Thursday, January 15, 2015

Can replacing Vitamin D improve asthma control in Adults?

JAMA. doi:10.1001/jama.2014.5052. Published online May 18, 2014. 
Vitamin D is known to be important when it comes to bone health and also in diseases where inflammation occurs, like asthma. Many people, including some of those with asthma, have low levels of vitamin D
Importance  In asthma and other diseases, vitamin D insufficiency is associated with adverse outcomes. It is not known if supplementing inhaled corticosteroids with oral vitamin D3 improves outcomes in patients with asthma and vitamin D insufficiency.
Objective  To evaluate if vitamin D supplementation would improve the clinical efficacy of inhaled corticosteroids in patients with symptomatic asthma and lower vitamin D levels.
Design, Setting, and Participants  The VIDA (Vitamin D Add-on Therapy Enhances Corticosteroid Responsiveness in Asthma) randomized, double-blind, parallel, placebo-controlled trial studying adult patients with symptomatic asthma and a serum 25-hydroxyvitamin D level of less than 30 ng/mL was conducted across 9 academic US medical centers in the National Heart, Lung, and Blood Institute’s AsthmaNet network, with enrollment starting in April 2011 and follow-up complete by January 2014. After a run-in period that included treatment with an inhaled corticosteroid, 408 patients were randomized.
Interventions  Oral vitamin D3 (100 000 IU once, then 4000 IU/d for 28 weeks; n = 201) or placebo (n = 207) was added to inhaled ciclesonide (320 µg/d). If asthma control was achieved after 12 weeks, ciclesonide was tapered to 160 µg/d for 8 weeks, then to 80 µg/d for 8 weeks if asthma control was maintained.
Main Outcomes and Measures  The primary outcome was time to first asthma treatment failure (a composite outcome of decline in lung function and increases in use of b-agonists, systemic corticosteroids, and health care).
Results  Treatment with vitamin D3 did not alter the rate of first treatment failure during 28 weeks (28% [95% CI, 21%-34%] with vitamin D3 vs 29% [95% CI, 23%-35%] with placebo; adjusted hazard ratio, 0.9 [95% CI, 0.6-1.3]). Of 14 prespecified secondary outcomes, 9 were analyzed, including asthma exacerbation; of those 9, the only statistically significant outcome was a small difference in the overall dose of ciclesonide required to maintain asthma control (111.3 µg/d [95% CI, 102.2-120.4 µg/d] in the vitamin D3 group vs 126.2 µg/d [95% CI, 117.2-135.3 µg/d] in the placebo group; difference of 14.9 µg/d [95% CI, 2.1-27.7 µg/d]).
Conclusions and Relevance  Vitamin D3 did not reduce the rate of first treatment failure or exacerbation in adults with persistent asthma and vitamin D insufficiency. These findings do not support a strategy of therapeutic vitamin D3 supplementation in patients with symptomatic asthma.
Comment: Vit D is being used for a lot of conditions as its deficiency has been found to be huge in Indian population (even though we are a tropical country with a lot of sunlight). The studies that have tried to see its effect in treating various medical conditions have unfortunately continued to be quite disappointing, suggesting that Vitamin D may not have a role in causing these illnesses but its low levels may just be associated with these medical conditions. More research would help resolve this question further.

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