The school year is fast approaching. An interview with the incoming chair of the American Academy of Pediatrics Council on School Health discusses strategies to help children feel comfortable returning to learning in the classroom.

Cough is a common reason for pediatric visits. When should bronchitis be on the diagnostic radar?

Plus, a look at whether vitamin D supplementation could lead to improvements in asthma control.

Articles

A look at what to expect from Contemporary Pediatrics this week

What's new on Contemporary Pediatrics: August 2 to 6

This is the major finding of an analysis of data from the prospective cohort study TRacking Adolescents' Individual Lives Survey (TRAILS) in women aged 13 to 25.

Journal of Child Psychology and Psychiatry

 underscores one of the potential side effects of oral contraceptives, which will help women and their health care providers make informed choices among possible methods of birth control.

“Oral contraceptives are used by many women and are generally considered safe; however, several studies have suggested that their use may increase risk for depression, especially when oral contraceptives are used during adolescence,” said Albertine Oldehinkel, PhD, a professor of lifecourse epidemiology of common mental disorders at the University Medical Center Groningen in Groningen, The Netherlands.

Oldehinkel, who serves as principal investigator of the TRAILS study, said the evidence is mixed on oral contraceptives causing depression and that little is known about long-term effects of the birth control method after discontinuing use.

“In TRAILS, we followed women from early adolescence until young adulthood and collected information about both oral contraceptive use and depressive symptoms and disorders, so we had an excellent opportunity to shed more light on this issue,” Oldehinkel told 

The research team analyzed a variety of different models, 818 in total, among 534 adolescent oral contraceptive users and 191 nonusers.

The results indicated that adolescent oral contraceptive users were, across all models, on average 1.41 times (minimum estimation 1.08, maximum 2.18) more likely to have an episode of MMD in early adulthood than adolescents who did not use oral contraceptives (

This association was mainly driven by adolescents with no history of MDD, who were on average 1.72 more likely to have an episode of MMD in early adulthood after oral contraceptive use.

“Associations between oral contraceptive use and depression had been reported before, and our results strengthen the evidence for this association,” Oldehinkel said. “In addition, it was interesting to notice that this connection was strongest for women who had not been depressed before.”

Because the TRAILS study was observational, “it is too early to jump to causal conclusions,” Oldehinkel said. “We therefore do not yet advocate that oral contraceptive use be limited to prevent depression risk, because many women benefit from oral contraceptive use. But it is important for clinicians to be aware that oral contraceptive use among adolescents might produce an increased risk of depression.”

Depression is an extremely heterogeneous disorder with various expressions and risk factors, according to Oldehinkel, and the etiology of depressive disorders is highly multifactorial. “Depressive episodes are almost always caused by a combination of personal vulnerabilities and external triggers, but the exact nature of these factors can vary widely,” she said. “Oral contraceptive use might be one of those triggers.”

To reduce the incidence of MDD in the study population, Oldehinkel recommends teaching children from an early age onward how to cope with stressful experiences effectively to increase their resilience.

“Still, it appears to be very hard to reduce the prevalence of depression, despite a wealth of evidence-based prevention and intervention strategies,” she said. “It is definitely not an easy job.”

This article was originally published by Contemporary OB/GYN.

1. Anderl C, de Wit AE, Giltay E, et al. Association between adolescent oral contraceptive use and future major depressive disorder: a prospective cohort study. 

. Published online July 12, 2021. doi:10.1111/jcpp.13476

Adolescent oral contraceptive use is associated with a small yet meaningful increased risk of experiencing an episode of major depressive disorder (MDD) in early adulthood, especially among women with no history of MDD in adolescence. 

Small but meaningful link between teen oral contraceptives and future depression

Dr Farber is a pediatrician in Woodbridge, Virginia.

All by itself, preoperative identification of viral bronchiolitis by polymerase chain reaction (PCR) does not predict increased morbidity or mortality, according to a retrospective review that compared outcomes in patients with virus detected by PCR on nasopharyngeal swabs at the time of surgery with outcomes in patients who tested viral negative. Participants included a group of single-ventricle patients and a group of 2-ventricle patients, all of whom were PCR viral positive but had only mild symptoms or were largely asymptomatic; both groups had cardiac surgery without postponement. The 2 control groups comprised age-and procedure-matched patients who were viral negative at the time of surgery or had no clinical indication warranting respiratory viral testing. Investigators found no statistical difference between the 81 patients with 2 ventricles in the viral-positive group and the control group regarding extubation in the operating room, reintubation, hospital length of stay, or mortality. Similarly, the 36 single-ventricle, viral-positive patients showed no differences in any outcome variable compared with the control group.

