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Martineau AR, MacLaughlin BD, Hooper RL, Barnes NC, Jolliffe DA, Greiller CL, Kilpin K, McLaughlin D, Fletcher G, Mein CA, Hoti M, Walton R, Grigg J, Timms PM, Rajakulasingam RK, Bhowmik A, Rowe M, Venton TR, Choudhury AB, Simcock DE, Sadique Z, Monteiro WR, Corrigan CJ, Hawrylowicz CM, Griffiths CJ. Double-blind randomised placebo-controlled trial of bolus-dose vitamin D3 supplementation in adults with asthma (ViDiAs). Thorax 2015; 70:451-7. [PMID: 25724847 DOI: 10.1136/thoraxjnl-2014-206449] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 01/27/2015] [Indexed: 12/31/2022]
Abstract
RATIONALE Asthma exacerbations are commonly precipitated by viral upper respiratory infections (URIs). Vitamin D insufficiency associates with susceptibility to URI in patients with asthma. Trials of vitamin D in adults with asthma with incidence of exacerbation and URI as primary outcome are lacking. OBJECTIVE To conduct a randomised controlled trial of vitamin D3 supplementation for the prevention of asthma exacerbation and URI (coprimary outcomes). MEASUREMENTS AND METHODS 250 adults with asthma in London, UK were allocated to receive six 2-monthly oral doses of 3 mg vitamin D3 (n=125) or placebo (n=125) over 1 year. Secondary outcomes included asthma control test and St George's Respiratory Questionnaire scores, fractional exhaled nitric oxide and concentrations of inflammatory markers in induced sputum. Subgroup analyses were performed to determine whether effects of supplementation were modified by baseline vitamin D status or genotype for 34 single nucleotide polymorphisms in 11 vitamin D pathway genes. MAIN RESULTS 206/250 participants (82%) were vitamin D insufficient at baseline. Vitamin D3 did not influence time to first severe exacerbation (adjusted HR 1.02, 95% CI 0.69 to 1.53, p=0.91) or first URI (adjusted HR 0.87, 95% CI 0.64 to 1.16, p=0.34). No clinically important effect of vitamin D3 was seen on any of the secondary outcomes listed above. The influence of vitamin D3 on coprimary outcomes was not modified by baseline vitamin D status or genotype. CONCLUSIONS Bolus-dose vitamin D3 supplementation did not influence time to exacerbation or URI in a population of adults with asthma with a high prevalence of baseline vitamin D insufficiency. TRIAL REGISTRATION NUMBER NCT00978315 (ClinicalTrials.gov).
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Affiliation(s)
- Adrian R Martineau
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK Asthma UK Centre for Applied Research, Blizard Institute, Queen Mary University of London, London, UK
| | - Beverley D MacLaughlin
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Richard L Hooper
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Neil C Barnes
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK Asthma UK Centre for Applied Research, Blizard Institute, Queen Mary University of London, London, UK
| | - David A Jolliffe
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Claire L Greiller
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Kate Kilpin
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - David McLaughlin
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Gareth Fletcher
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Charles A Mein
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Mimoza Hoti
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Robert Walton
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Jonathan Grigg
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | | | | | | | | | | | | | - Zia Sadique
- London School of Hygiene and Tropical Medicine, London, UK
| | - William R Monteiro
- NIHR Leicester Respiratory Biomedical Research Unit, Glenfield Hospital, Leicester, UK
| | - Christopher J Corrigan
- MRC and the Asthma UK Centre for Allergic Mechanisms in Asthma, King's College London, London, UK
| | - Catherine M Hawrylowicz
- MRC and the Asthma UK Centre for Allergic Mechanisms in Asthma, King's College London, London, UK
| | - Christopher J Griffiths
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK Asthma UK Centre for Applied Research, Blizard Institute, Queen Mary University of London, London, UK MRC and the Asthma UK Centre for Allergic Mechanisms in Asthma, King's College London, London, UK
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Martineau AR, James WY, Hooper RL, Barnes NC, Jolliffe DA, Greiller CL, Islam K, McLaughlin D, Bhowmik A, Timms PM, Rajakulasingam RK, Rowe M, Venton TR, Choudhury AB, Simcock DE, Wilks M, Degun A, Sadique Z, Monteiro WR, Corrigan CJ, Hawrylowicz CM, Griffiths CJ. Vitamin D3 supplementation in patients with chronic obstructive pulmonary disease (ViDiCO): a multicentre, double-blind, randomised controlled trial. THE LANCET. RESPIRATORY MEDICINE 2015; 3:120-130. [PMID: 25476069 DOI: 10.1016/s2213-2600(14)70255-3] [Citation(s) in RCA: 158] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Patients with chronic obstructive pulmonary disease (COPD) often have vitamin D deficiency, which is associated with increased susceptibility to upper respiratory infection-a major precipitant of exacerbation. Multicentre trials of vitamin D supplementation for prevention of exacerbation and upper respiratory infection in patients with COPD