Nebulized magnesium sulfate in the management of acute exacerbations of asthma

OBJECTIVE: To evaluate the efficacy and safety of nebulized magnesium sulfate in the treatment of acute exacerbations of asthma. DATA SOURCES: MEDLINE, EMBASE, and PubMed (all to October 2005) were searched using the key words magnesium, magnesium sulfate, magnesium compounds, nebulise, nebulize, vaporise, vaporize, nebulizers and vaporizers, aerosols, asthma, exacerbation, bronchial spasm, and bronchospasm. STUDY SELECTION AND DATA EXTRACTION: Prospective, randomized, controlled trials that evaluated efficacy and safety endpoints of nebulized magnesium sulfate in the management of acute exacerbations of asthma were included. All studies were evaluated independently by both authors. Efficacy outcomes included pulmonary function, clinical disease severity (as defined by each study), and rate of hospitalization. Safety outcomes were as described by each trial. DATA SYNTHESIS: Six prospective trials met the study criteria. Nebulized magnesium alone failed to demonstrate any benefit compared with beta(2)-agonists alone at improving pulmonary function. In trials in which nebulized magnesium was used as a vehicle for albuterol, there appear to be additional benefits to albuterol therapy in terms of improvements in pulmonary function in a population with mild-to-moderate asthma. The heterogeneous patient populations, study designs, magnesium doses, and the delivery methods preclude the extrapolation of these results to current clinical practice. CONCLUSIONS: The studies included in this review fail to clarify the role of nebulized magnesium sulfate; therefore, this therapy cannot be recommended at this time. Future studies evaluating the role of nebulized magnesium as an adjunct therapy to beta(2)-agonist, anticholinergic, and corticosteroid therapy are necessary to determine whether a clinically relevant benefit of this intervention exists.     

Serum magnesium levels in asthmatic patients during acute exacerbations of asthma.

The purpose of this study was to determine whether serum magnesium levels in asthmatic patients during acute exacerbations differ from those of a control population. Twenty-three known asthmatics presenting to the emergency department in acute exacerbation (cases) and 15 nonasthmatic patients (controls) matched for age, sex, race, and socioeconomic status had serum magnesium assays drawn. Admission criteria were: age 18 to 50 years with no history of alcoholism, heart disease, renal disease, or diuretic use. Patients giving a history of pregnancy were excluded. Serum magnesium levels were not significantly different in the two study populations, nor did they correlate with the severity of asthma (mean values: cases, 2.04 +/- 0.159 versus controls, 2.03 +/- 0.134 mg/dL; SD of the difference of the means = .048). An analysis for beta-error demonstrated the true difference of the means to be less than .1 (95% confidence) or less than .13 (99% confidence). In conclusion, serum magnesium levels in asthmatics are not significantly different from those of a control nonasthmatic population. They are not clinically useful for predicting the severity of disease.     

Early versus delayed administration of intravenous magnesium sulfate for pediatric asthma

ObjectiveThis study aims to describe and examine the factors associated with the early administration of intravenous magnesium sulfate (IV Mg) in children presenting to the pediatric emergency department (ED) for an asthma exacerbation.MethodsRetrospective cohort study of children aged 5–11 years who received IV Mg in the pediatric ED between September 1, 2018 and August 31, 2019 for management of an asthma exacerbation. Primary outcome was administration of IV Mg in ≤60 min from ED triage (‘early administration’). Comparison of clinical management and therapies in children who received early versus delayed IV Mg and the factors associated with early administration of IV Mg were examined.ResultsEarly (n = 90; 31.6%) IV Mg was associated with more timely bronchodilators (47 versus 68 min; p ≤ 0.001) and systemic corticosteroids (36 versus 46.5 min; p ≤ 0.001). There was no difference between the two cohorts in returns to the ED within 72 h (1.1% versus 2.1%; p = .99) or readmissions within 1 week one week (2.2% versus 0.5%; p = .2). Hypoxia (aOR = 3.76; 95% CI = 2.02–7.1), respiratory rate (aOR = 1.04; 95% CI = 1.02–1.07), retractions (aOR = 2.21; 95% CI = 1.25–3.94), and prior hospital use for asthma-related complaints (aOR = 2.1; 95% CI = 1.16–3.84) were significantly associated with early IV Mg.ConclusionsEarly administration of IV Mg was associated with more timely delivery of first-line asthma therapies, was safe, and improved ED throughput without increasing return ED visits or hospitalizations for asthma.     

