Incidence Of Upper Respiratory Infections Research Articles

Intake of vitamin C, vitamin E, selenium, zinc and polyunsaturated fatty acids and upper respiratory tract infection-a prospective cohort study.

Antioxidants and polyunsaturated fatty acids (PUFAs) have a role in the human immune defense and may affect the susceptibility to upper respiratory tract infection (URTI). To examine dietary intake of vitamin C, vitamin E, selenium, zinc and PUFAs in relation to URTI incidence in a prospective cohort study. A total of 1533 Swedish women and men aged 25-64 years were followed for nine months during 2011-2012. Information on dietary intake was assessed through a web-based food frequency questionnaire, and events of URTI were self-reported prospectively as they occurred. Cox proportional hazards regression was applied to obtain incidence rate ratios with 95% confidence intervals. The mean number of URTI events was 0.9 among all participants, 1.0 among women and 0.7 among men. In women, the incidence rate ratios (95% confidence interval) for high compared with low intake were 0.69 (0.55-0.88) for vitamin C, 0.77 (0.62-0.96) for vitamin E, 0.57 (0.39-0.83) for docosahexaenoic acid (DHA) and 0.80 (0.65-0.99) for arachidonic acid (AA). No association was found for selenium or zinc among women. In men, an increased URTI incidence was seen with medium vitamin E intake (1.42 (1.09-1.85)) and high zinc intake (1.50 (1.04-2.16)). No association was found for vitamin C, selenium or PUFAs among men. We found an inverse association of URTI incidence among women for vitamin C, vitamin E, DHA and AA intake and a positive association among men for vitamin E and zinc intake. The observed gender differences warrant further investigation.

Possible Risks and Protective Factors of Upper Respiratory Tract Infections in Healthy Japanese Office Workers

Objective: In order to determine the risks and protective factors of upper respiratory tract infections (URTIs) in healthy office workers, we conducted a preliminary epidemiological survey and analysis of saliva parameter levels. Methods: One hundred and forty-six (98 men, 48 women; aged 20-59 years) healthy, full-time office workers in Tokyo and its suburbs participated in a questionnaire survey on lifestyle habits and daily physical condition, including symptoms of URTIs, from October 2012 to March 2013. Salivary parameters (secretory IgA, beta-defensin 2, LL-37, granulysin, lysozyme, cortisol) levels were also measured to analyze the correlation to URTI incidence and lifestyle habits. Results: Both the incidence rate and frequency of URTIs per person during the investigation period were highest among participants in their 50s and lowest among participants in their 30s. Participants who lived with their family showed higher URTI incidence than those who lived alone, while those with exercise habits showed lower URTI incidence. Higher saliva cortisol levels significantly correlated with high URTI incidence, while higher salivary granulysin levels significantly correlated with low URTI incidence. Conclusions: The risk factors of URTI incidence among healthy, full-time office workers include not only aging, but also living with family and higher salivary cortisol levels, and the protective factors are exercise habits and higher salivary granulysin levels.

Infecciones de vía aérea superior relacionada con el uso del biberón en la alimentación del lactante menor

Introducción. La lactancia materna ofrece un efecto protector contra las infecciones respiratorias, principalmente de la vía aérea superior; por tanto, es necesario determinar si su sustitución por biberón afecta la incidencia de infecciones respiratorias del tracto superior.Método. Utilizando la metodología de práctica clínica basada en evidencia (PCBE), y según las etapas fundamentales del sistema PICO, se planteó la interrogante: en el lactante menor ¿el uso del biberón para la alimentación comparado con el amamantamiento exclusivo aumenta el riesgo de infecciones en las vías aéreas superiores? Se realizó una búsqueda de artículos en la base de datos en línea PubMed, después de establecer los criterios de inclusión y exclusión y realizar un análisis crítico se seleccionó 5 documentos que dieran respuesta a la pregunta planteada.Resultado. A partir de la búsqueda en la base de datos Pub Med, se obtuvo 969 artículos publicados; tras depurar los resultados iniciales, se logró un total de 25 publicaciones vinculadas a estudios clínicos que abordan la relación entre lactancia materna exclusiva y la incidencia de infecciones respiratorias de vía aérea superior en el lactante menor. Finalmente, se consiguió cinco publicaciones que investigaron el uso del biberón y su posible asociación con infecciones respiratorias. La evaluación de estos estudios evidenció que su calidad es de nivel medio. Las publicaciones concluyen que hay una mayor incidencia de infecciones respiratorias de vía aérea superior en infantes lactantes menores, en los que la lactancia materna no es exclusiva, sino mixta o sustituida por el uso de biberón.Conclusión. Esta revisión breve de literatura muestra que existe evidencia de mediana calidad que apoya la asociación entre el uso de biberón en la alimentación y una mayor incidencia de infecciones respiratorias de vía aérea superior en el lactante menor.