When I first started pediatrics, routine preoperative testing included a complete blood count, urinalysis, and often a chest x-ray. We eventually learned that this was worthless in the child who had no clinical indications for testing. The wheel reinvents itself here. Testing for viruses in the not very ill child is not of benefit, even with high-risk surgery.

1.Cox VK, Hersey D, Valentine M, et al. Impact of viral PCR positive nasal swabs (non Covid-19) on outcomes following cardiac surgery. 

. 2021.13;1-5. Published online May 13, 2021. doi:10.1007/s00246-021-02636-8

A study examines whether a positive test for bronchiolitis increases morbidity or mortality in patients undergoing cardiac surgery.

Positive viral PCR test may not contraindicate cardiac surgery

The Infectious Disease Society of America discussed keeping children and teenagers safe in the upcoming school year.

Improving flu shot rates in hospitalized children

Hospitalized children are often at risk of influenza morbidity and mortality, which means that influenza vaccination before discharge can help mitigate those risks. A study discusses how a quality improvement program could make a difference.

New report guides pediatricians on offering sexual education to children with disabilities

A guideline update from the American Academy of Pediatrics offers help to clinicians in guiding children and teenagers with disabilities through sexual development.

Using patient portals to improve flu shot rates

Patient portals can be a powerful communication tool for both clinician and family, but can they also be used to improve uptake of the annual influenza vaccine?

It was a very busy week for the Contemporary Pediatrics team.

In case you missed it: July 26 to July 30

Ms. Hester is Content Specialist with Contemporary OB/GYN and Contemporary Pediatrics.

The first 1000 days of a child’s life has become increasingly seen as a crucial time to shape lifelong health outcomes and habits. This may be particularly true with regards to nutrition, as the period sets dietary habits and cover key points in brain development. An 

 was used to see how it would impact the prevalence of an overweight infant as well as the mother’s postpartum weight retention and care.

The investigators examined the effects of the First 1000 Days program among 995 term, low-income infants as well as their mothers who received care at 2 intervention community health centers. There were 650 infant/mother pairs at 2 comparison health centers for control purposes. The pairs in the control arm received usual care. At the intervention centers, there was staff training, health, and behavioral screening, patient navigating, educational materials, health coaching, growth tracking, and text messaging. Infants were assessed at 6 and 12 months of age. 

The average birth weight was 3.34 kg. Two-thirds of the infant/mother pairs were publicly insured. At 6 months, the infants in intervention group had lower weight-for length 

 scores (β: −.27; 95% CI: −.39 to −.15) as well as lower odds of overweight (adjusted odds ratio [OR]: 0.46; 95% CI: 0.28 to 0.76) than the infants who were seen at the comparison sites. These differences were maintained through the 12 month assessment (z score β: −.18; 95% CI: −.30 to −.07; adjusted OR for overweight: 0.60; 95% CI: 0.39 to 0.92). Mothers who were part of the intervention program were found to have lower weight retention, noted as nonsignificant, when they were seen 6 weeks’ postpartum (β: −.51 kg; 95% CI: −1.15 to .13). Furthermore, the mothers had higher odds of having a postpartum visit than the mothers in the control sites.

The investigators concluded that the intervention, when used in combination with coaching appeared to be linked to improvements in both maternal postpartum care as well as infant weight status.

1. Taveras E, Perkins M, Boudreau A, et al. Twelve-Month outcomes of the first 1000 days program on infant weight status. 

. July 29, 2021. Epub ahead of print. doi:10.1542/peds.2020-046706

The first months of life set the course of a child’s health. How effective is an intervention at improving weight outcomes in the infant and use of postpartum care by the mother?

“First 1000 day” intervention improves newborn weight status

For children with systemic juvenile idiopathic arthritis, steroids have long been one of the only available treatments, despite the fact that they can increase the risk of infection and impede growth. The introduction of biologic therapies over the past few years has offered a new way to treat the condition without those adverse effects. A 

 examined how early initiation of biologic therapy impacted the use of glucocorticoids.