Comparison of nebulized magnesium sulfate plus albuterol to nebulized albuterol plus saline in children with acute exacerbations of mild to moderate asthma

A prospective, randomized, double blinded study was conducted to determine whether a combination of nebulized magnesium sulfate and albuterol as a single dose adds any benefit in management of children with mild to moderate asthma when compared to nebulized albuterol with saline. The difference in FEV1 was significant at 10 and 20 min after a single dose of the combined treatment with magnesium and albuterol when compared with the albuterol and saline group (1.41 L +/- 0.53 vs. 1.13 L +/- 0.34, respectively, p = 0.03). The addition of magnesium to albuterol seems to provide short-term benefits in children with acute exacerbations of mild to moderate asthma.     

Point of care lung ultrasound of children with acute asthma exacerbations in the pediatric ED

Objectives

Primary objective was to characterize lung ultrasound findings in children with asthma presenting with respiratory distress to the emergency department (ED). Secondary objectives included correlating these findings with patients' clinical course in the ED.

孟鲁司特钠联合硫酸镁治疗老年支气管哮喘的疗效观察

目的：探讨孟鲁司特钠联合硫酸镁治疗老年支气管哮喘的临床疗效。方法选取2012年6月至2013年6月玉林市第二人民医院收治的老年支气管哮喘患者80例,按照随机数字表法分为观察组与对照组各40例。对照组给予吸氧、抗感染、祛痰、β2受体激动剂、糖皮质激素等常规治疗,观察组在对照组的基础上加用孟鲁司特钠片和硫酸镁注射液治疗。观察并比较两组的临床疗效。结果观察组总有效率为97．1％明显高于对照组的77．1％,复发率为5．7％明显低于对照组的28．6％,差异均有统计学意义（ P＜0．05）;观察组喘息、咳嗽及胸闷等症状缓解时间均明显早于对照组,差异有统计学意义（P＜0．05）。两组患者治疗前肺功能指标比较,差异无统计学意义（P＞0．05）;治疗后肺功能指标较治疗前均明显改善,观察组改善程度优于对照组,差异有统计学意义（P＜0．05）。两组均未见呼吸抑制、血压下降等严重不良反应。结论孟鲁司特钠片联合硫酸镁注射液治疗老年支气管哮喘临床疗效显著,症状缓解快,复发率低,安全可靠,值得临床推广。     

Intravenous versus oral corticosteroids for treatment of acute asthma exacerbations

OBJECTIVE: To compare the duration of hospitalization of patients treated with either oral or intravenous corticosteroids for an acute asthma exacerbation. METHODS: A retrospective chart review was performed on a random sample of inpatients. Patients were included with the following: a discharge diagnosis of an acute asthma exacerbation, a past medical history significant for asthma, age between 16 and 60 years, and treatment with either oral or intravenous corticosteroids at the time of admission. Exclusion criteria included: patients receiving chronic prednisone therapy, a past medical history significant for chronic obstructive pulmonary disease, an admission to the intensive care unit, or a consistent smoking habit of at least 1 pack daily. Length of hospitalization was the primary outcome measured. Secondary outcomes included 24-hour peak expiratory flow rate, 24-hour pulse oximetry (pO(2)), and amount of beta-agonist and ipratropium used. RESULTS: Fifty-three patients were included in the final data analysis. Patients were grouped by route of corticosteroid administration (intravenous or oral). No significant differences were noted between the 2 groups for race, gender, age, height, weight, admission peak expiratory flow rate, admission pO(2), or types of asthma medications used prior to admission. No significant differences were demonstrated in any of the outcome measures. CONCLUSIONS: Both the intravenous and oral corticosteroid groups demonstrated similar clinical outcomes and lengths of hospitalization in the treatment of acute asthma exacerbations. These results support the initial use of oral corticosteroids for the treatment of acute asthma exacerbations in adult patients admitted to a general medical service.     

Efficacy of magnesium sulfate in acute adult asthma: a meta-analysis of randomized trials

The purpose of this article was to review of the literature to determine whether MgSO4 provides an additive improvement in adults with acute asthma in the emergency department (ED). English-language published and unpublished studies (1968-1998) were retrieved using MEDLINE, SCIENCE CITATION INDEX, CURRENT CONTENTS, bibliographic reviews of primary research, review articles, consultation with experts, and the register of Medical Editors' Trial Amnesty. Meta-analysis of randomized, placebo controlled trials. The five selected trials included 374 patients with acute asthma (mean age 38.3 +/- 13.4 years, 30% men, 70% women). The main outcome measure was pulmonary function; admission rate was evaluated as a secondary goal. Individual and pooled effect sizes (ES) were determined for pulmonary function data. Binary outcome (admission rate) was combined and reported as odds ratio (OR). The overall summary ES (95% confidence interval [CI]) of the five trials satisfying all inclusion criteria, weighted by sample size was nonsignificant (ES = 0.02, -0.20 to 0.24, P = .84). This pooled ES was equivalent to 1.7%, 95% CI: -9.8 to 13.1%) greater in pulmonary function the MgSO4 compared with the control group. On the other hand, four studies addressed the effect of MgSO4 administration on hospital admissions. Pooled results revealed that MgSO4 did not decrease significantly admission rates (OR = 0.68, 95% CI: 0.41 to 1.15). The existing evidence reveals that the addition of MgSO4 to ED patients with moderate to severe asthmatic exacerbations does not alter treatment outcomes. Nevertheless, the number and size of studies being pooled remain small.     