Microbiological Features of Upper Respiratory Tract Infections in Bulgarian Children for the Period 1998-2014.

Across the globe, upper respiratory tract infections (URTIs) are the most prevalent cause of morbidity in childhood. The aim of our study is to analyze the incidence and etiology of bacterial URTIs in Bulgarian children, as well as the increasing antimicrobial resistance to the most common etiologic agents over a period of 17 years. Retrospective study. The study material comprised the data from 4768 patients (aged 1-16 years) with URTI during the period from 1998-2014. Specific microbiology agent detection was performed by culture examination. Susceptibilities to the investigated pathogens were determined by the disk diffusion method and minimal inhibitory concentration according to the criteria of the Clinical and Laboratory Standards Institute (CLSI). Polymerase chain reaction was used to detect the presence of β-lactam resistance genes. We identified the following as the most common URTI bacterial pathogens: Streptococcus pneumoniae (40.94%), Streptococcus pyogenes (34.16%), Haemophilus influenzae (44.23%), Moraxella catarrhalis (39.19%) and Staphylococcus aureus (23.88%). In more than 70% of cases, a polymicrobial etiology was found. The most commonly affected individuals were pre-school-aged children, which accounted for more than 36% of all patients. During the study period, a dramatic increase in resistance to antibiotic agents was observed. The most frequent types of resistance were the enzymatic inactivation of penicillins and cephalosporins (close to 100% in staphylococci and moraxellae) and inducible macrolide-lincozamide resistance (about 20% of Gram-positive cocci). Due to mandatory immunization against pneumococci and H. influenzae in Bulgaria and the vast expanding resistance to the most popular antimicrobial agents changes in the etiology of URTI have recently been noted. Regular analysis of this etiological dynamic and the antimicrobial resistance of respiratory pathogens is important for choosing the correct therapy and successful treatment.

Probiotic Supplements Beneficially Affect Tryptophan-Kynurenine Metabolism and Reduce the Incidence of Upper Respiratory Tract Infections in Trained Athletes: A Randomized, Double-Blinded, Placebo-Controlled Trial.

Background: Prolonged intense exercise has been associated with transient suppression of immune function and an increased risk of infections. In this context, the catabolism of amino acid tryptophan via kynurenine may play an important role. The present study examined the effect of a probiotic supplement on the incidence of upper respiratory tract infections (URTI) and the metabolism of aromatic amino acids after exhaustive aerobic exercise in trained athletes during three months of winter training. Methods: Thirty-three highly trained individuals were randomly assigned to probiotic (PRO, n = 17) or placebo (PLA, n = 16) groups using double blind procedures, receiving either 1 × 1010 colony forming units (CFU) of a multi-species probiotic (Bifidobacterium bifidum W23, Bifidobacterium lactis W51, Enterococcus faecium W54, Lactobacillus acidophilus W22, Lactobacillus brevis W63, and Lactococcus lactis W58) or placebo once per day for 12 weeks. The serum concentrations of tryptophan, phenylalanine and their primary catabolites kynurenine and tyrosine, as well as the concentration of the immune activation marker neopterin were determined at baseline and after 12 weeks, both at rest and immediately after exercise. Participants completed a daily diary to identify any infectious symptoms. Results: After 12 weeks of treatment, post-exercise tryptophan levels were lowered by 11% (a significant change) in the PLA group compared to the concentrations measured before the intervention (p = 0.02), but remained unchanged in the PRO group. The ratio of subjects taking the placebo who experienced one or more URTI symptoms was increased 2.2-fold compared to those on probiotics (PLA 0.79, PRO 0.35; p = 0.02). Conclusion: Data indicate reduced exercise-induced tryptophan degradation rates in the PRO group. Daily supplementation with probiotics limited exercise-induced drops in tryptophan levels and reduced the incidence of URTI, however, did not benefit athletic performance.

