The value of magnesium sulfate nebulization in treatment of acute bronchial asthma during pregnancy

Badawy, Mohamed; Hassanin, Ibrahim M.A.

doi:10.1016/j.ejcdt.2013.12.011

Cited by 7 publications

(6 citation statements)

References 19 publications

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“…The treatment dose of MgSO4 differs between the different studies. Three studies give the highest cumulative dose of 1,5 g of nebulized MgSO4 (10,18,23). Of these three studies, two find an effect, and one does not find an effect of MgSO4, which indicates that the difference in the given dose is unlikely to explain the different results.…”

Section: Discussionmentioning

confidence: 94%

“…Ahmed et al found that the % increase in PEF after 20 min was significantly greater in the MgSO4 group (35% ± 7%) than in the placebo group (24% ± 6%, p < 0.001) (22). The study by Badawy et al similarly found significant improvement of FEV 1 after 120 min in the MgSO4 group compared to placebo (MgSO4: 56.31 ± 8.25, control: 32.86 ± 7.15, p < 0.001, measuring unit not given) (23). Hossein et al showed that PEF%predicted was significantly higher in the MgSO4 group (48.7%pred ± 23.4) than in the placebo group (36%pred ± 28.7; p = 0.002 and p < 0.001) after 60 min (18).…”

Section: Nebulized Magnesium Sulfate In Acute Refractory Asthma Exace...mentioning

confidence: 89%

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Magnesium sulfate treatment for acute severe asthma in adults—a systematic review and meta-analysis

2023

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IntroductionAdd-on magnesium sulfate (MgSO4) for refractory asthma exacerbation has been much debated. The aim of this review and meta-analysis is, therefore, to provide an update on the current evidence for the efficacy of MgSO4 in exacerbations of asthma in adults refractory to standard of care treatment.MethodsA systematic review was performed in accordance with the PRISMA guidelines. The search was performed in the PubMed database (updated April 2023). For the meta-analysis, a random-effects model was applied using the metaphor package for RStudio (RStudio, Inc.).ResultsA total of 17 randomized controlled trials were included. Three of the nine studies addressing treatment with intravenous (IV) MgSO4 found a significant effect on lung function compared to placebo. Of the eight studies investigating hospital admission rate, only two found a significant effect of MgSO4. Six of the nine studies investigating treatment with nebulized MgSO4 compared to placebo found a favorable effect on forced expiratory volume in 1. second (FEV1) and peak expiratory flow rate (PEF). Only two of the five studies investigating the effect on hospital admission rate found an effect of MgSO4. Comparing effect sizes in a meta-analysis revealed a greater effect on PEF in asthma patients treated with nebulized MgSO4 (MD, 23.57; 95% CI, −2.48 to 49.62, p < 0.01) compared to placebo. The analysis of patients treated with i.v. MgSO4 compared to placebo showed no statistically significant difference (MD, 5.49; 95% CI, −18.67 to 29.65, p = 0.10).ConclusionUp to two out of three studies revealed an effect of MgSO4 treatment for asthma exacerbation when assessed by FEV1/PEF, but fewer studies were positive for the outcome of hospital admissions.

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Section: Discussionmentioning

confidence: 94%

Section: Nebulized Magnesium Sulfate In Acute Refractory Asthma Exace...mentioning

confidence: 89%

Magnesium sulfate treatment for acute severe asthma in adults—a systematic review and meta-analysis

2023

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“…To circumvent this, authors have applied different approaches in their studies. Badawy did a small change in therapy proving that a drug is safe [25] while some authors have modified existing therapy after monitoring different parameters [26], or have made modifications in pregnant women after introducing non-pharmacological therapy [27, 28]. In one of the ongoing studies in South Australia, Grzeskowiak et al are trying to determine whether enhanced antenatal care by a specially educated medical nurse in the Antenatal Asthma Management Service can lower the incidence of exacerbations in asthmatic pregnant women and if such antenatal centers are cost effective [27].…”

Section: Results From Intervention Trialsmentioning

confidence: 99%

“…The results have not yet been published [29]. Badawy conducted a randomized controlled trial of 60 respondents who had been treated at an emergency department intervening in the acute asthma therapy, with the aim of reducing the influence of exacerbations [25]. Half of the patients from control group received standard therapy (oxygen, iv.…”

Section: Results From Intervention Trialsmentioning

confidence: 99%

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What is safe enough - asthma in pregnancy - a review of current literature and recommendations

Labor

Tir

Plavec

et al. 2018

asthma res and pract

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BackgroundAlthough asthma is one of the most serious diseases causing complications during pregnancy, half of the women discontinue therapy thus diminishing the control of the disease, mostly due to the inadequate education and fear of adverse events. Sadly, this is sometimes encouraged by insufficiently educated physicians. Since the incidence and the prevalence of asthma is increasing, it is important to arouse the importance of proper asthma therapy during pregnancy. Inadequate therapy, as well as interrupting or discontinuing therapy, may result in adverse perinatal outcomes for both mother and child.Main bodyThe main goal of asthma control during pregnancy is control of symptoms and prevention of exacerbations, same as in every asthmatic, but even more important. Maintaining optimal lung function, as well as regular daily activities, ensures maintenance of optimal fetal oxygenation. The therapy should be adapted depending on the frequency and severity of daily and nocturnal symptoms, demand for reliever therapy, by the limitations in everyday activities and the frequency of emergency asthma-related hospitalizations. Pre-conceptual education and therapy are very important and should be supported by an asthma action plan adjusted for the period of pregnancy. It is very important to note that most of the drugs used before pregnancy can be safely continued during pregnancy. Pharmacological and non-pharmacological therapy should be used in parallel. Pregnant women should be informed about the nature of the disease, therapy used during pregnancy, possible complications, avoidance of triggers, proper administration of therapy and, most important, why should the therapy be continued throughout the pregnancy on individual basis. Although drug treatment should be based on using drugs with less harm risk, if control of severe symptoms is needed to be achieved in order to protect both mother and child, any anti-asthmatic drug would have the beneficial benefit/harm ratio.ConclusionThere is no solid evidence that asthma treatment during pregnancy causes adverse outcomes for the mother and child but for many, especially new drugs, there is not enough data gathered. On the other hand, harmfulness of uncontrolled asthma during pregnancy is well documented so every effort should be put on preserving good control of asthma during pregnancy.

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Inhaled magnesium sulfate in the treatment of acute asthma

Powell

Dwan

Milan

et al. 2017

Cochrane Database of Systematic Reviews

109

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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.

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The value of magnesium sulfate nebulization in treatment of acute bronchial asthma during pregnancy

Cited by 7 publications

References 19 publications

Magnesium sulfate treatment for acute severe asthma in adults—a systematic review and meta-analysis

Magnesium sulfate treatment for acute severe asthma in adults—a systematic review and meta-analysis

What is safe enough - asthma in pregnancy - a review of current literature and recommendations

Inhaled magnesium sulfate in the treatment of acute asthma

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