Inhaled magnesium sulfate in the treatment of acute asthma

Powell, Colin; Dwan, Kerry; Milan, Stephen J; Beasley, Richard; Hughes, Rodney; Knopp-Sihota, Jennifer; Rowe, Brian H.

doi:10.1002/14651858.cd003898.pub5

Cited by 60 publications

(58 citation statements)

References 51 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…All SRs were published between 1997 and 2013. Ten SRs searched for RCTs only, two searched for RCTs and CCTs (19,25), and one did not report study designs (29). The SRs contained 189 trials and 16 547 patients, of which 82 trials (43%) and 8040 patients (49%) matched our eligibility criteria and were included in the overview.…”

Section: Results Of the Searchmentioning

confidence: 99%

“…All SRs searched MEDLINE, 11 searched CENTRAL (17,(19)(20)(21)(22)(23)(24)(25)(26)(27)(28), and nine searched EMBASE (17)(18)(19)(20)(21)(22)(25)(26)(27)(28). Four or less searched AMED (17,19,20,22), PsycINFO (17,19,20,22), PubMed (23,25), and clinicaltrials.gov (19), and all Cochrane SRs searched the Cochrane Airways Group Specialized Register of Trials.…”

Section: Search Methods Used In the Included Srsmentioning

confidence: 99%

“…Four or less searched AMED (17,19,20,22), PsycINFO (17,19,20,22), PubMed (23,25), and clinicaltrials.gov (19), and all Cochrane SRs searched the Cochrane Airways Group Specialized Register of Trials. Common additional sources searched included the following: handsearching reference lists, journals, meeting abstracts, and/or conference proceedings (17)(18)(19)(20)(21)(22)(24)(25)(26)(27)(28)(29); and contacting authors, clinicians, collaborators, and/or drug companies (17-19, 21, 22, 24, 27, 29).…”

Section: Search Methods Used In the Included Srsmentioning

confidence: 99%

“…The included SRs provided outcome data relating to nine comparisons: SABA vs placebo (23), SABA vs SAAC (20), SABA vs adrenaline (26), SABA vs SABA (24), SABA and SAAC vs SABA alone (18,21,27), SABA and SAAC vs SAAC alone (20), SABA and MgSO 4 vs SABA alone (19,25), SABA delivered via MDI with spacer or VHC vs nebulizer (17,28,29), and SABA delivered by continuous vs intermittent nebulization (22). No SR provided data examining SAAC vs placebo.…”

Section: Interventions and Comparatorsmentioning

confidence: 99%

“…No SR provided data examining SAAC vs placebo. Co-interventions were permitted in four SRs (17,19,21,22) and not reported in nine SRs.…”

Section: Interventions and Comparatorsmentioning

confidence: 99%

See 4 more Smart Citations

Inhaled short-acting bronchodilators for managing emergency childhood asthma: an overview of reviews

Pollock

Sinha

Hartling

et al. 2016

Allergy

View full text Add to dashboard Cite

International guidelines provide conflicting recommendations on how to use bronchodilators to manage childhood acute wheezing conditions in the emergency department (ED), and there is variation within and among countries in how these conditions are managed. This may be reflective of uncertainty about the evidence. This overview of systematic reviews (SRs) aimed to synthesize, appraise, and present all SR evidence on the efficacy and safety of inhaled short-acting bronchodilators to treat asthma and wheeze exacerbations in children 0-18 years presenting to the ED. Searching, review selection, data extraction and analysis, and quality assessments were conducted using methods recommended by The Cochrane Collaboration. Thirteen SRs containing 56 relevant trials and 5526 patients were included. Results demonstrate the efficacy of short-acting beta-agonist (SABA) delivered by metered-dose inhaler as first-line therapy for younger and older children (hospital admission decreased by 44% in younger children, and ED length of stay decreased by 33 min in older children). Short-acting anticholinergic (SAAC) should be added to SABA for older children in severe cases (hospital admission decreased by 27% and 74% when compared to SABA and SAAC alone, respectively). Continuous nebulization, addition of magnesium sulfate to SABA, and levosalbutamol compared to salbutamol cannot be recommended in routine practice.Acute wheeze in children is one of the most common reasons for presentation to the emergency departments (ED) (1). In school-aged children, acute wheeze usually signifies underlying asthma, while in preschool children this sign may be the result of either asthma or viral-induced wheeze with distinct phenotypes and underlying mechanisms. In these age groups, regardless of the underlying pathology, exacerbations of recurrent wheeze and dyspnoea are largely caused by bronchoconstriction of the small airways. Although most children improve with bronchodilator therapy, many require hospital admission, and others may even require admission to critical or intensive care units. It is important, therefore, that children with wheeze and dyspnoea are treated promptly and appropriately in the ED to reduce symptoms and respiratory distress, mitigate hospital admission, and prevent respiratory failure. Across the UK and many other countries, there is a 10-fold difference in rates of hospital admission for acute asthma in children (2).Although the reasons for this are complex, one factor may be variations among EDs in the management of pediatric asthma, which have recently been described for key interventions such as inhaled bronchodilators (3).The three most common groups of inhaled bronchodilators used to treat acute asthma and wheeze in EDs are short-acting beta-agonists (SABA) such as salbutamol (albuterol), levosalbutamol (levalbuterol), and adrenaline (epinephrine); short-acting anticholinergics (SAACs) such as ipratropium bromide; and, more recently, a third category of muscle relaxants comprising magnesium sulfate (MgSO ...

