Magnesium Sulfate in the Treatment of Acute Severe Asthma * (original) (raw)
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IV Magnesium Sulfate in the Treatment of Acute Severe Asthma *
CHEST Journal, 2002
Background: Studies of IV magnesium sulfate as a treatment for acute asthma have had mixed results, with some data suggesting a benefit for acute severe asthma, but not for mild-to-moderate asthma. In a multicenter cohort, this study tests the hypothesis that administration of magnesium sulfate improves pulmonary function in patients with acute severe asthma. Design: Placebo-controlled, double-blind, randomized clinical trial. Setting: Emergency departments (EDs) of eight hospitals. Patients: Patients aged 18 to 60 years presenting with acute asthma and FEV 1 < 30% predicted on arrival to the ED. Intervention: All patients received nebulized albuterol at regular intervals and IV methylprednisolone. Two grams of IV magnesium sulfate or placebo were administered 30 min after ED arrival. The primary efficacy end point was FEV 1 at 240 min, and the data analysis was intent to treat. Results: Two hundred forty-eight patients were included, and the mean FEV 1 on ED arrival was 22.9% predicted. At 240 min, patients receiving magnesium had a mean FEV 1 of 48.2% predicted, compared to 43.5% predicted in the placebo-treated group (mean difference, 4.7%; 95% confidence interval [CI], 0.29 to 9.3%; p ؍ 0.045). A regression model confirmed the effect of magnesium compared to placebo was greater in patients with a lower initial FEV 1 (p < 0.05). If the initial FEV 1 was < 25% predicted, the final FEV 1 was 45.3% predicted in the magnesium-treated group and 35.6% predicted in the placebo-treated group (mean difference, 9.7%; 95% CI, 4.0 to 15.3%; p ؍ 0.001). If the initial FEV was > 25% predicted, magnesium administration was not beneficial; the final FEV 1 was 51.1% predicted in the magnesiumtreated group and 53.9% predicted in the placebo-treated group (mean difference, ؊ 2.9%, 95% CI, ؊ 9.4 to 3.7; p ؍ not significant). Overall, the use of magnesium sulfate did not improve hospital admission rates. Conclusion: Administration of 2 g of IV magnesium sulfate improves pulmonary function when used as an adjunct to standard therapy in patients with very severe, acute asthma.
Inhaled magnesium sulfate in the treatment of acute asthma
The Cochrane database of systematic reviews, 2005
Asthma exacerbations can be frequent and range in severity from relatively mild to status asthmaticus. The use of magnesium sulfate (MgSO4) is one of numerous treatment options available during acute exacerbations. While the efficacy of intravenous MgSO4 has been demonstrated, little is known about inhaled MgSO4. To examine the efficacy of inhaled MgSO4 in the treatment asthma exacerbations. Randomised controlled trials were identified from the Cochrane Airways Group "Asthma and Wheez*" register. These trials were supplemented with trials found in the reference list of published studies, studies found using extensive electronic search techniques, as well as a review of the gray literature and conference proceedings. Randomised (or pseudo-randomised) controlled trials were eligible for inclusion. Studies were included if patients were treated with nebulised MgSO4 alone or in combination with beta(2)-agonist and where compared to beta2-agonist alone or inactive control. Tria...
