A randomized trial of magnesium in the emergency department treatment of children with asthma

Scarfone, Richard J.; Loiselle, John M.; Joffe, Mark; Mull, Colette C.; Stiller, Sonya; Thompson, Kim D.; Gracely, Edward J.

doi:10.1067/mem.2000.111060

Cited by 127 publications

(99 citation statements)

References 21 publications

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“…Despite extensive research, standard stabilization therapy for pediatric acute asthma 1,2 has not substantially improved outcomes. 3 Since many patients do not respond to inhaled ␤ 2 agonists, 4 and delayed response to corticosteroids is common, the hospitalization rate has remained stable and the related costs are increasing.…”

Section: Introductionmentioning

confidence: 99%

Testing of Nebulizers for Delivering Magnesium Sulfate to Pediatric Asthma Patients in the Emergency Department

Coates¹,

Leung²,

Vecellio

et al. 2011

Respir Care

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BACKGROUND: As the use of intravenous magnesium sulfate (MgSO 4 ) for the treatment of refractory asthma is becoming more common, the incidence of MgSO 4 -related systemic hypotension is also rising. One option is to deliver MgSO 4 via aerosol, but compared to most inhaled medications, which are active in the microgram dose range, the MgSO 4 dose requirement is in the milligram range. This, along with inefficient aerosol delivery systems, may be the reason that some studies have found lack of efficacy with aerosol MgSO 4 . In preparation for a multicenter study of inhaled MgSO 4 in asthmatic children 2-17 years old, we conducted an in vitro study to choose the best MgSO 4 nebulizer system that would be effective over the entire age range. METHODS: We tested the Pari LC Star jet nebulizer, Omron MicroAir vibrating-mesh nebulizer, and the Aeroneb Go vibrating-mesh nebulizer with the Idehaler valve-less holding chamber. Aerosol delivery was via face mask. RESULTS: The Pari LC Star had an appropriate particle size distribution but a very slow aerosol output rate. The Omron MicroAir had an even slower output rate and a larger particle size distribution, which would be inappropriate for smaller children. In vitro lung deposition with the Aeroneb Go with Idehaler was 16.0 ؎ 0.4 mg/min in older children and approximately a fifth of that in toddlers. CONCLUSIONS: The Aeroneb Go with Idehaler was chosen for the multicenter clinical study.

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Section: Introductionmentioning

confidence: 99%

Testing of Nebulizers for Delivering Magnesium Sulfate to Pediatric Asthma Patients in the Emergency Department

Coates¹,

Leung²,

Vecellio

et al. 2011

Respir Care

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“…[12][13][14] The diversity displayed by these results may be justified by considerable variation between individuals which would be consistent with the heterogeneous nature of asthmatic patient responses to treatment. 14 A single dose of prednisolone improves the peak expiratory flow of children hospitalized for acute asthma after 3 hours.…”

Section: Discussionmentioning

confidence: 50%

“…Oral corticoids prevent e x a c e r b a t i o n s f r o m p r o g r e s s i n g a n d r e d u c e hospitalization rates, due to improved pulmonary function and arterial oxygen pressure. 5,[11][12][13][14][15] Treatment was evaluated using a clinical severity score and hemoglobin saturation measurement. The importance of clinical scoring systems when indicating hospital admission has been demonstrated by a number of studies.…”

Section: Discussionmentioning

confidence: 99%

Budesonida inalatória em crianças com asma aguda

Milani¹,

Filho²,

Riedi³

et al. 2004

J. Pediatr. (Rio J.)

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Objective: To investigate the efficacy of a single dose of inhaled budesonide as compared to oral prednisone in patients with acute asthma.Methods: Randomized double-blind, double-dummy and placebo-controlled clinical trial. Fortynine children aged 2 to 7 years with acute asthma were randomized in three groups after receiving nebulized salbutamol (0.15 mg/kg). Group I received placebo both as tablets and nebulization, group II was treated with a single dose of oral prednisone (1 mg/kg) and inhaled placebo, and group III received a single dose of placebo tablet and nebulized budesonide (2 mg). Patients were evaluated in terms of symptom score and transcutaneous hemoglobin saturation. Nebulized salbutamol was repeated in case of increasing symptom score or lower saturation.Results: Progressive clinical improvement was observed in all three groups. However, a significant increase in hemoglobin saturation was observed after 2 hours with prednisone, 4 hours with budesonide, and 24 hours with placebo. Conclusion:A combination of single-dose nebulized budesonide and salbutamol may be as effective as oral prednisone to improve symptom severity, but the latter increases hemoglobin saturation in exacerbation of asthma.J Pediatr (Rio J). 2004;80(2):106-12: Budesonide, acute asthma, prednisone, inhaled steroids.