The investigators performed an emulated pragmatic trial that used observational data from children who had been hospitalized with new-onset systemic juvenile idiopathic arthritis. The Pediatric Health Information System was used to determine diagnostic and billing records. Glucocorticoid exposure during the index hospitalization was found through an inpatient billing code for oral or intravenous dexamethasone, hydrocortisone, methylprednisolone, prednisolone, or prednisone. Biologic therapy included anakinra, rilonacept, canakinumab, or tocilizumab.

A total of 468 children met the eligibility criteria for the study. Among this cohort, 19% of the patients had a billing code for biologic therapy without either preceding or concurrent initiation of immunomodulatory medications. The proportion saw significant increase over the study period from 2008 to 2019, reaching 40% of all patients discharged between 2017 and 2019. Median time to initiate a biologic therapy from admission was 4 days. For glucocorticoids, it was 5 days. Overall 51.3% of patients were given glucocorticoids, including 22.5% who were administered at least 1 dose of pulse dose glucocorticoids. Once glucocorticoids were started in patients, nearly all of them continued receiving them until they were discharged. Additionally, exposure to methotrexate was more common in patients who did not initiate biologics versus those who initiated them (8.6% vs 2.8%, 

= 0.09). The most common biologic therapy used was anakinra, which was initiated in 69 patients. Canakinumab was used in 1 patient and tocilizumab was used another patient.

The investigators concluded that not only has the use of biologic therapy with new-onset systemic juvenile idiopathic arthritis increased meaningfully over the past decade, but this shift in treatment appeared to be linked to less exposure to glucocorticoids. They believe that this increase in biologics could lead to clinically relevant reductions in adverse effects tied to the use of glucocorticoids.

1. Peterson R, Xiao R, Katcoff H, Fisher B, Weiss P. Effect of first-line biologic initiation on glucocorticoid exposure in children hospitalized with new-onset systemic juvenile idiopathic arthritis: emulation of a pragmatic trial using observational data. 

. 2021;19(1)109. doi:10.1186/s12969-021-00597-z

Treatment for systemic juvenile idiopathic arthritis (sJIA) has long included steroids, but biologics now offer new ways to treat. Does early initiation of biologic therapy lead to a lessening in steroid use?

 Reducing steroid use with sJIA

Patient portals in electronic health records are a helpful way for patients and families to have beneficial information about diagnoses and prescriptions. The portal is also a helpful tool for clinicians and families to communicate with one another. A 

 looked at whether using the portal to remind parents about influenza vaccines had a positive impact on vaccination rates.

The investigators performed an intention-to-treat randomized clinical trial in children aged 6 months to <18 years who were seen in 1 of 53 primary care practices. Patients or their parent/proxy who were considered active portal users were randomly assigned to 1 of 2 groups: receive reminder messages that were framed as gains or losses or receive no messages. The participants were also separately randomized to receive a precommitment message before the start of the influenza season. The administration of ≥1 seasonal influenza vaccinations were considered primary outcomes. Among patients aged 6 months to < 3 years who needed a second influenza vaccine dose, participants were randomized to either receive a message reminding the parent about the second dose or receiving no reminder.

There were 22,046 children included in the study. In the main control group, the vaccination rate was 56.9%. Within the intervention groups, the rate was 58.0% in the loss-frame reminders group (

 = .07), and 58.0% in the gain-frame group (

 = .47). When looking at the precommitment messaging, the investigators found that the rate was 58.3% in the precommitment group versus 57.0% in the control group (P = .11). Furthermore, the adjusted risk ratio for precommitment messaging was 1.02 (95% CI: 1.00–1.04) versus the control and 1.01 (95% CI: 0.98–1.05) for gain-frame reminders as well as 1.02 (95% confidence interval [CI]: 1.00–1.04) for loss-frame reminders. For the subset of children who required a second dose, the second-dose vaccination rates were 55.0% in the intervention group and 44.1% in the control group and had an adjusted risk ratio of 1.25 (95% CI: 1.07–1.45).

The investigators concluded that using patient portal reminders for influenza vaccines had no impact on first-dose influenza vaccination rates. However, the use of reminders was found to be an effective way to get young children back into the office for their second dose of the influenza vaccine.

1. Lerner C, Albertin C, Casillas A, et al. Patient portal reminders for pediatric influenza vaccinations: a randomized clinical trial. 