show abstract

Section: Results Of the Searchmentioning

confidence: 99%

Section: Search Methods Used In the Included Srsmentioning

confidence: 99%

Section: Search Methods Used In the Included Srsmentioning

confidence: 99%

Section: Interventions and Comparatorsmentioning

confidence: 99%

“…No SR provided data examining SAAC vs placebo. Co-interventions were permitted in four SRs (17,19,21,22) and not reported in nine SRs.…”

Section: Interventions and Comparatorsmentioning

confidence: 99%

See 3 more Smart Citations

Inhaled short-acting bronchodilators for managing emergency childhood asthma: an overview of reviews

Pollock

Sinha

Hartling

et al. 2016

Allergy

View full text Add to dashboard Cite

show abstract

Inhaled magnesium sulfate in the treatment of acute asthma

Powell

Dwan

Milan

et al. 2017

Cochrane Database of Systematic Reviews

109

View full text Add to dashboard Cite

Treatment with nebulised MgSO₄ may result in modest additional benefits for lung function and hospital admission when added to inhaled β₂-agonists and ipratropium bromide, but our confidence in the evidence is low and there remains substantial uncertainty. The recent large, well-designed trials have generally not demonstrated clinically important benefits. Nebulised MgSO₄ does not appear to be associated with an increase in serious adverse events. Individual studies suggest that those with more severe attacks and attacks of shorter duration may experience a greater benefit but further research into subgroups is warranted.Despite including 24 trials in this review update we were unable to pool data for all outcomes of interest and this has limited the strength of the conclusions reached. A core outcomes set for studies in acute asthma is needed. This is particularly important in paediatric studies where measuring lung function at the time of an exacerbation may not be possible. Placebo-controlled trials in patients not responding to standard maximal treatment, including inhaled β₂-agonists and ipratropium bromide and systemic steroids, may help establish if nebulised MgSO₄ has a role in acute asthma. However, the accumulating evidence suggests that a substantial benefit may be unlikely.

show abstract

Interventions for managing asthma in pregnancy

Bain

Pierides

Clifton

et al. 2014

Cochrane Database of Systematic Reviews

View full text Add to dashboard Cite

Analysis 4.1. Comparison 4 Inhaled corticosteroid versus oral theophylline, Outcome 1 Asthma exacerbations.. . Analysis 4.2. Comparison 4 Inhaled corticosteroid versus oral theophylline, Outcome 2 Asthmatic symptoms at delivery. Analysis 4.3. Comparison 4 Inhaled corticosteroid versus oral theophylline, Outcome 3 Asthmatic symptoms (nocturnal). Analysis 4.4. Comparison 4 Inhaled corticosteroid versus oral theophylline, Outcome 4 Asthma medication requirements

show abstract

Inhaled magnesium sulfate in the treatment of acute asthma

Cited by 60 publications

References 51 publications

Inhaled short-acting bronchodilators for managing emergency childhood asthma: an overview of reviews

Inhaled short-acting bronchodilators for managing emergency childhood asthma: an overview of reviews

Inhaled magnesium sulfate in the treatment of acute asthma

Interventions for managing asthma in pregnancy

Contact Info

Product

Resources

About