Vitamin D supplementation in children with asthma: a systematic review and meta-analysis

Juan Carlos Ivancevich Saturday, 07 February 2015 12:23
Research article

Munes M FaresLina H AlkhaledSalman M Mroueh and Elie A Akl

Abstract (provisional)


Epidemiologic studies suggest an association between vitamin D deficiency and atopic diseases, including asthma. The objective of this study was to systematically review the benefits and harms of vitamin D supplementation in children with asthma.


We used standard Cochrane systematic review methodology. The search strategy included an electronic search in February 2013 of MEDLINE and EMBASE. Two reviewers completed in duplicate and independently study selection, data abstraction, and assessment of risk of bias. We pooled the results of trials using a random-effects model. We assessed the quality of evidence by outcome using the GRADE methodology.


Four trials with a total of 149 children met eligibility criteria. The trials had major methodological limitations. Given the four studies reporting on asthma symptoms used different instruments to measure that outcome, we opted not to conduct a meta-analysis. Three of those studies reported improvement in asthma symptoms in the vitamin D supplemented group study, while the fourth reported no effect (very low quality evidence). For the lung function outcome, a meta-analysis of two trials assessing post treatment FEV-1 found a mean difference of 0.54 liters per second (95% CI -5.28; 4.19; low quality evidence). For the vitamin D level outcome, a meta-analysis of three trials found a mean difference of 6.56 ng/ml (95% CI -0.64; 13.77; very low quality evidence).


The available very low to low quality evidence does not confirm or rule out beneficial effects of vitamin D supplementation in children with asthma. Large-scale, well-designed and executed randomized controlled trials are needed to better understand the effectiveness and safety of vitamin D in children with asthma.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

Asthma phenotypes and the use of biologic medications in asthma and allergic disease: The next steps toward personalized care

Juan Carlos Ivancevich Thursday, 05 February 2015 12:40

Abstract: Traditionally, asthma and allergic diseases have been defined by broad definitions and treated with nonspecific medications, including corticosteroids and bronchodilators. There is an increasing appreciation of heterogeneity within asthma and allergic diseases based primarily on recent cluster analyses, molecular phenotyping, biomarkers, and differential responses to targeted and nontargeted therapies. These pioneering studies have led to successful therapeutic trials of molecularly targeted therapies in defined phenotypes. This review analyzed randomized double-blind, placebo-controlled trials of molecularly targeted therapies in defined allergic disease and asthma phenotypes. IgE was the first successful biological target used in patients with allergic disease and asthma. This review shows that therapies targeting the canonical type 2 cytokines IL-4, IL-5, and IL-13 have shown consistent efficacy, especially in asthmatic patients with evidence of TH2/type 2 inflammation (“type 2 high”). As of yet, there are no successful trials of targeted therapies in asthmatic patients without evidence for type 2 inflammation. We conclude that further refinement of type 2 therapies to specific type 2 phenotypes and novel approaches for patients without type 2 inflammation are needed for asthma and allergic disease treatment.


ADAM wearable monitors asthma via app

Juan Carlos Ivancevich Saturday, 31 January 2015 04:09

Health Care Originals ADAM asthma wearable

According to the Centers for Disease Control and Prevention, asthma affects over 25 million adults and children in the US alone, and is responsible for 14.2 million physician visits each year as well as 1.8 million emergency care visits. With that huge - and growing - population of asthma sufferers and the associated costs of treating the disease, monitoring and managing asthma is quickly becoming a necessity. Health Care Originals highlighted its ADAM (Asthma Detection And Monitoring) wearable and app at CES 2015, a system designed to detect symptoms of asthma, provide alerts, and more.

ADAM uses a small wearable patch to detect coughs, monitor respiration and heart rate, and listen for wheezing. The device and app are expected to ship in the second quarter of 2015. By that time it's expected that the sensor will also be able to monitor inhaler use, provide alerts of impending asthma attacks, let patients forward those alerts to their primary care physician or specialist, track and trend symptoms, and even provide treatment plans.

ADAM description

Need a reminder to use your inhaler or take other prescribed medication? The ADAM app will provide you with reminders. All data that is generated by the sensor and captured by the app is kept in HIPAA-compliant storage, and the company is looking into integration with HealthKit as well.