. July 28, 2021. Epub ahead of print. doi:10.1542/peds.2020-048413

Where a child lives can impact, among other things, his or her nutrition, exposure to pollutants, and quality of education. Neighborhood disadvantage is a major social determinant of health. For children who live in a suboptimal neighborhood, is there a

 link to neurocognition and brain structure

, even after controlling for family socioeconomic status?

Investigators ran a cross-section study that looked at baseline data from the Adolescent Brain and Cognitive Development study, which is a cohort study that was run at 21 sites in the United States. Participants in the study were children who were aged 9.00 to 10.99 years at the time of enrollment. The child and caregiver had a baseline visit between October 2016 and October 2018. The National Institutes of Health Toolbox Cognition Battery was used for measuring neurocognition. The brain structure was assessed with T1-weighted magnetic resonance imaging.

There were 8598 children included who had an average age of 118.8 months. Investigators found that every 1-unit increase in the neighborhood disadvantage factor, which was determined by US Census data, was tied to lower performance on 6 of 7 subtests like List Sorting Working Memory (unstandardized Β = −0.7; 95% CI, −1.0 to −0.3; false discovery rate (FDR)–corrected 

 < .001) and Flanker Inhibitory Control and Attention (unstandardized Β = −0.5; 95% CI, −0.7 to −0.2; FDR–corrected 

 = .001), in addition to all composite measures of neurocognition, such as the Total Cognition Composite (unstandardized Β = −0.7; 95% CI, −0.9 to −0.5; FDR-corrected 

 < .001). Furthermore, such an increase was linked to lower subcortical volume (unstandardized Β = −113.9 mm3; 95% CI, −198.5 to −29.4 mm3; FDR-corrected 

 = .03) in addition to lower whole-brain cortical surface area (unstandardized Β = −692.6 mm2; 95% CI, −1154.9 to −230.4 mm2; FDR-corrected 

 = .007). These links remained after adjusting for perceptions of neighborhood safety and were constant across metropolitan areas.

Investigators concluded that neighborhood disadvantage was linked to smaller cortical surface area and subcortical volume as well as lower neurocognitive performance in young people. These findings illustrate that addressing neighborhood disadvantage in these areas could be a promising way to improve the development and cognitive health in children and teenagers.

1. Hackman D, Cserbik D, Chen J, et al. Association of local variation in neighborhood disadvantage in metropolitan areas with youth neurocognition and brain structure. 

. 2021;175(8):e210426. doi:10.1001/jamapediatrics.2021.0426

Neighborhood disadvantage can lead to suboptimal health outcomes in children. Is this true for brain structure and neurocognition?

Impact of neighborhood disadvantage on a child’s brain

MediWound Ltd, a biopharmaceutical company with a focus in biotherapeutics solutions for tissue repair and regeneration, announced positive efficacy and safety results from its phase 3 pediatric clinical study, Children Innovation Debridement Study (CIDS) with NexoBrid to treat children with severe thermal burns.

The CIDS study was a multicenter, multinational, randomized, controlled, open label study, that investigated the safety and efficacy of NexoBrid to the current standard of care in pediatric patients with deep partial thickness (DPT) and full thickness (FT) thermal burns. Study participants were pediatric patients hospitalized with severe thermal burns ranging from 1% to 30% of the total Body Surface Area (TBSA). A total of 145 pediatric patients were enrolled ages 0 to 18 years and randomized to either the NexoBrid or standard of care treatment arms at a 1:1 ratio across 36 burn centers globally.

Topline results included the acute phase and 12-month follow up data analysis. The long-term data for the cosmesis and function, quality of lift, and safety measurements are expected in the first half of 2023.

The primary endpoints of the study were the early eschar removal, reduction of the wound area surgically excised, and non-inferiority cosmesis and function at 12 months following wound closures. The secondary endpoints were the decrease in surgical excision for eschar removal, blood loss, the reduced need for autograft in DPT wounds, and non-inferiority cosmesis and function at the 24-month follow up from wound closures. To measure safety, the time to complete wound closure along with other factors were used.

All 3 of the primary endpoints were met in the study, with NexoBrid demonstrating a significant decrease in time to and in wound area requiring surgery. It also was not inferior to the current standard of care in quality of scars. The secondary endpoints achieved included a reduction in the incidence of surgical excision and reduction in the need for autograft in deep partial burns and the amount of blood loss during the eschar removal process while being well tolerated.