Association between serum vitamin D, retinol and zinc status, and acute respiratory infections in underweight and normal-weight children aged 6-24 months living in an urban slum in Bangladesh.

We conducted a longitudinal assessment in 466 underweight and 446 normal-weight children aged 6-24 months living in the urban slum of Dhaka, Bangladesh to determine the association between vitamin D and other micronutrient status with upper respiratory tract infection (URI) and acute lower respiratory infection (ALRI). Incidence rate ratios of URI and ALRI were estimated using multivariable generalized estimating equations. Our results indicate that underweight children with insufficient and deficient vitamin D status were associated with 20% and 23-25% reduced risk of URI, respectively, compared to children with sufficient status. Underweight children, those with serum retinol deficiency were at 1·8 [95% confidence interval (CI) 1·4-2·4] times higher risk of ALRI than those with retinol sufficiency. In normal-weight children there were no significant differences between different vitamin D status and the incidence of URI and ALRI. However, normal-weight children with zinc insufficiency and those that were serum retinol deficient had 1·2 (95% CI 1·0-1·5) times higher risk of URI and 1·9 (95% CI 1·4-2·6) times higher risk of ALRI, respectively. Thus, our results should encourage efforts to increase the intake of retinol-enriched food or supplementation in this population. However, the mechanisms through which vitamin D exerts beneficial effects on the incidence of childhood respiratory tract infection still needs further research.

Effects of zinc supplementation in the prevention of respiratory tract infections and diarrheal disease in Colombian children: A 12-month randomised controlled trial

BackgroundAmong the preventive strategies for lowering the incidence of upper respiratory tract infections (URTI) and acute diarrhoea episodes, two of the most common diseases in children, zinc supplementation has received special interest. However, there is a need for additional studies that determine the preventive effects of different doses of zinc on URTI and diarrhoeal disease episodes in children. MethodsIn a randomised, triple-blind clinical trial, we evaluated the efficacy of 12 months of daily zinc supplementation in the incidence of URTI and acute diarrhoea in a population of healthy children aged between 6 and 12 months living in Bogota, Colombia. The outcomes analysed were incidence of URTI, acute diarrhoeal disease episodes, and side effects of the interventions. ResultsBetween 2010 and 2013, a total of 355 children underwent randomisation, with 174 assigned to the zinc supplementation group and 181 to the control group. In the multivariate analyses, having been randomised to the non-supplemented control group (IRR 1.73, 95% CI 1.52–1.97, p<0.001), and nursery attendance (IRR 1.41, 95% CI 1.07–1.87, p=0.016) were independently linked to the number of URTI. Likewise, having been randomised to the non-supplemented group (IRR 1.43, 95% CI 1.20–1.71, p<0.001), and lower socioeconomic status (IRR 1.86, 95% CI 1.11–3.13, p=0.018) were independently associated to the number of diarrhoeal disease episodes. ConclusionsDaily supplementation of 5mg of zinc during 12 months significantly decreased the incidence of URTI and diarrhoeal disease episodes in a healthy population of children aged between 6 and 12 months.

