Rapid vitamin D supplementation may prevent asthma exacerbations in children
Rapid vitamin D supplementation may significantly reduce asthma exacerbations in the short but not in the long term as compared with maintenance oral supplementation in asthmatic children with vitamin D deficiency, a study has shown.
The study randomly assigned children with moderate-severe asthma exacerbations and 25(OH)D (vitamin D) levels <25ng/mL to either the group receiving open-label daily oral supplementation 400 IU/day together with intramuscular (IM) injection of 300,000 IU (IM+oral; n=116) or the group receiving oral-only therapy at 400 IU/d (n=115). IM therapy was given to ensure absorption. All patients were followed for 12 months.
The main outcome of patient-initiated unplanned visits for asthma exacerbations was evaluated two ways: 1) cumulative proportions with an exacerbation and 2) average exacerbation frequency. Treatment groups were analysed by quartiles of baseline vitamin D level, with measurements and clinical observations performed at 3, 6, 9 and 12 months after enrolment.
Mean baseline levels of vitamin D were similar between the IM+oral and oral-only groups (15.1 vs 15.8 ng/mL; range, 3 to 25 ng/mL). Over the entire 12-month observation period, the main outcome did not significantly differ between the two groups.
However, rapid IM+oral supplementation was associated with a significant reduction in unplanned visits for asthma exacerbations among children with baseline vitamin D levels of 3 to 11 ng/L during the first 3 months of treatment (relative exacerbation rate, 0.48; 95 percent CI, 0.28 to 0.89; p=0.008; average exacerbation frequency per child analysis: relative rate, 0.36; 0.13 to 0.87; p=0.017).
The present data show that rapid vs maintenance oral supplementation with vitamin D can markedly reduce unplanned visits for asthma exacerbations in children with baseline vitamin D levels of 3 to 11 ng/mL during the initial 3 months of treatment but not thereafter. Testing, then treating, might attenuate moderate to severe asthma in children with the lowest baseline levels, researchers said.
“Our results should prompt consideration of measuring 25(OH)D levels in asthmatic children and employing some type of rapid supplementation (eg, oral) in those patients with the lowest levels, at least for 3 minutes. What blood level of vitamin D in these children will reflect ‘sufficiency’ remains to be determined,” they added.