Magnesium for acute exacerbation of chronic obstructive pulmonary disease: A systematic review of randomised trials

Abstract

The efficacy of magnesium sulphate in chronic obstructive pulmonary disease (COPD) was assessed by conducting a systematic review of published randomized clinical trials through extensive searches in MEDLINE and SCOPUS with no date limits, as well as manual review of journals. Outcome measures varied depending on route(s) of administration of magnesium sulphate and medications co-administered. Risk of bias was evaluated and quality of evidence was graded. Four (4) randomized trials were included. All trials had a moderate risk of bias and were of average methodological quality. Magnesium sulphate given intravenously did not seem to have an immediate bronchodilatory effect; however it appears to potentiate the bronchodilatory effect of inhaled beta-2 agonists. Increase in peak expiratory flow rate (PEFR) at 30 and 45 min was greater in those who received magnesium sulphate compared to placebo (P = 0.03), although the mean percentage change in PEFR was just 24%, without significant differences in dyspnoea scores, hospital admission rates, or emergency department readmission rates compared to placebo. Nebulized magnesium sulphate with salbutamol versus nebulized salbutamol with saline placebo showed no significant differences is forced expiratory volume in 1 s (FEV1) measured at 90 min after adjustment for baseline FEV1 (P = 0.34) or differences in the need for hospital admission. Combined inhalational and intravenous magnesium sulphate versus intravenous saline placebo and nebulized ipratropium bromide were comparable in terms of hospital admission, intubation and death, but the ipratropium bromide group showed better bronchodilator effect and improvement in arterial blood gas parameters. Overall, trial evidence for trial evidence for magnesium sulphate in acute exacerbation of COPD is poor, and further well-designed trials are needed.

Life-saving Inhaled Sevoflurane Administered to an Adult With Severe Bronchospasm Secondary to COPD Exacerbation

“…Nebulized Mg sulfate has not been shown to statistically improve outcome measures in any current studies. 5 At this time, more data are needed to evaluate the effects of IV Mg's role in the treatment of acute bronchospasm before it can be recommended on a routine basis for these patients.…”

Nonantibiotic Pharmacological Treatment of Severe Chronic Obstructive Pulmonary Disease Exacerbations

“…A systematic review of randomized trials showed that intravenous magnesium sulfate may potentiate the bronchodilatory effect of inhaled β-2 agonists in AECOPD; however, this did not translate into significant differences in dyspnea, hospital admission rates, or emergency department readmission rates compared with placebo. 23 The comparison of intravenous magnesium sulfate versus intravenous saline placebo and nebulized ipratropium bromide failed to show any difference in terms of hospital admission, intubation rate, and death, although the patients receiving ipratropium bromide had better bronchodilator effect and improvement in gas exchange variables. 23 Another trial conducted in New Zealand on patients with AECOPD presenting at the emergency department showed that adding nebulized magnesium to nebulized salbutamol in the setting of AECOPD had no effect on FEV1.…”

“…23 The comparison of intravenous magnesium sulfate versus intravenous saline placebo and nebulized ipratropium bromide failed to show any difference in terms of hospital admission, intubation rate, and death, although the patients receiving ipratropium bromide had better bronchodilator effect and improvement in gas exchange variables. 23 Another trial conducted in New Zealand on patients with AECOPD presenting at the emergency department showed that adding nebulized magnesium to nebulized salbutamol in the setting of AECOPD had no effect on FEV1. 24 Importantly, none of the patients included in this trial required admission to the intensive care.…”

Indicator of arteriosclerosis in patients with COPD

“…Because COPD is not usually detected until patients seek medical attention for dyspnea or exacerbation 17) , COPD is under-diagnosed and available prevalence and mortality data are thus likely to be greatly underestimated by healthcare providers. There is, therefore, a need to improve our diagnostic and therapeutic options for such a devastating disease.…”