Khalid Alansari1, Bruce L Davidson2, Khalid Ibrahim Yousef3, Abdel Nasser H Mohamed3, Imad Alattar3. 1. Division of Pediatric Emergency Medicine, Department of Pediatrics, Hamad Medical Corporation, Doha, Qatar; Division of Pediatric Emergency Medicine, Department of Pediatrics, Sidra Medical and Research Centre, Doha, Qatar; Weill Cornell Medical College in Qatar, Doha, Qatar. 2. Pulmonary and Critical Care Medicine Division, University of Washington School of Medicine, Seattle, WA. Electronic address: brucedavidson@pobox.com. 3. Division of Pediatric Emergency Medicine, Department of Pediatrics, Hamad Medical Corporation, Doha, Qatar.
Abstract
BACKGROUND: Whether vitamin D reduces clinically important exacerbations of childhood asthma remains uncertain. We compared rapid to maintenance vitamin D repletion analyzed by baseline vitamin D level. METHODS:Children presenting to the ED with moderate-to-severe asthma exacerbations and vitamin D levels ≤ 25 ng/mL underwent masked randomization, and then open dosing to either IM+oral (the latter daily) therapy or daily oral-only therapy, and were followed for 12 months. The primary outcome was patient-initiated unplanned visits for asthma exacerbations, examined two ways: cumulative proportions with an exacerbation, and average exacerbation frequency. As this was a nutrient study, we analyzed treatment groups by quartile of baseline vitamin D level, collecting repeat levels and clinical observations at 3, 6, 9, and 12 months after enrollment. RESULTS:One hundred and sixteen patients in the IM+oral cohort vs 115 in the oral-only cohort had similar mean (SD) baseline levels: 15.1 (5.4) vs 15.8 (5.2) ng/mL (range, 3-25 ng/mL). There was no difference in the primary outcome over the entire 12-month observation period. However, rapid IM+oral supplementation significantly reduced unplanned visits for asthma exacerbations for children with baseline levels of 3 to 11 ng/mL during the initial 3 months: the relative exacerbation rate for the IM+oral cohort compared with the oral-only cohort at 3 months was 0.48 (95% CI, 0.28-0.89; P = .008); average exacerbation frequency per child analysis, relative rate 0.36 (95% CI, 0.13-0.87; P = .017). Otherwise, there were no significant differences between groups. CONCLUSIONS: Rapid compared to maintenance vitamin D supplementation for children with the lowest levels resulted in short- but not long-term reduction in asthma exacerbations.
RCT Entities:
BACKGROUND: Whether vitamin D reduces clinically important exacerbations of childhood asthma remains uncertain. We compared rapid to maintenance vitamin D repletion analyzed by baseline vitamin D level. METHODS:Children presenting to the ED with moderate-to-severe asthma exacerbations and vitamin D levels ≤ 25 ng/mL underwent masked randomization, and then open dosing to either IM+oral (the latter daily) therapy or daily oral-only therapy, and were followed for 12 months. The primary outcome was patient-initiated unplanned visits for asthma exacerbations, examined two ways: cumulative proportions with an exacerbation, and average exacerbation frequency. As this was a nutrient study, we analyzed treatment groups by quartile of baseline vitamin D level, collecting repeat levels and clinical observations at 3, 6, 9, and 12 months after enrollment. RESULTS: One hundred and sixteen patients in the IM+oral cohort vs 115 in the oral-only cohort had similar mean (SD) baseline levels: 15.1 (5.4) vs 15.8 (5.2) ng/mL (range, 3-25 ng/mL). There was no difference in the primary outcome over the entire 12-month observation period. However, rapid IM+oral supplementation significantly reduced unplanned visits for asthma exacerbations for children with baseline levels of 3 to 11 ng/mL during the initial 3 months: the relative exacerbation rate for the IM+oral cohort compared with the oral-only cohort at 3 months was 0.48 (95% CI, 0.28-0.89; P = .008); average exacerbation frequency per child analysis, relative rate 0.36 (95% CI, 0.13-0.87; P = .017). Otherwise, there were no significant differences between groups. CONCLUSIONS: Rapid compared to maintenance vitamin D supplementation for children with the lowest levels resulted in short- but not long-term reduction in asthma exacerbations.
Authors: Julie Nyholm Kyvsgaard; Ulrik Ralfkiaer; Nilofar Følsgaard; Trine Mølbæk Jensen; Laura Marie Hesselberg; Ann-Marie M Schoos; Klaus Bønnelykke; Hans Bisgaard; Jakob Stokholm; Bo Chawes Journal: BMJ Open Date: 2022-04-13 Impact factor: 2.692
Authors: Brian P O'Sullivan; Laura James; Joseph M Majure; Scott Bickel; Ly-Thao Phan; Monica Serrano Gonzalez; Heather Staples; Jade Tam-Williams; Jason Lang; Jessica Snowden Journal: Pediatr Pulmonol Date: 2020-12-08
Authors: Megan E Jensen; Francine M Ducharme; Nathalie Alos; Geneviève Mailhot; Benoît Mâsse; John H White; Mohsen Sadatsafavi; Ali Khamessan; Sze Man Tse; Reza Alizadehfar; Dirk E Bock; Patrick Daigneault; Chantal Lemire; Connie Yang; Dhenuka Radhakrishnan Journal: BMJ Open Date: 2019-12-30 Impact factor: 2.692