Effect of Flavonoids on Upper Respiratory Tract Infections and Immune Function: A Systematic Review and Meta-Analysis

Previous research on animals indicates flavonoid compounds have immunomodulatory properties; however, human research remains inconclusive. The aim of this systematic review was to assess the efficacy of dietary flavonoids on upper respiratory tract infections (URTIs) and immune function in healthy adults. A created search strategy was run against Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and EMBASE classic, CINAHL, and AMED. The returned studies were initially screened, and 2 reviewers independently assessed the remaining studies for eligibility against prespecified criteria. Fourteen studies, of 387 initially identified, were included in this review, and the primary outcome measure was the effect of flavonoids on URTI incidence, duration, and severity. Of the included studies, flavonoid supplementation ranged from 0.2 to 1.2 g/d. Overall, flavonoid supplementation decreased URTI incidence by 33% (95% CI: 31%, 36%) compared with control, with no apparent adverse effects. Sick-day count was decreased by 40% with flavonoid supplementation, although unclear. Differences in bio-immune markers (e.g., interleukin-6, tumor necrosis factor-α, interferon-γ, neutrophils) were trivial between the intervention and control groups during the intervention and after exercise when a postintervention exercise bout was included. These findings suggest that flavonoids are a viable supplement to decrease URTI incidence in an otherwise healthy population.

Exercise, immune function and respiratory infection: An update on the influence of training and environmental stress

This review outlines recent advancements in the understanding of athlete immune health. Controversies discussed include whether high levels of athletic training and environmental stress (for example, heat acclimation, cryotherapy and hypoxic training) compromise immunity and increase upper respiratory tract infection (URTI). Recent findings challenge early exercise immunology doctrine by showing that international athletes performing high-volume training suffer fewer, not greater, URTI episodes than lower-level performers and URTI incidence decreases, not increases, around the time of competition compared with heavy training. Herein we raise the possibility of host genetic influences on URTI and modifiable behavioural and training-related factors underpinning these recent observations. Continued controversy concerns the proportion of URTI symptoms reported by athletes that are due to infectious pathogens, airway inflammation or as yet unknown causes and indeed whether the proportion differs in athletes and non-athletes. Irrespective of the cause of URTI symptoms (infectious or non-infectious), experts broadly agree that self-reported URTI hinders high-volume athletic training but, somewhat surprisingly, less is known about the influence on athletic performance. In athletes under heavy training, both innate and acquired immunity are often observed to decrease, typically 15-25%, but whether relatively modest changes in immunity increase URTI susceptibility remains a major gap in knowledge. With the exception of cell-mediated immunity that tends to be decreased, exercising in environmental extremes does not provide an additional threat to immunity and host defence. Recent evidence suggests that immune health may actually be enhanced by regular intermittent exposures to environmental stress (for example, intermittent hypoxia training).

Daily intake of fermented milk with Lactobacillus casei strain Shirota reduces the incidence and duration of upper respiratory tract infections in healthy middle-aged office workers

PurposeAlthough several studies have demonstrated the efficacy of probiotics for preventing upper respiratory tract infections (URTIs) in at-risk populations, including children and the elderly, few studies have investigated the efficacy of probiotics in healthy adults living normal, everyday lives. Thus, we tried to evaluate the effects of Lactobacillus casei strain Shirota-fermented milk (LcS-FM) on the incidence of URTIs in healthy middle-aged office workers.MethodsIn a randomized controlled trial, 96 eligible male workers aged 30–49 years consumed LcS-FM containing 1.0 × 1011 viable LcS cells or control milk (CM) once daily for 12 weeks during the winter season. URTI episodes were evaluated by a physician via a questionnaire of URTI symptoms.ResultsThe incidence of URTIs during the intervention period was significantly lower in the LcS-FM group than in the CM group (22.4 vs. 53.2 %, P = 0.002). The time-to-event analysis showed that the LcS-FM group had a significantly higher URTI-free rate than the CM group over the test period (log-rank test: χ2 11.25, P = 0.0008). The cumulative number of URTI episodes and cumulative days with URTI symptoms per person was lower in the LcS-FM group, and the duration per episode was shorter. Inhibition of both reductions in NK cell activity in peripheral blood mononuclear cells and increases in salivary cortisol levels was observed in the LcS-FM group.ConclusionThe results suggest that the daily intake of fermented milk with LcS may reduce the risk of URTIs in healthy middle-aged office workers, probably through modulation of the immune system.

