A multi-strain Synbiotic may reduce viral respiratory infections in asthmatic children
A randomized controlled trial
Keywords:
Asthma, Children, Probiotic, Synbiotic, Viral infection, Asthma exacerbationAbstract
Background and objective: Asthma is a growing problem worldwide. Acute exacerbations impose considerable morbidity, mortality, and increased cost. Viral respiratory infections are the most common cause (80-85%) of pediatric asthma exacerbations and admissions to the hospital. The aim of this study was to determine the effect of a new synbiotic Lactocare® on viral respiratory infections and asthma exacerbations in asthmatic children.
Methods: In this double blind, placebo-controlled, randomized clinical trial, 72 children with mild persistent asthma, aged between 6 and 12 years, were randomized to receive either Lactocare®, a Synbiotic containing 1 billion CFU/Capsule of Lactobacillus casei, Lactobacillus rhamnosus, Streptococcus thermophilus, Bifidobacterium breve, Lactobacillus acidophilus, Bifidobacterium infantis, Lactobacillus bulgaricus, and Fructooligosacharide (Zist Takhmir, Tehran, Iran) or placebo daily for 60 days. The primary outcome was the number of viral respiratory infections, and secondary outcomes were school absence, salbutamol and prednisolone usage, outpatient visits, and hospital admission for asthma. The outcomes were compared among study groups using the SPSS 11.5 program and the Mann Whitney and Fisher exact tests.
Results: Of the 72 children who were enrolled with mild persistent asthma, 36 were assigned randomly to be treated with synbiotic and 36 with placebo. The number of viral respiratory infections was significantly higher in placebo group than the synbiotic group during the first month of intervention (0.74 ± 0.12 vs. 0.44 ± 0.1, p < 0.007) but not during the second month (0.5 ± 0.8 vs. 0.5 ± 0.8, p < 0.641). Considering the total duration of the study (two months), infection episodes also were significantly lower in the synbiotic group (0.92 ± 0.15 vs. 0.69 ± 0.11, p < 0.046). Salbutamol consumption was significantly lower in the synbiotic group, but there were no significant differences in school absenteeism, oral prednisolone use, outpatient visits, or hospital admissions.
Conclusion: This new synbiotic (a mixture of seven probiotic strains plus fructooligosacharide may reduce episodes of viral infection in asthmatic children.
Trial registration: This study is registered in Iranian Registry of Clinical Trials with registration number of IRCT201509234976N3.
Funding: This research was supported financially by the Research Council of Mashhad University of Medical Sciences (Grant Number: 911048).
References
Jackson DJ, Sykes A, Mallia P, Johnston SL. Asthma exacerbations: origin, effect, and prevention. J
Allergy Clin Immunol. 2011; 128(6): 1165-74. doi: 10.1016/j.jaci.2011.10.024. PMID: 22133317.
Sears MR, Johnston NW. Understanding the September asthma epidemic. J Allergy Clin Immunol. 2007;
(3): 526-9. PMID: 17658590.
Busse WW, Lemanske RF Jr, Gern JE. Role of viral respiratory infections in asthma and asthma
exacerbations. Lancet. 2010; 376(9743): 826-34. doi: 10.1016/S0140-6736(10)61380-3. PMID: 20816549,
PMCID: PMC2972660.
Gern JE. The ABCs of rhinoviruses, wheezing, and asthma. J Virol. 2010; 84(15): 7418-26. doi:
1128/JVI.02290-09. PMID: 20375160, PMCID: PMC2897627.
Wark PA, Johnston SL, Bucchieri F, Powell R, Puddicombe S, Laza Stanca V, et al. Asthmatic bronchial
epithelial cells have a deficient innate immune response to infection with rhinovirus. J Exp Med. 2005;
(6): 937-47. PMID: 15781584, PMCID: PMC2213100.
Ahanchian H, Jones CM, Chen YS, Sly PD. Respiratory viral infections in children with asthma: do they
matter and can we prevent them? BMC Pediatr. 2012; 12: 147. doi: 10.1186/1471-2431-12-147. PMID:
, PMCID: 3471019.
Razi CH, Harmanci K, Abaci A, Ozdemir O, Hizli S, Renda R, et al. The immunostimulant OM-85 BV
prevents wheezing attacks in preschool children. J Allergy Clin Immunol. 2010; 126(4): 763-9. doi:
1016/j.jaci.2010.07.038. PMID: 20920766.
Hatakka K, Blomgren K, Pohjavuori S, Kaijalainen T, Poussa T, Leinonen M, et al. Treatment of acute
otitis media with probiotics in otitis-prone children-a double-blind, placebo-controlled randomised study.
Clin Nutr. 2007; 26(3): 314-21. PMID: 17353072.
Hatakka K, Savilahti E, Ponka A, Meurman JH, Poussa T, Nase L, et al. Effect of long term consumption
of probiotic milk on infections in children attending day care centres: double blind, randomised trial. BMJ.
; 322(7298): 1327. PMID: 11387176, PMCID: PMC32161.
Lin JS, Chiu YH, Lin NT, Chu CH, Huang KC, Liao KW, et al. Different effects of probiotic
species/strains on infections in preschool children: A double-blind, randomized, controlled study. Vaccine.
; 27(7): 1073-9. doi: 10.1016/j.vaccine.2008.11.114. PMID: 19114073.
Liu S, Hu P, Du X, Zhou T, Pei X. Lactobacillus rhamnosus GG supplementation for preventing respiratory
infections in children: a meta-analysis of randomized, placebo-controlled trials. Indian Pediatr. 2013; 50(4):
-81. PMID: 23665598.