are lacking. We therefore investigated whether vitamin D3 (colecalciferol) supplementation would reduce the incidence of moderate or severe COPD exacerbations and upper respiratory infections. METHODS We did a randomised, double-blind, placebo-controlled trial of vitamin D3 supplementation in adults with COPD in 60 general practices and four Acute National Health Service Trust clinics in London, UK. Patients were allocated to receive six 2-monthly oral doses of 3 mg vitamin D3 or placebo over 1 year in a 1:1 ratio using computer-generated permuted block randomisation. Participants and study staff were masked to treatment assignment. Coprimary outcomes were time to first moderate or severe exacerbation and first upper respiratory infection. Analysis was by intention to treat. A prespecified subgroup analysis was done to assess whether effects of the intervention on the coprimary outcomes were modified by baseline vitamin D status. This trial is registered with ClinicalTrials.gov, number NCT00977873. FINDINGS 240 patients were randomly allocated to the vitamin D3 group (n=122) and placebo group (n=118). Vitamin D3 compared with placebo did not affect time to first moderate or severe exacerbation (adjusted hazard ratio 0·86, 95% CI 0·60-1·24, p=0·42) or time to first upper respiratory infection (0·95, 0·69-1·31, p=0·75). Prespecified subgroup analysis showed that vitamin D3 was protective against moderate or severe exacerbation in participants with baseline serum 25-hydroxyvitamin D concentrations of less than 50 nmol/L (0·57, 0·35-0·92, p=0·021), but not in those with baseline 25-hydroxyvitamin D levels of at least 50 nmol/L (1·45, 0·81-2·62, p=0·21; p=0·021 for interaction between allocation and baseline serum 25-hydroxyvitamin D status). Baseline vitamin D status did not modify the effect of the intervention on risk of upper respiratory infection (pinteraction=0·41). INTERPRETATION Vitamin D3 supplementation protected against moderate or severe exacerbation, but not upper respiratory infection, in patients with COPD with baseline 25-hydroxyvitamin D levels of less than 50 nmol/L. Our findings suggest that correction of vitamin D deficiency in patients with COPD reduces the risk of moderate or severe exacerbation. FUNDING UK National Institute for Health Research.
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Affiliation(s)
- Adrian R Martineau
- Barts and London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Asthma UK Centre for Applied Research, Blizard Institute, Queen Mary University of London, London, UK.
| | - Wai Yee James
- Barts and London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Richard L Hooper
- Barts and London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Neil C Barnes
- Barts and London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Asthma UK Centre for Applied Research, Blizard Institute, Queen Mary University of London, London, UK
| | - David A Jolliffe
- Barts and London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Claire L Greiller
- Barts and London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Kamrul Islam
- Barts and London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - David McLaughlin
- Barts and London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Peter M Timms
- Homerton University Hospital, Homerton Row, London, UK
| | | | - Marion Rowe
- Homerton University Hospital, Homerton Row, London, UK
| | | | | | | | - Mark Wilks
- Royal London Hospital, Whitechapel Road, London, UK
| | | | - Zia Sadique
- London School of Hygiene & Tropical Medicine, London, UK
| | - William R Monteiro
- Leicester Respiratory Biomedical Research Unit, Glenfield Hospital, Groby Road, Leicester, UK
| | - Christopher J Corrigan
- Medical Research Council, Asthma UK Centre in Allergic Mechanisms in Asthma, King's College London, London, UK
| | - Catherine M Hawrylowicz
- Medical Research Council, Asthma UK Centre in Allergic Mechanisms in Asthma, King's College London, London, UK
| | - Christopher J Griffiths
- Barts and London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Asthma UK Centre for Applied Research, Blizard Institute, Queen Mary University of London, London, UK; Medical Research Council, Asthma UK Centre in Allergic Mechanisms in Asthma, King's College London, London, UK
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Chalmers JD, Greening NJ, José RJ, Janes SM. Review of the British Thoracic Society Winter Meeting 2013, 4-6 December, London, UK. Thorax 2014; 69:378-82. [PMID: 24609894 DOI: 10.1136/thoraxjnl-2014-205177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
This article reviews the British Thoracic Society Winter Meeting 2013, the annual scientific meeting attended by over 2000 delegates and representing the depth and breadth of UK respiratory medicine. This year's meeting from 4 to 6 December in London featured cutting-edge research alongside keynote symposia from international experts in respiratory science, epidemiology and clinical trials. This article reviews the key symposia and selected abstract sessions from the 2013 meeting.
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Affiliation(s)
- James D Chalmers
- Tayside Respiratory Research Group, University of Dundee, , Dundee, UK
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