Cochrane for Clinicians

Putting Evidence into Practice

Vitamin D for the Management of Asthma

 

Am Fam Physician. 2017 Sep 1;96(5):290-291.

Author disclosure: No relevant financial affiliations.

Clinical Question

Does the use of vitamin D improve asthma symptoms and reduce asthma exacerbations requiring corticosteroid treatment?

Evidence-Based Answer

Despite the authors' caution that further data are needed to clarify the role of vitamin D in care, this Cochrane review found that its use reduces the average number of asthma exacerbations requiring corticosteroid treatment from 0.44 to 0.28 per person per year. It also decreases the risk of emergency department visits and hospitalizations due to asthma exacerbation from 6% per year to around 3% per year.1 (Strength of Recommendation: A, based on high-quality evidence.) Vitamin D has no effect on asthma symptom control as measured by the Asthma Control Test or on lung function as measured by predicted forced expiratory volume in one second (FEV1).1 (Strength of Recommendation: A, based on high-quality evidence.) Family physicians should await further studies and updated guidelines before recommending the use of vitamin D for this indication.

Practice Pointers

Asthma is a chronic inflammatory small airway disease characterized by recurrent episodes of dyspnea, wheezing, cough, and chest tightness (commonly known as asthma exacerbations). Asthma affects all age groups, with a prevalence of 8.4% in children and 7.6% in adults in the United States.2 Exacerbation is a major cause of morbidity and mortality in persons with asthma. An exacerbation is classified as severe when the treatment includes systemic corticosteroids, emergency department visits, or hospitalization.3 Vitamin D levels are often low in patients with asthma, and this has been linked to an increased risk of exacerbation.4,5 Vitamin D has been shown to induce antimicrobial activity 6 and anti-inflammatory activities.7 It also enhances responsiveness to inhaled corticosteroids in patients with asthma.8 The authors of this review sought to determine if use of vitamin D prevents asthma exacerbations and improves asthma symptoms.

This Cochrane review included

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REFERENCES

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1. Martineau AR, Cates CJ, Urashima M, et al. Vitamin D for the management of asthma. Cochrane Database Syst Rev. 2016;(9):CD011511....

2. Centers for Disease Control and Prevention. Asthma surveillance data. https://www.cdc.gov/asthma/asthmadata.htm. Accessed January 6, 2017.

3. Reddel HK, Taylor DR, Bateman ED, et al. An official American Thoracic Society/European Respiratory Society statement: asthma control and exacerbations: standardizing endpoints for clinical asthma trials and clinical practice. Am J Respir Crit Care Med. 2009;180(1):59–99.

4. Brehm JM, Schuemann B, Fuhlbrigge AL, et al. Serum vitamin D levels and severe asthma exacerbations in the Childhood Asthma Management Program study. J Allergy Clin Immunol. 2010;126(1):52–58.

5. Confino-Cohen R, Brufman I, Goldberg A, Feldman BS. Vitamin D, asthma prevalence and asthma exacerbations: a large adult population-based study. Allergy. 2014;69(12):1673–1680.

6. Greiller CL, Martineau AR. Modulation of the immune response to respiratory viruses by vitamin D. Nutrients. 2015;7(6):4240–4270.

7. Mann EH, Chambers ES, Pfeffer PE, Hawrylowicz CM. Immunoregulatory mechanisms of vitamin D relevant to respiratory health and asthma. Ann N Y Acad Sci. 2014;1317:57–69.

8. Nanzer AM, Chambers ES, Ryanna K, et al. The effects of calcitriol treatment in glucocorticoid-resistant asthma. J Allergy Clin Immunol. 2014;133(6):1755–1757.

9. Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline [published correction appears in J Clin Endocrinol Metab. 2011;96(12):3908]. J Clin Endocrinol Metab. 2011;96(7):1911–1930.

These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, Assistant Medical Editor.

A collection of Cochrane for Clinicians published in AFP is available at http://www.aafp.org/afp/cochrane.

 

 

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