“This study is one of the most comprehensive randomized controlled studies ever conducted in burn care generally and within the pediatric population specifically. We thank all the Principal Investigators and their teams, as well as the patients and their families, for their work and commitment to advance burn care,” said Lior Rosenberg, MD, MediWound’s chief medical technology officer. “We also thank the U.S. Biomedical Advanced Research and Development Authority (BARDA) for their continued support for this project. The current mode of pediatric burn management requires intensive medical therapy, which poses challenges due to the surgical complexities in treating young patients with severe burns. Having NexoBrid as a non-surgical option provides a minimally invasive alternative to the current surgical standard of care for treating severe burns in pediatric patients.”

The European Medicines Agency (EMA) endorsed the study design as a part of the previously agreed Pediatric Investigation Plan (PIP) to support the indication label expansion to include pediatric patients. The FDA allowed expansion into the US burn centers under the same protocol with the study aligning to the DETECT (NCT01619111) phase 3 trial protocols for adult population.

Funding and support for this pivotal pediatric Phase 3 clinical study (CIDS) with NexoBrid is provided by the Biomedical Advanced Research and Development Authority (BARDA), under the office of the Assistant Secretary for Preparedness and Response (ASPR), within the U.S. Department of Health and Human Services (HHS), under ongoing contract number HHSO100201500035C.

This article was originally published by Dermatology Times.

1. Ltd M. Mediwound announces positive topline results from phase 3 pediatric study (Cids) of nexobrid for eschar removal of severe thermal burns. GlobeNewswire News Room. Published July 20, 2021. Accessed July 29, 2021. 

https://www.globenewswire.com/news-release/2021/07/20/2265479/30505/en/MediWound-Announces-Positive-Topline-Results-from-Phase-3-Pediatric-Study-CIDS-of-NexoBrid-for-Eschar-Removal-of-Severe-Thermal-Burns.html

MediWound Ltd, announced the results for its CIDS trial studying NexoBrid as a treatment for children with severe thermal burns.

Promising phase 3 results reported by MediWound

Henoch-Schönlein purpura (HSP) is highly associated with streptococcal infection. However, this infection does not aggravate renal pathologic damage, and its elimination appears to protect against relapse or recurrence of HSP. Those were the major findings of a retrospective study conducted in China in 2074 children with HSP based on patients’ histories associated with HSP onset; laboratory data, including urine tests, blood samples, and infectious agents; and renal biopsy. Patients, all of whom were aged younger than 17 years and had purpura, had a median age of 8 years. HSP onset was most common in spring and winter, with the lowest rates in July, August, and September.

Investigators divided patients into 3 groups: those with streptococcal infection (the most common infectious trigger), identified in about 19% of patients with HSP; those with other infections, such as 

; and those with noninfectious triggers, such as allergy. Investigators found no significant differences among the 3 groups with regard to renal pathologic damage. More than a quarter (26.1%) of total patients relapsed or had a recurrence of HSP more than once within a 5-year period. The relapse/recurrence rate was significantly lower in the streptococcal infectious group than in the other infectious group or the noninfectious group.

My work-up for HSP is minimal, usually only a urinalysis. This is just 1 study, retrospective and not conclusive—in a homogenous population, at that—but enough is here that I will probably be adding a strep test when I see these patients.

1. Fan GZ, Li RX, Jiang Q, et al. Streptococcal infection in childhood Henoch-Schönlein purpura: a 5-year retrospective study from a single tertiary medical center in China, 2015-2019. 

 2021;19(1):79. doi:10.1186/s12969-021-00569-3

A study looks into triggers for Henoch-Schönlein purpura (HSP).

Streptococcal infection is common trigger for HSP

Bullying is something that many children are subjected to on a daily basis, and for many of those children it’s based on a minority race/ethnicity/national origin as well as other marginalized identities. An 

examined how those experiences are linked to physical health and mental health outcomes in adolescents.

The investigators looked at responses from an anonymous survey that had been performed at 13 public high schools in the Pittsburgh, Pennsylvania area. The survey was given to students in the 9th through 12th grade. Students were asked questions about bullying, harassment, gender identity, sexual orientation, racial/ethnic identity, and access to well-child care. The Centers for Disease Control and Prevention Youth Risk Behavior Survey was used to assess health, mental health, and violence involvement.

