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S5 Vitamin d for the management of asthma: cochrane systematic review and meta-analysis
  1. AR Martineau1,
  2. CJ Cates2,
  3. M Urashima3,
  4. M Jensen4,
  5. AP Griffiths1,
  6. U Nurmatov5,
  7. A Sheikh6,
  8. CJ Griffiths1
  1. 1Queen Mary University of London, London, UK
  2. 2St George’s University of London, London, UK
  3. 3Jikei University School of Medicine, Tokyo, Japan
  4. 4University of Newcastle, Newcastle, Australia
  5. 5Cardiff University, Cardiff, UK
  6. 6University of Edinburgh, Edinburgh, UK

Abstract

Introduction and objectives 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. We conducted a Cochrane systematic review and meta-analysis to evaluate the efficacy of administration of vitamin D in reducing asthma exacerbations treated with systemic corticosteroids (primary outcome) and improving asthma symptom control.

Methods Standard Cochrane collaboration procedures were followed. Double-blind randomised placebo-controlled trials of vitamin D in children and adults with asthma evaluating exacerbation risk and/or asthma symptom control were included.

Results Seven trials involving a total of 435 children and two trials involving a total of 658 adults were included in the primary analysis. 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 and/or hospitalisation (Odds Ratio [OR] 0.39, 95% CI: 0.19 to 0.78; number needed to treat for one additional person to experience a beneficial outcome (NNTB), 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; participants = 713; studies = 3; 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). No participant in any included trial suffered a fatal asthma exacerbation.

Conclusions Meta-analysis of a modest number of trials in patients with predominantly mild to moderate asthma suggests that vitamin D is likely to reduce the risk of severe asthma exacerbation and reduce health care use.

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