Intravenous Magnesium Sulfate as an Adjunct in the Treatment of Acute Asthma
Chest, 1995
This study was conducted to determine whether intravenous magnesium sulfate (MgS04), when used as part of a standardized treatment protocol, can improve pulmonary function and decrease admission rate in patients presenting to the emergency department with exacerbations of asthma. Design: In this randomized double-blind placebo-controlled study, patients with acute asthma were treated with inhaled ,8-agonists at regular intervals and intravenous (IV) steroids. At 30 min after entry, patients received either 2 g IV MgS0 4 or IV placebo. Patients were monitored for up to 4 h with regular measurements of pulmonary function. Patients who were discharged from the emergency department were contacted at 1 day and 7 days for follow-up. Setting: Emergency departments of a university-affiliated, voluntary hospital and municipal hospital. Participants: Asthmatics aged 18 to 65 years during acute exacerbation with FEV 1 less than 75% predicted both before and after a single albuterol treatment. Interventions: Patients were given 2 g of MgS0 4 or placebo as an adjunct to standardized emergency department procedure for acute asthma. Measurements and results: One hundred thirty-five patients were studied. Hospital admission rates were 35.3% for placebo-treated group and 25.4% for the magnesium-treated group (p=0.21). FEV 1 measured at _Nthma affects approximately 5% of the population and is a frequent cause of emergency department (ED) visits and hospital admissions.l• 2 Between 19 and 36% of patients who present to the ED with acute asthma require hospital admission despite treatment with ,8-agonists, methylxanthines, and corticosteroids. 3-5 It has been suggested that intravenous (IV) mag
Intravenous magnesium sulphate provides no additive benefit to standard management in acute asthma
Respiratory Medicine, 2008
Background: Treatment of acute asthma is based on rapid reversal of bronchospasm and airway inflammation. Magnesium sulphate (MgSO 4 ) is known to have a bronchodilator effect on smooth muscle but studies have shown conflicting results on its efficacy in acute asthma, although its use is recommended in national and international guidelines. Aims: To determine if intravenous MgSO 4 , when used as an adjunct to standard therapy, improves the outcome in acute asthma. Methods: A double blind, randomised placebo controlled trial comparing 1.2 g MgSO 4 with standard therapy in adult patients with acute asthma. Patients had a PEF p75% predicted and all were treated with oxygen, nebulised salbutamol and ipratropium, and IV hydrocortisone. They then received 1.2 g IV MgSO 4 or placebo. Outcome measures were % predicted PEF at 60 min and hospital admission rates. Results: One hundred and twenty nine patients were studied. Placebo and active treatment groups were well matched at baseline. MgSO 4 had no benefit with regards hospital admission rates or % predicted PEF at 60 min (p ¼ 0.48) for the whole group, or for subgroups of life-threatening (p ¼ 0.85), severe (p ¼ 0.63) and moderate (p ¼ 0.67) acute asthma. Conclusion: This study did not show additional benefit from 1.2 g IV MgSO 4 when given as an adjunct to standard therapy for acute asthma.
Pulmonary Pharmacology & Therapeutics, 2010
Rationale: Treatment of severe asthma may be difficult despite the use of several medications including parenteral corticosteroids. Intravenous magnesium sulfate (MgSO 4 ) is one ancillary drug for severe crisis; its inhaled use is controversial. Objectives: To evaluate the usefulness of inhaled MgSO 4 compared to placebo in improving lung function, oxygen saturation, and reducing hospital admission as an adjunct to standard treatment in severe asthma crisis. Patients and methods: We conducted a placebo-controlled, double-blind clinical trial with asthmatic patients >18 years of age with asthmatic crisis and FEV 1 < 60% of predicted (%p). All subjects received 125 mg of IV methylprednisolone followed by nebulization with the combination of albuterol (7.5 mg) and ipratropium bromide (1.5 mg) diluted in 3 ml of isotonic saline solution (as placebo) or 3 ml (333 mg) of MgSO 4 . After 90 min, subjects with FEV 1 < 60%p or SpO 2 < 88% or persistent symptoms were admitted to the emergency department (ED). Results: We included 30 patients per group who were similar at baseline. The MgSO 4 group showed higher post-bronchodilator (post-BD) FEV 1 %p (69 AE 13 vs. 61 AE 12, p < 0.014) and SpO 2 (92 AE 4 vs. 88 AE 5%, p < 0.006) than the placebo group. Fewer treated patients were admitted to the ED (5 vs. 13) (p < 0.047), with relative risk (RR) of 0.26 (95% CI 0.079e0.870). Conclusions: Adding inhaled MgSO 4 treatment to standard therapy in severe asthma crisis improves FEV 1 %p and SpO 2 post-BD and reduces the rate of ED admissions.