Effect of interactions with humans on behaviour, mucosal immunity and upper respiratory disease of shelter cats rated as contented on arrival

Sustained positive affect may decrease vulnerability to upper respiratory infections in cats admitted to a shelter. Incidence of upper respiratory infections was examined in cats rated as Content upon admission to an animal shelter when provided with or without treatment to sustain contentment. Ninety-six cats rated as Content upon admission were provided with either human interaction, including petting, playing, and grooming, in four 10min sessions/d for 10 days or were exposed to a control treatment of a human standing in front of the cage with eyes averted for the same period. Changes in emotional state and mucosal immune responses were measured daily in treated and control groups. Infectious status was determined upon admission and on days 4 and 10 using combined conjunctival and oropharyngeal swab specimens tested by quantitative real-time PCR for feline herpes virus type 1, feline calicivirus, Mycoplasma felis, Chlamydophila felis, and Bordetella bronchiseptica. The onset of upper respiratory disease (URD) was determined by veterinary staff based on clinical signs, including ocular or nasal discharge. Treated cats were more likely to remain Content (Incident Rate Ratio [IRR]:1.13, Confidence Interval: 0.98-1.30, P <0.0001) and less likely to be rated as Anxious or Frustrated than Control cats over a 10 day period (IRR: 0.61, 95% CI: 0.42-0.88, P =0.007). Feline secretory IgA (S-IgA) quantified in faeces by ELISA techniques, was greater for Treated than Control cats (1451 Vs 846μg/g). Within the Treatment group, S-IgA was greater for cats that sustained Contentment throughout the study period compared to cats that became Anxious or Frustrated (1846 Vs 1394μg/g). An increasing proportion of Control than Treated cats shed pathogens over time (Control 22%, 36%, 61%; Treated 35%, 26%, 32% on d 1, 4 and 10, respectively; P =0.006). Control cats were more likely to develop URD than Treated cats (HR 2.9, CI: 1.30-6.67, P =0.01). Cats that responded positively to Treatment had a lower incidence of URD than negative responders (P =0.02). We conclude that the provision of human interaction treatments to shelter cats can facilitate sustained contentment, enhance secretion of S-IgA, and reduce incidence of URD.

Relationship between upper respiratory tract infection incidence and low vitamin D levels in children

Relationship between upper respiratory tract infection incidence and low vitamin D levels in children

Vitamin D and respiratory infections.

Vitamin D or 1,25-hydroxyvitamin D (1,25(OH)2 D) has a well-established role in calcium homeostasis. In recent years, the discovery of vitamin D-metabolizing enzymes and vitamin D receptor (VDR) in the lungs and various cells of the immune system has led to numerous studies conducted to evaluate its role in respiratory functions and, in particular, upper respiratory tract infections (URTIs). A PubMed literature search was done using vitamin D and respiratory infections as key words. Only clinical studies were considered. This study aimed to review recent clinical and epidemiological studies conducted in adults and children, and to evaluate the functional role of vitamin D in respiratory infections. The evaluated studies show an important immunomodulatory role of vitamin D, which reduces the incidence and risk of URTIs, both in children and in adults. Combating URTIs can be done prophylactically, associating the use of vaccines against Streptococcus pneumoniae with strengthening the immune system through supplementation with vitamin D. These actions can significantly contribute to reducing the number of URTIs, the use of antibiotics, and consequently, the rates of antimicrobial resistance.

The Effect of Fish Oil, Vitamin D and Protein on URTI Incidence in Young Active People.