There were 3939 participants with an average age of 15.7 years. Among these participants, 1380 indicated they were Black; 2086 had been assigned a female gender at birth; 1021 stated that they were part of a sexual minority group; and 313 were gender diverse. When looking at reported social identities, the investigators found that race/ethnicity-based experiences of bullying and bullying perpetration were the most common, occurring in 375 students (9.5%) and bullying perpetration 209 students (5.8%), respectively. Teenagers who had multiple identities that were stigmatized were found to experience even higher rates of identity-based bullying and identity-based bullying perpetration. Overall, the highest rates of identity-based bullying were seen in gender diverse Black and Hispanic adolescents. Experiencing identity-based bullying due to a number of stigmatize identities was linked to a variety of negative outcomes including delayed well care (adjusted odds ratio [aOR], 1.41; 95% CI, 1.20-1.65), forgone medical care (aOR, 1.64; 95% CI, 1.44-1.87), nonsuicidal self-injury (aOR, 2.86; 95% CI, 2.53-3.24), suicidal ideation (aOR, 2.49; 95% CI, 2.20-2.83), and greater violence involvement (experiencing violence: aOR, 2.90; 95% CI, 2.45-3.43; homicide survivorship: aOR, 1.19; 95% CI, 1.06-1.33).

The investigators concluded that identity-based bullying leads to negative outcomes, especially when a person has more than 1 marginalized identity. The results indicate that bullying prevention programs should work on addressing systemic racism and be empathetic to the experiences of minority teenagers to improve outcomes.

1. Galán C, Stokes L, Szoko N, Abebe K, Culyba A. Exploration of experiences and perpetration of identity-based bullying among adolescents by race/ethnicity and other marginalized identities. 

. 2021;4(7):e2116364. doi:10.1001/jamanetworkopen.2021.16364

Bullying due to a marginalized identity is a sad fact of life for far too many children and teenagers. A study examines how such bullying can lead to poorer health.

Identity-based bullying linked to poorer health outcomes

Giving vitamin D supplements as an adjunct to standard treatment does not lead to better asthma control in children, according to a recent randomized, controlled trial in India. ­The 3-month trial was conducted in 60 youngsters aged 6 to 11 years who had moderate persistent asthma. Half of the participants were assigned to the intervention group and received 2000 IU of vitamin D per day. The other 30 children, assigned to the control group, received a daily placebo. At baseline, all participants underwent spirometry and fractional exhaled nitric oxide (FeNO) testing and were evaluated for the best forced expiratory volume in 1 second (FEV

). Blood samples were taken to evaluate serum 25(OH)D levels. All participants were treated with daily doses of budesonide 400 μg and formoterol 24 μg. Patients also used a diary to record symptoms, such as cough, breathlessness, sleep disturbance, school absences due to asthma, and use of rescue medicine. Participants were evaluated at monthly clinic visits, with asthma control assessed by the Childhood Asthma Control Test (C-ACT).

As expected, at the trial’s conclusion 12 weeks later, vitamin D levels were significantly higher in the intervention group (35.5 ng/mL vs 18.8 ng/mL). Nonetheless, C-ACT scores (the primary outcome) did not differ significantly between the groups, with median scores of 25 in both (a score of at least 19 indicates well-controlled asthma). Nor was there a significant difference between the 2 groups in FEV

 and FeNO levels. Eleven children had exacerbations (4 in the intervention group and 7 in the placebo group); none required emergency visits or hospitalization. The 2 groups did not differ in the number of exacerbations, emergency visits, and hospital admissions. Systemic steroids were given to 4 participants in the intervention group, 7 in the placebo group.

We are still searching for simple interventions for asthma and for areas in which vitamin D supplementation may be helpful. This does not appear to be such an area. Nevertheless, supplementation is a good idea for many children. Although it did not affect asthma control, vitamin D levels were low in the placebo group.

1. Thakur C, Kumar J, Kumar P, Goyal JP, Singh K, Gupta A. Vitamin-D supplementation as an adjunct to standard treatment of asthma in children: a randomized controlled trial (ViDASTA Trial). Pediatr Pulmonol. 2021;56(6):1427-1433. doi:10.1002/ppul.25287

Vitamin D supplement use has been suggested to improve a variety of health outcomes. A report investigates whether it can aid in providing better asthma control.