Question 35 - Reading Practice Test for the TOEFL Test

The word exacerbations in paragraph 1 of the attached passage is closest in meaning to ____.

    A new Cochrane Review, published in the Cochrane Library today and 
    presented at the ERS International Congress, has found evidence from 
    randomized trials, that taking an oral vitamin D supplement in addition 
    to standard asthma medication is likely to reduce severe asthma attacks. 
    [5] Asthma is a common chronic disease affecting about 300  million 
    people worldwide. The symptoms of asthma include wheezing, 
    coughing, chest tightness and shortness of breath. Low blood levels of 
    vitamin D have been linked to increased risk of asthma attacks in 
    children and adults with asthma. There has been a growing interest 
    [10] in the potential role of vitamin D in asthma management because it 
    might help to reduce upper respiratory infections, (such as the common 
    cold) that can lead to exacerbations of asthma. Several clinical trials 
    have tested whether taking vitamin D as a supplement has an effect 
    on asthma attacks, symptoms and lung function in children and 
    [15] adults with asthma.
 
    The team of Cochrane researchers found seven trials involving 435 
    children and two studies, involving 658 adults. The study participants 
    were ethnically diverse, reflecting the broad range of global geographic 
    settings, involving Canada, India, Japan, Poland, the UK, and the 
    [20] U.S. The majority of people recruited to the studies had mild to 
    moderate asthma, and a minority had severe asthma. Most people 
    continued to take their usual asthma medication while participating 
    in the studies. The studies lasted for between six and 12 months.
 
    The researchers found that giving an oral vitamin D supplement 
    [25] reduced the risk of severe asthma attacks requiring hospital 
    admission or emergency department attendance from 6% to around 
    3%. They also found that vitamin D supplementation reduced the rate 
    of asthma attacks needing treatment with steroid tablets. These results 
    are based largely on trials in adults. They also found that vitamin D did 
    [30] not improve lung function or day-to-day asthma symptoms, and 
    that it did not increase the risk of side effects at the doses that were 
    tested.
 
    The Cochrane Review's lead author, Professor Adrian Martineau from 
    the Asthma UK Centre for Applied Research, Queen Mary University 
    [35] of London, said, "We found that taking a vitamin D supplement in 
    addition to standard asthma treatment significantly reduced the risk of 
    severe asthma attached, without causing side effects."He added, "This 
    is an exciting result, but some caution is warranted. First, the 
    findings relating to severe asthma attacks come from just three trials: 
    [40] most of the patients enrolled in these studies were adults with mild 
    or moderate asthma. Further vitamin D trials in children and in adults 
    with severe asthma are needed to find out whether these patient 
    groups will also benefit. Further analyses to investigate this question 
    are on-going, and results should be available in the next few months."

Retrieved from: http://esciencenews.com/articles/2016/09/06/high.quality.evidence.suggests.vitamin.d.can.reduce.asthma.attacks

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