Upper respiratory tract infections (URTI) are a frequent illness among athletes. We investigated the effect of a multi-nutrient supplement (vitamin D, fish oil and protein) on the occurrence of URTI in young active people. 42 young recreational athletes were randomly assigned to receive either supplementation (550 mg DHA, 550 mg EPA, 10 µg vitamin D3 and 8 g whey protein) or placebo for 16 weeks. Unstimulated saliva samples were collected by passive drool. Samples were analysed for IgA (sIgA) concentration and the secretion rate extrapolated by multiplying concentration by saliva flow rate. Physical activity levels and URTI incidence were monitored by questionnaire. Training status was not different between the 2 groups. There were no differences in the incidence, severity and duration of URTI. However the number of symptom days was lower in the supplemented compared to the control group (1.72±1.67 vs. 2.79±1.76; P

Clinical and etiological profile of the pediatric population with upper respiratory tract infection in ubaldo laya evacuation center, iligan city, philippines

Upper Respiratory Tract Infections (URTIs) especially in children are very common following natural disasters. Incidence of URTI among 146 children with ages 5 to 12 years old was determined through a field survey in an evacuation center in Iligan City. Predisposing factors such as age, sex, educational attainment of mothers and lack of measles immunization were correlated with URTI symptoms using Fisher’s Exact Test. Aerobic plate count for bacterial colonies was also compared with the rise of new cases of URTIs in the evacuation center. Results showed that educational attainment among mothers and ages of children (5 to 8 years) were significant factors in URTI symptoms. Linear regression analysis for aerobic plate count in five selected sites suggests positive correlation of bacterial population with occurring new cases of URTIs in the area. Crowding in room sites was also found as important factor contributing to the faster rate of URTI transmission among children confined in these areas. Result suggests the importance of raising awareness on the predisposing factors of URTI.

In vitro Production of IL-6 and IFN-γ is Influenced by Dietary Variables and Predicts Upper Respiratory Tract Infection Incidence and Severity Respectively in Young Adults.

Assessment of immune responses in healthy adults following dietary or lifestyle interventions is challenging due to significant inter-individual variability. Thus, gaining a better understanding of host factors that contribute to the heterogeneity in immunity is necessary. To address this question, healthy adults [n = 36, 18–40 years old, body mass index (BMI) 20–35 kg/m2] were recruited. Dietary intake was obtained via 3-day dietary recall records, physical activity level was evaluated using the International Physical Activity Questionnaire, and peripheral blood mononuclear cells were isolated from peripheral blood. Expression of activation markers on unstimulated immune subsets was assessed by flow cytometry. T-cell proliferation and cytokine secretion was assessed following in vitro stimulation with anti-CD3 or lipopolysaccharide. Furthermore, the incidence and severity of cold or flu symptoms were obtained from self-reported upper respiratory tract infection (URTI) questionnaires. The relationship between activation marker expression on T cells and T-cell effector functions; and in vitro cytokine secretion and URTI was determined by linear or logistic regression. CD69 and CD25 expression on unstimulated T cells was significantly associated with T-cell proliferation and interleukin-2 secretion. Incidence and severity of cold or flu symptoms was significantly associated with in vitro interleukin-6 and interferon-gamma secretion, respectively. Furthermore, host factors (e.g., age, BMI, physical activity, and diet) contributed significantly to the relationship between activation marker expression and T-cell effector function, and cytokine secretion and cold and flu status. In conclusion, these results suggest that lifestyle and dietary factors are important variables that contribute to immune responses and should be included in human clinical trials that assess immune endpoints.

Double-blind randomised placebo-controlled trial of bolus-dose vitamin D3 supplementation in adults with asthma (ViDiAs)

RationaleAsthma 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...

The Effect of Fish Oil, Vitamin D and Protein on URTI Incidence in Young Active People.

Upper respiratory tract infections (URTI) are a frequent illness among athletes. We investigated the effect of a multi-nutrient supplement (vitamin D, fish oil and protein) on the occurrence of URTI in young active people. 42 young recreational athletes were randomly assigned to receive either supplementation (550 mg DHA, 550 mg EPA, 10 µg vitamin D3 and 8 g whey protein) or placebo for 16 weeks. Unstimulated saliva samples were collected by passive drool. Samples were analysed for IgA (sIgA) concentration and the secretion rate extrapolated by multiplying concentration by saliva flow rate. Physical activity levels and URTI incidence were monitored by questionnaire. Training status was not different between the 2 groups. There were no differences in the incidence, severity and duration of URTI. However the number of symptom days was lower in the supplemented compared to the control group (1.72±1.67 vs. 2.79±1.76; P<0.05). sIgA concentration and secretion rate did not differ between groups. This study demonstrates that 16 weeks of supplementation with fish oil, vitamin D and protein did not modify the incidence, severity and duration of URTI, although the total number of symptom days was reduced, in a healthy active population.

