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Vitamin D Supplementation for Childhood Asthma: A Systematic Review and Meta-Analysis.
PLoS One 2015; 10(8):e0136841Plos

Abstract

IMPORTANCE

There is growing evidence that vitamin D plays a role in the pathogenesis of asthma but it is unclear whether supplementation during childhood may improve asthma outcomes.

OBJECTIVES

The objective of this systematic review and meta-analysis was to evaluate the efficacy and safety of vitamin D supplementation as a treatment or adjunct treatment for asthma.

DATA SOURCES

We searched MEDLINE, Embase, CENTRAL, and CINAHL through July 2014.

STUDY SELECTION

We included RCTs that evaluated vitamin D supplementation in children versus active control or placebo for asthma.

DATA EXTRACTION AND SYNTHESIS

One reviewer extracted data and one reviewer verified data accuracy. We qualitatively summarized the main results of efficacy and safety and meta-analyzed data on comparable outcomes across studies. We used GRADE for strength of evidence.

MAIN OUTCOME MEASURES

Main planned outcomes measures were ED visits and hospitalizations. As secondary outcomes, we examined measures of asthma control, including frequency of asthma exacerbations, asthma symptom scores, measures of lung function, β2-agonist use and daily steroid use, adverse events and 25-hydroxyvitamin D levels.

RESULTS

Eight RCTs (one parallel, one crossover design) comprising 573 children aged 3 to 18 years were included. One study (moderate-quality, n = 100) reported significantly less ED visits for children treated with vitamin D. No other studies examined the primary outcome (ED visits and hospitalizations). There was a reduced risk of asthma exacerbations in children receiving vitamin D (low-quality; RR 0.41, 95% CI 0.27 to 0.63, 3 studies, n = 378). There was no significant effect for asthma symptom scores and lung function. The serum 25(OH)D level was higher in the vitamin D group at the end of the intervention (low-quality; MD 19.66 nmol/L, 95% CI 5.96 nmol/L to 33.37 nmol/L, 5 studies, n = 167).

LIMITATIONS

We identified a high degree of clinical diversity (interventions and outcomes) and methodological heterogeneity (sample size and risk of bias) in included trials.

CONCLUSIONS AND RELEVANCE

Randomized controlled trials provide some low-quality evidence to support vitamin D supplementation for the reduction of asthma exacerbations. Evidence on the benefits of vitamin D supplementation for other asthma-related outcomes in children is either limited or inconclusive. We recommend that future trials focus on patient-relevant outcomes that are comparable across studies, including standardized definitions of asthma exacerbations.

Authors+Show Affiliations

Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Quebec, Canada.The Applied Health Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics, St. Michael's Hospital, Toronto, Ontario, Canada; Pediatric Outcomes Research Team (PORT), Division of Pediatric Medicine, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada.Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Quebec, Canada.

Pub Type(s)

Journal Article
Meta-Analysis
Systematic Review

Language

eng

PubMed ID

26322509

Citation

Riverin, Bruno D., et al. "Vitamin D Supplementation for Childhood Asthma: a Systematic Review and Meta-Analysis." PloS One, vol. 10, no. 8, 2015, pp. e0136841.
Riverin BD, Maguire JL, Li P. Vitamin D Supplementation for Childhood Asthma: A Systematic Review and Meta-Analysis. PLoS ONE. 2015;10(8):e0136841.
Riverin, B. D., Maguire, J. L., & Li, P. (2015). Vitamin D Supplementation for Childhood Asthma: A Systematic Review and Meta-Analysis. PloS One, 10(8), pp. e0136841. doi:10.1371/journal.pone.0136841.
Riverin BD, Maguire JL, Li P. Vitamin D Supplementation for Childhood Asthma: a Systematic Review and Meta-Analysis. PLoS ONE. 2015;10(8):e0136841. PubMed PMID: 26322509.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Vitamin D Supplementation for Childhood Asthma: A Systematic Review and Meta-Analysis. AU - Riverin,Bruno D, AU - Maguire,Jonathon L, AU - Li,Patricia, Y1 - 2015/08/31/ PY - 2015/05/12/received PY - 2015/08/10/accepted PY - 2015/9/1/entrez PY - 2015/9/1/pubmed PY - 2016/5/18/medline SP - e0136841 EP - e0136841 JF - PloS one JO - PLoS ONE VL - 10 IS - 8 N2 - IMPORTANCE: There is growing evidence that vitamin D plays a role in the pathogenesis of asthma but it is unclear whether supplementation during childhood may improve asthma outcomes. OBJECTIVES: The objective of this systematic review and meta-analysis was to evaluate the efficacy and safety of vitamin D supplementation as a treatment or adjunct treatment for asthma. DATA SOURCES: We searched MEDLINE, Embase, CENTRAL, and CINAHL through July 2014. STUDY SELECTION: We included RCTs that evaluated vitamin D supplementation in children versus active control or placebo for asthma. DATA EXTRACTION AND SYNTHESIS: One reviewer extracted data and one reviewer verified data accuracy. We qualitatively summarized the main results of efficacy and safety and meta-analyzed data on comparable outcomes across studies. We used GRADE for strength of evidence. MAIN OUTCOME MEASURES: Main planned outcomes measures were ED visits and hospitalizations. As secondary outcomes, we examined measures of asthma control, including frequency of asthma exacerbations, asthma symptom scores, measures of lung function, β2-agonist use and daily steroid use, adverse events and 25-hydroxyvitamin D levels. RESULTS: Eight RCTs (one parallel, one crossover design) comprising 573 children aged 3 to 18 years were included. One study (moderate-quality, n = 100) reported significantly less ED visits for children treated with vitamin D. No other studies examined the primary outcome (ED visits and hospitalizations). There was a reduced risk of asthma exacerbations in children receiving vitamin D (low-quality; RR 0.41, 95% CI 0.27 to 0.63, 3 studies, n = 378). There was no significant effect for asthma symptom scores and lung function. The serum 25(OH)D level was higher in the vitamin D group at the end of the intervention (low-quality; MD 19.66 nmol/L, 95% CI 5.96 nmol/L to 33.37 nmol/L, 5 studies, n = 167). LIMITATIONS: We identified a high degree of clinical diversity (interventions and outcomes) and methodological heterogeneity (sample size and risk of bias) in included trials. CONCLUSIONS AND RELEVANCE: Randomized controlled trials provide some low-quality evidence to support vitamin D supplementation for the reduction of asthma exacerbations. Evidence on the benefits of vitamin D supplementation for other asthma-related outcomes in children is either limited or inconclusive. We recommend that future trials focus on patient-relevant outcomes that are comparable across studies, including standardized definitions of asthma exacerbations. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/26322509/Vitamin_D_Supplementation_for_Childhood_Asthma:_A_Systematic_Review_and_Meta_Analysis_ L2 - http://dx.plos.org/10.1371/journal.pone.0136841 DB - PRIME DP - Unbound Medicine ER -