Effectiveness of magnesium sulphate in acute asthma: a retrospective study
Objective: The recent interest in intravenous magnesium sulphate for using it in many other indications other than control of eclamptic fits lead the researchers to try it as a smooth muscle relaxant in cases of acute bronchial asthma. The results have largely been controversial, so we conducted this study to determine efficacy of intravenous magnesium sulphate in acute asthma based on its terminal outcome.. We retrospectively reviewed the medical data sheets of all cases of acute asthma admitted during the study period, and extracted the relevant information. All the patients were initially treated with standard therapy for asthma and then given 4ml of 50% MgSO4 (2g) diluted in 250 ml of normal saline intravenously. Outcomes were presented in percentages and frequencies while patient age is presented as mean ± SD. Results: The mean age of the population was 45.29 ± 20.1 y. We had a female predominance in our population (60.3%). Successfully cured patients were 32.3% whereas those expired were 57.4%. There was not a significant difference between the genders for the outcome (p > 0.05). Conclusions: We found that intravenous magnesium sulphate is ineffective in successfully management of patients with acute asthma in terms of enhanced survival rate. ABSTRACT Citation: Khaskheli MS, Tabassum R, Awan AH. Effectiveness of magnesium sulphate in acute asthma: a retrospective study. Anaesth Pain & Intensive Care 2017;21(4):458-462
Intravenous magnesium sulfate in acute severe asthma not responding to conventional therapy
Indian pediatrics, 1997
To evaluate the effectiveness of early administration of intravenous Magnesium sulfate (i.v. MgSO4) in children with acute severe asthma not responding to conventional therapy. Randomized double-blind, placebo-controlled trial. Pediatric emergency service of a large teaching hospital. 47 children aged between 1-12 years with acute severe asthma showing inadequate or poor response to 3 doses of nebulized salbutamol given at an interval of 20 min each. The MgSO4 group received 0.2 ml/kg of 50% MgSO4 as intravenous (i.v.) infusion over 35 minutes and the placebo group received normal saline infusion in the same dose and at the same rate. MgSO4 solution and normal saline were coded and dispensed in identical containers. Decoding was done at the completion of the study. All the patients received oxygen, nebulized salbutamol, i.v. aminophylline and corticosteroids. MgSO4 group showed early and significant improvement as compared to placebo group in PEFR and SaO2 at 30 min and 1, 2, 3 and ...
Magnesium sulfate for acute asthma in adults: a systematic literature review
2012
Magnesium sulfate (MgSO 4 ) has been considered as an adjunct therapy for severe and life-threatening asthma exacerbation. The literature search was performed using MEDLINE, EMBASE, Cochrane Library and Google Scholar to summarize the current state of knowledge regarding magnesium therapy in acute exacerbation of adult asthma. A total of 16 trials and 4 meta-analyses were identified. As results, intravenous MgSO 4 was beneficial in severe exacerbation, but evidence for nebulized magnesium was insufficient. However, larger trials are required to draw confirmative conclusions on the efficacy. Regarding the safety concern, the risk of major toxicity appears to be very low at usual doses described in the literature. Additionally, results from 4 surveys were examined on the gaps between knowledge and practice, and on the barrier to the use of MgSO 4 at emergency departments. This literature review summarized the up-to-date evidence on the issues regarding the use of MgSO 4 for acute asthma. We expect more studies to be conducted for evidence making in the Asian-Pacific regions.
Archivos argentinos de pediatría, 2012
Magnesium sulfate is a calcium antagonist that inhibits bronchial smooth muscle contraction promoting bronchodilation. It is used for the management of acute severe asthma in children; however most of the studies have been performed in adults. To evaluate the effectiveness of intravenous magnesium sulfate for the treatment of pediatric patients with acute severe asthma exacerbations. A clinical, randomized, controlled trial was conducted between March 2006 and March 2011 at Hospital Universitario Austral. Children with acute severe asthma admitted to the emergency department were randomized into two groups. Group A (control group): standard protocol for the initial treatment of acute asthma exacerbation. Group B: treatment protocol with magnesium sulphate for acute severe asthma exacerbation. The primary outcome was the requirement of invasive or non invasive mechanical ventilation support. One hundred and forty three patients randomized into 2 groups were analyzed. The treatment gr...