Objective: To determine the role of vitamin D supplementation as an adjunct to standard treatment in childhood asthma.Study Design: In this placebo-controlled, blinded, randomized controlled trial, we enrolled 60 children aged 6 to 11 years with moderate persistent asthma and randomly assigned them into intervention (2000 IU per day of vitamin D) and placebo groups (n = 30 each). The primary outcome was asthma control as assessed by the childhood asthma control test (C-ACT) scores at 12 weeks post-randomization. The secondary outcomes were improvement in the forced expiration in 1 s (FEV 1 ), fractional exhaled nitric oxide (FeNO), asthma exacerbations, use of systemic steroids, number of emergency visits, post-intervention vitamin D levels, and adverse outcomes. We analyzed by intention to treat.Results: There was no significant difference between the C-ACT score in the two groups (median [first-third quartile] scores were 25 [24][25][26] in both groups, p = 0.7).Also, there was no significant difference between the two groups in terms of the FEV 1 , FeNO, number of exacerbations, emergency visits, hospital admissions, and adverse outcomes. However, the post-intervention vitamin D levels (ng/ml) were significantly higher in the intervention group (35.5 vs. 18.8; p < 0.001). As compared to the baseline, both the groups showed better asthma control at 12 weeks postintervention, irrespective of the type of intervention.
Conclusion:Vitamin-D supplementation as an adjunct to standard treatment does not improve asthma control in children.
BackgroundThere is conflicting evidence for vitamin D supplementation in childhood asthma. We aimed to systematically synthesize the evidence on the efficacy and safety of vitamin D supplementation in childhood asthma.MethodsWe searched electronic databases (Medline, Embase, Web of Science) and register (CENTRAL) for randomised controlled trials (RCTs) published until September 30, 2021. RCTs enrolling asthmatic children (1–18 years) and comparing vitamin D against placebo/routine care were included if they met at least one of the endpoints of interest (asthma attacks, emergency visits, hospitalisation). We used the Risk of Bias (RoB) 2 tool for risk of bias assessment. Random-effects meta-analysis with RevMan 5.3 software was done. The GRADE approach was used to assess the level of certainty of the evidence.ResultsEighteen RCTs (n=1579 participants) were included. The pooled meta-analysis did not find a significant effect of vitamin D supplementation on asthma attacks requiring rescue systemic corticosteroids (6 studies, 445 participants, Risk ratio: 1.13; 95% CI: 0.86 to 1.48, I2–0%) (Moderate-certainty evidence). In addition, there was no significant difference in the proportion of children with asthma attacks of any severity (11 trials, 1132 participants, RR: 0.84; 95% CI: 0.65 to 1.09; I2–58%) (Very-low certainty evidence). Vitamin D does not reduce the need for emergency visits (3 studies, 361 participants, RR: 0.97; 95% CI: 0.89 to 1.07, I2–0%) and hospitalisation (RR: 1.38; 95% CI: 0.52 to 3.66, I2–0%) (Low certainty evidence).ConclusionVery low to moderate certainty evidence suggests that vitamin D supplementation might not have any protective effect in childhood asthma.
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