ADAM is yet another example of how app-connected devices are beginning to revolutionize health care, hopefully reducing both patient visits and the cost of treatment.

More information:

Human tissue models for a human disease: what are the barriers?

Juan Carlos Ivancevich Tuesday, 03 February 2015 13:06

Thorax doi:10.1136/thoraxjnl-2014-206648

Open Access
  1. Joanna Edwards1
  2. Maria Belvisi2
  3. Sven-Erik Dahlen3
  4. Stephen Holgate4
  5. Anthony Holmes1

+Author Affiliations 1National Centre for the Replacement, Refinement and Reduction of Animals in ResearchLondon, UK2Faculty of MedicineNational Heart & Lung Institute, Imperial College LondonLondon, UK3Institute of Environmental Medicine, Karolinska InstituteStockholm, Sweden 4Faculty of MedicineUniversity of SouthamptonSouthampton, UK


Asthma represents an area of significant unmet medical need, with few new drugs making it to the clinic in the past 50 years. Much asthma research is currently carried out in non-human models. However, as asthma is a uniquely human condition, it is difficult to translate findings from these models to efficacious therapies. Based on the results of a survey of the UK asthma research community carried out jointly between the NC3Rs, Asthma UK, the UK Respiratory Research Collaborative and the Human Tissue Authority, we propose that more emphasis be placed on the use of human tissue studies to provide more relevant models that better translate to the clinic and which reduce the reliance of the asthma community on less predictive animal models.

This Article

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:


The minimal clinically important difference of the control of allergic rhinitis and asthma test (CARAT): cross-cultural validation and relation with pollen counts

Juan Carlos Ivancevich Saturday, 24 January 2015 13:24


npj Primary Care Respiratory Medicine 25, Article number: 14107 (2015) 


Background: The Control of Allergic Rhinitis and Asthma Test (CARAT) monitors control of asthma and allergic rhinitis.

Aims: To determine the CARAT’s minimal clinically important difference (MCID) and to evaluate the psychometric properties of the Dutch CARAT.

Methods: CARAT was applied in three measurements at 1-month intervals. Patients diagnosed with asthma and/or rhinitis were approached. MCID was evaluated using Global Rating of Change (GRC) and standard error of measurement (s.e.m.). Cronbach’s alpha was used to evaluate internal consistency. Spearman’s correlation coefficients were calculated between CARAT, the Asthma Control Questionnaire (ACQ5) and the Visual Analog Scale (VAS) on airway symptoms to determine construct and longitudinal validity. Test–retest reliability was evaluated with intra-class correlation coefficient (ICC). Changes in pollen counts were compared with delta CARAT and ACQ5 scores.

Results: A total of 92 patients were included. The MCID of the CARAT was 3.50 based on GRC scores; the s.e.m. was 2.83. Cronbach’s alpha was 0.82. Correlation coefficients between CARAT and ACQ5 and VAS questions ranged from 0.64 to 0.76 (P<0.01). Longitudinally, correlation coefficients between delta CARAT scores and delta ACQ5 and VAS scores ranged from 0.41 to 0.67 (P<0.01). Test–retest reliability showed an ICC of 0.81 (P<0.01) and 0.80 (P<0.01). Correlations with pollen counts were higher for CARAT than for ACQ5.

Conclusions: This is the first investigation of the MCID of the CARAT. The CARAT uses a whole-point scale, which suggests that the MCID is 4 points. The CARAT is a valid and reliable tool that is also applicable in the Dutch population.

Article tools


Interasma on Twitter

Interasma Top story: Matthew Bowdish MD on Twitter: "Castro: Site of action of targeted t…, see more
Interasma RT @Aller_MD: Top story: @MatthewBowdish: 'Castro: Site of action of targeted therapies for s…, see more https://t.…
Interasma RT @Aller_MD: “Regeneron (REGN) Reports Approval of DUPIXENT in Japan for Treatment of Atopic Dermatitis” https://t…
Interasma RT @Aller_MD: Bilastine Newsletter - Discover what´s new in allergy and antihistamines

Editor: Juan C. Ivancevich, MD

Copyright © Interasma 2003-2017  •  Terms of Use  •  Privacy Policy  •  Contact Us  •  Sitemap

Powered by FREI SA