufacturing at Low Energy, Low Environmental Load
- Government
- National Institute for Health Research (NIHR)
- Grants
- National Institute for Health and Care Research (13/89/14); National Institute for Health and Care Research (RP-PG-0407-10398); National Institute for Health and Care Research (13/03/25); National Institute for Health and Care Research (HTA/13/03/25)
Based on 3 listed funder(s).
Publication
- Published
- 2016-09-05 · Cochrane Database Syst Rev · vol. 2019 · issue 4 · p. CD011511
- Publisher
- Elsevier BV
- Cited
- 191 citations · more than 100% of similar papers · 24.6× the field average
- Impact
- Top 10% most cited in its field
- References
- 83 works
- Access
- Free to read
- Research areas
- Vitamin D Research Studies · Asthma and respiratory diseases · Vitamin C and Antioxidants Research
- Keywords
- Medicine, Asthma, Exacerbation, Placebo, Clinical trial, Relative risk, Meta-analysis, Randomized controlled trial, Confidence interval, Pediatrics, Number needed to treat, Internal medicine, Physical therapy, Alternative medicine, Pathology
8 authors
From GB, JP, AU
- Adrian R. MartineauQueen Mary University of London; Asthma UK; Asthma UK Centre for Applied Research
- Christopher J CatesSt George's, University of London
- Mitsuyoshi UrashimaJikei University School of Medicine
- Megan E. JensenUniversity of Newcastle Australia
- Alex GriffithsQueen Mary University of London; Asthma UK; Asthma UK Centre for Applied Research
- Ulugbek B. NurmatovCardiff University
Abstract
Background
Several clinical trials of vitamin D to prevent asthma exacerbation and improve asthma control have been conducted in children and adults, but a meta-analysis restricted to double-blind, randomised, placebo-controlled trials of this intervention is lacking.
Objectives
To evaluate the efficacy of administration of vitamin D and its hydroxylated metabolites in reducing the risk of severe asthma exacerbations (defined as those requiring treatment with systemic corticosteroids) and improving asthma symptom control.
Search methods
We searched the Cochrane Airways Group Trial Register and reference lists of articles. We contacted the authors of studies in order to identify additional trials. Date of last search: January 2016.
Selection criteria
Double-blind, randomised, placebo-controlled trials of vitamin D in children and adults with asthma evaluating exacerbation risk or asthma symptom control or both.
Data collection and analysis
Two review authors independently applied study inclusion criteria, extracted the data, and assessed risk of bias. We obtained missing data from the authors where possible. We reported results with 95% confidence intervals (CIs).
Main results
We included seven trials involving a total of 435 children and two trials involving a total of 658 adults in the primary analysis. Of these, one trial involving 22 children and two trials involving 658 adults contributed to the analysis of the rate of exacerbations requiring systemic corticosteroids. Duration of trials ranged from four to 12 months, and the majority of participants had mild to moderate asthma. Administration of vitamin D reduced the rate of exacerbations requiring systemic corticosteroids (rate ratio 0.63, 95% CI 0.45 to 0.88; 680 participants; 3 studies; high-quality evidence), and decreased the risk of having at least one exacerbation requiring an emergency department visit or hospitalisation or both (odds ratio (OR) 0.39, 95% CI 0.19 to 0.78; number needed to treat for an additional beneficial outcome, 27; 963 participants; 7 studies; high-quality evidence). There was no effect of vitamin D on % predicted forced expiratory volume in one second (mean difference (MD) 0.48, 95% CI -0.93 to 1.89; 387 participants; 4 studies; high-quality evidence) or Asthma Control Test scores (MD -0.08, 95% CI -0.70 to 0.54; 713 participants; 3 studies; high-quality evidence). Administration of vitamin D did not influence the risk of serious adverse events (OR 1.01, 95% CI 0.54 to 1.89; 879 participants; 5 studies; moderate-quality evidence). One trial comparing low-dose versus high-dose vitamin D reported two episodes of hypercalciuria, one in each study arm. No other study reported any adverse event potentially attributable to administration of vitamin D. No participant in any included trial suffered a fatal asthma exacerbation. We did not perform a subgroup analysis to determine whether the effect of vitamin D on risk of severe exacerbation was modified by baseline vitamin D status, due to unavailability of suitably disaggregated data. We assessed two trials as being at high risk of bias in at least one domain; neither trial contributed data to the analysis of the outcomes reported above.
Authors' conclusions
Meta-analysis of a modest number of trials in people with predominantly mild to moderate asthma suggests that vitamin D is likely to reduce both the risk of severe asthma exacerbation and healthcare use. It is as yet unclear whether these effects are confined to people with lower baseline vitamin D status; further research, including individual patient data meta-analysis of existing datasets, is needed to clarify this issue. Children and people with frequent severe asthma exacerbations were under-represented; additional primary trials are needed to establish whether vitamin D can reduce the risk of severe asthma exacerbation in these groups.
Abstract via Europe PMC. Copyright remains with the authors or publisher.
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