Magnesium sulfate for treating exacerbations of acute asthma in the emergency department

Abstract

BackgroundTreatment of acute asthma is based on rapid reversal of bronchospasm and arresting airway inflammation. There is some evidence that intravenous magnesium can provide additional bronchodilation when given in conjunction with standard bronchodilating agents and corticosteroids. No systematic review of this literature has been completed on this topic. ObjectivesTo examine the effect of additional intravenous magnesium sulfate in patients with acute asthma managed in the emergency department. Search methodsRandomised controlled trials were identified from the Cochrane Airways Review Group register. Bibliographies from included studies, known reviews and texts were searched. Primary authors and content experts were contacted. Selection criteriaRandomised controlled trials or quasi-randomised trials were eligible for inclusion. Studies were included if patients presented with acute asthma and were treated with IV magnesium sulfate versus placebo. Data collection and analysisData were extracted and methodological quality was assessed independently by two reviewers. Missing data were obtained from authors. Main resultsSeven trials were included (5 adult, 2 pediatric). A total of 665 patients were involved. Patients receiving magnesium sulfate demonstrated non-significant improvements in peak expiratory flow rates when all studies were pooled (weighted mean difference: 29.4 L/min; 95% confidence interval: -3.4 to 62). In studies of people with severe acute asthma, peak expiratory flow rate improved by 52.3 L/min (95% confidence interval: 27 to 77.5). The forced expiratory volume in one second also improved by 9.8 % predicted (95% confidence interval: 3.8 to 15.8). Overall, admission to hospital was not reduced, odds ratio: 0.31 (95% confidence interval: 0.09 to 1.02). In the severe subgroup, admissions were reduced in those receiving magnesium sulfate (odds ratio: 0.10, 95% confidence interval: 0.04 to 0.27). No clinically important changes in vital signs or adverse side effects were reported.1 Magnesium sulfate for treating exacerbations of acute asthma in the emergency department (Review)

Severe Acute Asthma Exacerbation in Children: A Stepwise Approach for Escalating Therapy in a Pediatric Intensive Care Unit

“…From current data, magnesium sulfate is likely to improve bronchospasm and consequent clinical symptoms and reduce hospitalization in children with moderate to severe acute asthma when added to classic therapy. 121 Some studies [122][123][124] have shown clinical improvement in patients with severe asthma receiving intravenous magnesium infusion.…”

Efficiency of nebulised magnesium sulphate in infective exacerbations of chronic obstructive pulmonary disease

“…Non-invaziv veya invaziv mekanik ventilasyon ihtiyacı olan hastalar çalışmaya dahil edilmemiştir. MS tedavisinin daha ağır astım ataklarında daha etkili olduğu bulgusundan yola çıkarak, daha ağır alevlenme ile başvuran ve MS tedavisinden daha fazla yarar görebilecek bir grup hastanın değerlendirilmemiş olabileceği söyle-nebilir (38). Akciğer volümlerinin ve solunum kas gücüne yönelik ölçümlerin yapılamamış olması da çalışmamızın diğer bir dezavantajıdır.…”

Guideline for the management of acute asthma in children: 2013 update

“…[37,38] The response to magnesium appears to be best in patients who present with very severe illness (evidence C). [39][40][41] The benefits associated with the use of nebulised magnesium sulphate remain controversial. Nebulised magnesium sulphate (0.4 ml 50% MgSO 4 added to total volume of 4 ml nebuliser volume to achieve an isotonic solution) added to inhaled β 2 -agonists in the treatment of an acute asthma exacerbation has been shown to improve lung function in patients with severe asthma, with a trend towards fewer hospital admissions.…”