Probiotics for the prevention of pediatric upper respiratory tract infections: a systematic review

Background: Acute upper respiratory tract infections (URTIs) contribute substantially to pediatric morbidity and mortality worldwide. Prevention of these infections in childhood is a very important public health challenge. Previous systematic reviews, including both adult and childhood populations, have reported that probiotics seem promising, but with modest evidence. This study aimed to focus on prophylactic probiotic use in the prevention of URTIs in childhood.Methods: Relevant trials on two databases were identified in a systematic review, from inception to June 2014. Study selection, data extraction and quality assessment were carried out by two reviewers. In this review, the effects of probiotics, particularly the Lactobacillus and Bifidobacterium strains, on the incidence and symptom scores of URTI in otherwise healthy children were evaluated for the first time. This review comprises 14 randomized controlled trials (RCTs) applied to a pediatric population with high-quality methodology.Results: This systematic review suggests that probiotics in immunocompetent children have a modest effect both in diminishing the incidence of URTIs and the severity of the infection symptoms.Conclusions: At least one beneficial effect of prophylactic probiotic was observed in the majority of RCTs. Even a minimal reduction of 5 – 10% in the incidence of URTIs would have an important clinical and economic mpact on societies. Furthermore, the long-term administration of probiotics appeared to have a good safety profile in childhood and none of the studies reported any serious adverse events related to the probiotic strain.

S95 Double-blind Multi-centre Randomised Controlled Trial Of Vitamin D3 Supplementation In Adults With Inhaled Corticosteroid-treated Asthma (vidias)

Introduction and objectives Asthma exacerbations are commonly precipitated by viral upper respiratory infections (URI). Vitamin D insufficiency associates with susceptibility to URI in patients with asthma. A recent vitamin D trial in adults with asthma reported a trend towards reduced exacerbation risk in the intervention arm as a secondary outcome. Trials of vitamin D in adults with asthma with incidence of exacerbation and URI as primary outcome are lacking. We therefore conducted a multi-centre randomised controlled trial of vitamin D 3 supplementation in adults with asthma with co-primary outcomes of severe exacerbation and URI. Methods Two hundred and fifty adults with inhaled corticosteroid (ICS)-treated asthma were allocated to receive six 2-monthly oral doses of 3 mg vitamin D 3 or placebo over one year. Co-primary outcomes were time to first severe exacerbation and time to first URI. Sub-group analyses were performed to determine whether effects of supplementation were modified by baseline vitamin D status or genotype for thirty-four single nucleotide polymorphisms in eleven vitamin D pathway genes. Results Participants were allocated to vitamin D 3 vs. placebo in equal numbers; 82% were vitamin D insufficient at baseline. Vitamin D 3 supplementation did not influence time to first severe exacerbation (aHR 1.02, 95% CI 0.69–1.53, P = 0.91) or time to first URI (aHR 0.87, 95% CI 0.64–1.16, P = 0.34). The influence of vitamin D 3 on co-primary outcomes was not modified by baseline vitamin D status or genotype. Of 16 pre-specified secondary outcomes, only one showed a difference between arms: vitamin D supplementation induced a modest improvement in respiratory quality of life as evidenced by a reduction in mean total score for the St George’s Respiratory Questionnaire at 2 months (-3.9 points, p = 0.005), 6 months (-3.7 points, p = 0.038) and 12 months (-3.3 points, p = 0.060). Conclusions Vitamin D 3 supplementation did not influence time to exacerbation or URI in a population of adults with ICS-treated asthma with a high prevalence of baseline vitamin D insufficiency.