In adults with persistent asthma and low vitamin D levels, treatment with vitamin D3 did not reduce the rate of treatment failure or exacerbation of symptoms, according to a study published by JAMA. The study is being released early online to coincide with its presentation at the American Thoracic Society International Conference.
In children and adults with asthma, lower vitamin D levels have been linked to impaired lung function, increased frequency of exacerbations, and reduced responsiveness to steroid therapy. Data suggesting that vitamin D supplementation could modify steroid response and reduce airway inflammation have led to questions about whether treatment with vitamin D might improve outcomes in patients with asthma, according to background information in the article.
Mario Castro, M.D., M.P.H., of the Washington University School of Medicine, St. Louis, and colleagues randomly assigned adults with asthma and low vitamin D levels to vitamin D3 (100,000 IU once, then 4,000 IU/daily for 28 weeks; n = 201) or placebo (n = 207), which was added to treatment with the inhaled corticosteroid ciclesonide.
The researchers found that the addition of vitamin D3 to ciclesonide did not significantly reduce the rate of first treatment failure (a composite outcome of decline in lung function and increases in use of beta-agonists, systemic steroids, and health care utilization) compared with placebo; 28 percent and 29 percent of participants in each group, respectively, experienced at least 1 treatment failure during 28 weeks. Participants most commonly experienced treatment failure due to the need for increased inhaled or systemic steroids (58 percent) or by experiencing an exacerbation of asthma symptoms (46 percent).
There was also no significant reduction in other measured outcomes related to asthma control, airway function, quality of life, or airway inflammation.
"These findings do not support a strategy of therapeutic vitamin D3 supplementation in patients with symptomatic asthma," the authors conclude.
- Mario Castro, Tonya S. King, Susan J. Kunselman, Michael D. Cabana, Loren Denlinger, Fernando Holguin, Shamsah D. Kazani, Wendy C. Moore, James Moy, Christine A. Sorkness, Pedro Avila, Leonard B. Bacharier, Eugene Bleecker, Homer A. Boushey, James Chmiel, Anne M. Fitzpatrick, Deborah Gentile, Mandeep Hundal, Elliot Israel, Monica Kraft, Jerry A. Krishnan, Craig LaForce, Stephen C. Lazarus, Robert Lemanske, Njira Lugogo, Richard J. Martin, David T. Mauger, Edward Naureckas, Stephen P. Peters, Wanda Phipatanakul, Loretta G. Que, Ajay Sheshadri, Lewis Smith, Julian Solway, Lisa Sullivan-Vedder, Kaharu Sumino, Michael E. Wechsler, Sally Wenzel, Steven R. White, E. Rand Sutherland. Effect of Vitamin D3on Asthma Treatment Failures in Adults With Symptomatic Asthma and Lower Vitamin D Levels. JAMA, 2014; DOI: 10.1001/jama.2014.5052
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