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“…Outros desfechos, como necessidade de internação e o tempo necessário para preencher critério de alta, também não demonstraram significância. Concluíram não existir benefício da associação de dose elevada de magnésio, para crises agudas de asma (moderada à grave), quando uma terapêutica com ß 2 -agonista e corticóides é utilizada 52 . Revisão sistemática da literatura 53 , anterior a estes estudos referidos, também não foi capaz de demonstrar evidências que fundamentassem o emprego do sulfato de magnésio nos pacientes portadores de asma aguda.…”

Section: Outros Broncodilatadores: Metilxantinas E Sulfato De Magnésiounclassified

Controvérsias no manejo farmacológico da asma aguda infantil

Amantéa

Sánchez²,

Piva³

et al. 2002

J. Pediatr. (Rio J.)

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Objective: to present a review of controversial issues related to the pharmacological management of the treatment of acute asthma in children.Sources: articles published in national and international scientific journals. Data were selected from Lilacs and Medline databases.Summary of the findings: the article was organized into topics, presenting aspects on which there is consensus regarding the pharmacological treatment of asthma in children. Issues related to the use of metered dose inhaler versus nebulizers, the role of ß2-adrenergic drugs administered intravenously as well as the role of methylxanthine and magnesium sulfate are approached critically. Conclusions:Inhaled ß2-agonist drugs combined with corticosteroids remain the treatment of choice for acute episodes of asthma in children. Either nebulizers or metered dose inhalers connected to spacers are efficient for the relief of acute symptoms. Patients who are refractory to conventional treatment and develop severe acute asthma should receive ß2-agonist drugs intravenously, provided they are properly monitored. Methylxanthine and magnesium sulfate should be considered a second choice for selected patients.J Pediatr (Rio J) 2002; 78 (Supl.2): S151-S160: acute asthma, beta-agonist, magnesium sulfate, aminophylline. ResumoObjetivo: apresentar uma revisão acerca de questões controversas, relativas ao manejo farmacológico utilizado nos pacientes pediátricos portadores de asma aguda. Fontes dos dados: foram utilizadas informações de artigos publicados em revistas científicas nacionais e internacionais, selecionadas das bases de dados Lilacs e Medline.Síntese dos dados: o artigo foi estruturado em tópicos, apresentando aspectos consensuais no tratamento farmacológico da asma infantil. Questões relacionadas à utilização de inaladores dosimetrados versus nebulizadores, o papel das drogas ß 2 -adrenérgicas utilizadas pela via endovenosa, bem como das metilxantinas e do sulfato de magnésio, são abordados de maneira crítica.Conclusões: os ß 2 -agonistas administrados pela via inalatória, associados aos coricosteróides, permanecem o tratamento de eleição para episódios agudos de asma na população pediátrica. Tanto os nebulizadores quanto os inaladores dosimetrados, acoplados a espaçadores, são efetivos para alívio dos sintomas agudos. Pacientes refratários ao tratamento convencional, que evoluem para quadros de asma aguda grave, devem ter considerada a utilização de drogas ß 2 -agonistas pela via endovenosa, desde que adequadamente monitorizados. Quanto às metilxantinas e ao sulfato de magnésio, devem ser considerados alternativas secundárias para pacientes selecionados.J Pediatr (Rio J) 2002; 78 (Supl.2): S151-S160: asma aguda, beta-agonistas, sulfato de magnésio, aminofilina.

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A randomized trial of magnesium in the emergency department treatment of children with asthma

Cited by 127 publications

References 21 publications

Testing of Nebulizers for Delivering Magnesium Sulfate to Pediatric Asthma Patients in the Emergency Department

Testing of Nebulizers for Delivering Magnesium Sulfate to Pediatric Asthma Patients in the Emergency Department

Budesonida inalatória em crianças com asma aguda

Controvérsias no manejo farmacológico da asma aguda infantil

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