Niittynen L, Pitkaranta A, Korpela R. Probiotics and otitis media in children. Int J Pediatr
Otorhinolaryngol. 2012; 76(4): 465-70. doi: 10.1016/j.ijporl.2012.01.011. PMID: 22305688.
Weizman Z, Asli G, Alsheikh A. Effect of a probiotic infant formula on infections in child care centers:
comparison of two probiotic agents. Pediatrics. 2005; 115(1): 5-9. PMID: 15629974.
Hao Q, Dong BR, Wu T. Probiotics for preventing acute upper respiratory tract infections. Cochrane
Database Syst Rev. 2015; 2: 006895. doi: 10.1002/14651858. PMID: 25927096.
Schijf MA, Kruijsen D, Bastiaans J, Coenjaerts FE, Garssen J, van Bleek GM, et al. Specific dietary
oligosaccharides increase Th1 responses in a mouse respiratory syncytial virus infection model. J Virol.
; 86(21): 11472-82. doi: 10.1128/JVI.06708-11. PMID: 22896622, PMCID: PMC3486291.
Farid R, Ahanchian H, Jabbari F, Moghiman T. Effect of a new synbiotic mixture on atopic dermatitis in
children: a randomized-controlled trial. Iran J Pediatr. 2011; 21(2): 225-30. PMID: 23056792, PMCID:
PMC3446166.
Kianifar H, Ahanchian H, Grover Z, Jafari S, Noorbakhsh Z, Khakshour A, et al. Synbiotic in the
management of infantile colic: A randomised controlled trial. J Paediatr Child Health. 2014; 50(10): 801-5.
doi: 10.1111/jpc.12640. PMID: 24962875.
Kukkonen K, Savilahti E, Haahtela T, Juntunen Backman K, Korpela R, Poussa T, et al. Long-term safety
and impact on infection rates of postnatal probiotic and prebiotic (synbiotic) treatment: randomized,
double-blind, placebo-controlled trial. Pediatrics. 2008; 122(1): 8-12. doi: 10.1542/peds.2007-1192. PMID:
van de Pol MA, Lutter R, Smids BS, Weersink EJ, van der Zee JS. Synbiotics reduce allergen-induced T- helper 2 response and improve peak expiratory flow in allergic asthmatics. Allergy. 2011; 66(1): 39-47.
doi: 10.1111/j.1398-9995.2010.02454. PMID: 20716319.
Teach SJ, Gergen PJ, Szefler SJ, Mitchell HE, Calatroni A, Wildfire J, et al. Seasonal risk factors for
asthma exacerbations among inner-city children. J Allergy Clin Immunol. 2015; 135(6): 1465-73. doi:
1016/j.jaci.2014.12.1942. PMID: 25794658, PMCID: PMC4461505.
Wheeler JG, Shema SJ, Bogle ML, Shirrell MA, Burks AW, Pittler A, et al. Immune and clinical impact of
Lactobacillus acidophilus on asthma. Ann Allergy Asthma Immunol. 1997; 79(3): 229-33. PMID:
Giovannini M, Agostoni C, Riva E, Salvini F, Ruscitto A, Zuccotti GV, et al. A randomized prospective
double blind controlled trial on effects of long-term consumption of fermented milk containing
Lactobacillus casei in pre-school children with allergic asthma and/or rhinitis. Pediatr Res. 2007; 62(2):
-20. PMID: 17597643.
Gutkowski P, Madalinski K, Grek M, Dmenska H, Syczewska M, Michalkiewicz J. Effect of orally
administered probiotic strains Lactobacillus and Bifidobacterium in children with atopic asthma. Centr Eur
J Immunol. 2010; 35(4): 233-8.
Chapman CM, Gibson GR, Rowland I. In vitro evaluation of single- and multi-strain probiotics: Inter- species inhibition between probiotic strains, and inhibition of pathogens. Anaerobe. 2012; 18(4): 405-13.
doi: 10.1016/j.anaerobe.2012.05.004. PMID: 22677262.
Das RR, Naik SS, Singh M. Probiotics as additives on therapy in allergic airway diseases: a systematic
review of benefits and risks. Biomed Res Int. 2013; 2013: 231979. doi: 10.1155/2013/231979. PMID:
, PMCID: PMC3727208.
Stockert K, Schneider B, Porenta G, Rath R, Nissel H, Eichler I. Laser acupuncture and probiotics in school
age children with asthma: a randomized, placebo-controlled pilot study of therapy guided by principles of
Traditional Chinese Medicine. Pediatr Allergy Immunol. 2007; 18(2): 160-6. PMID: 17338790.
Helin T, Haahtela S, Haahtela T. No effect of oral treatment with an intestinal bacterial strain,
Lactobacillus rhamnosus (ATCC 53103), on birch-pollen allergy: a placebo-controlled double-blind study.
Allergy. 2002; 57(3): 243-6. PMID: 11906339.
Rose MA, Stieglitz F, Koksal A, Schubert R, Schulze J, Zielen S. Efficacy of probiotic Lactobacillus GG
on allergic sensitization and asthma in infants at risk. Clin Exp Allergy. 2010; 40(9): 1398-405. doi:
1111/j.1365-2222.2010.03560. PMID: 20604800.
Van der Aa LB, van Aalderen WM, Heymans HS, Henk Sillevis Smitt J, Nauta AJ, Knippels LM, et al.
Synbiotics prevent asthma-like symptoms in infants with atopic dermatitis. Allergy. 2011; 66(2): 170-7.
doi: 10.1111/j.1398-9995.2010.02416. PMID: 20560907.
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