Effects of magnesium sulfate aerosol on indices of external respiration in patients with bronchial asthma

Plethysmography and pneumotachography were applied to measure bronchial permeability, and reactivity of the bronchi in 10 patients with pre-asthma and 17 with asthma upon administration of magnesium sulfate aerosol (solution osmolality 260 mmol/l, pH-6.6). Though the drug inhalation did not induce bronchial dilatation, it diminished both hypersensitivity and hyperreactivity of the bronchial tree to acetylcholine. These properties of magnesium sulfate in the absence of unwanted sequelae when introduced endobronchially allow its advocating in combined treatment of asthma and pre-asthma.     

小儿阴囊急症应用硫酸镁湿敷联合红外线照射干预的效果观察

[目的]探讨硫酸镁湿敷联合红外线照射护理对小儿阴囊急诊预后的影响。[方法]选取在我院住院的小儿阴囊急诊病人54例,随机分为对照组和观察组各27例,对照组给予常规护理,观察组在常规护理的基础上给予硫酸镁局部湿敷联合红外线照射,观察两组伤口愈合时间、住院时间及术后并发症的发生情况。[结果]观察组患儿伤口愈合时间及住院时间较对照组短,术后并发症发生率较对照组低,差异有统计学意义(P0.05)。[结论]硫酸镁湿敷联合红外线照射可有效缩短病人的伤口愈合时间及住院时间,降低并发症的发生率。     

Use of magnesium sulfate in alcohol withdrawal

Magnesium deficiency plays an important role in alcohol withdrawal syndromes. Parenteral replacement of magnesium in the form of magnesium sulfate is safe and diminishes the severity of withdrawal symptoms in recently alcohol-abstinent patients. Early diagnosis of withdrawal illness and institution of magnesium replacement therapy decrease the need for benzodiazepines, diminish withdrawal complications and reduce the length of hospital stay. Testing for serum magnesium levels is useful, but experience supports the empiric use of magnesium replacement therapy in alcohol withdrawal.     

硫酸镁对尿激酶静脉溶栓治疗急性心肌梗塞的影响

目的：研究硫酸镁（ＭＳ）对尿激酶（ＵＫ）静脉溶栓治疗急性心肌梗塞（ＡＭＩ）的影响。方法：１００例ＡＭＩ住院患者随机分为ＭＳ＋ＵＫ组（ＭＵ组，５２例）和ＵＫ组（４８例）。ＭＵ组在静滴ＵＫ前后加用ＭＳ。结果：２组的再灌注率无显著性差异（Ｐ＞０．０５），但ＭＵ组的再灌注心律失常（ＲＡ）发生率、４周病死率显著低于ＵＫ组（Ｐ＜０．０１，Ｐ＜０．０５）；开始治疗后并发的严重心律失常（ＳＡ）、心力衰竭（ＨＦ）及梗塞后心绞痛（ＰＩＡ）的发生率显著低于ＵＫ组（Ｐ均＜０．０５）；休克、再梗塞（ＲＩ）及梗塞延展（ＩＥ）的发生率也均低于ＵＫ组（但Ｐ均＞０．０５）。结论：在ＵＫ静脉溶栓前后加用ＭＳ，可提高ＵＫ溶栓疗效，缩小梗塞面积，减少并发症，并有益于缺血再灌注损伤的防治。     

Effectiveness of steroid therapy in acute exacerbations of asthma: a meta-analysis.

The objective of this study was to determine the effect of steroid therapy on pulmonary function, admission rates, and relapse rates in patients presenting with acute exacerbations of asthma. Computerized MEDLINE and SCIENCE CITATION searches were combined with review of reference lists from book chapters and articles to identify published randomized trials on steroid interventions. Over 700 articles were reviewed by two independent reviewers who identified 30 relevant randomized controlled trials for analysis. Study validity was independently assessed by two reviewers and information regarding populations, interventions, and outcomes was abstracted. Binary outcomes were combined and reported as odds ratios (OR), using the Mantel-Haenszel method. Individual and pooled effect sizes (ES) were determined for pulmonary function data. The authors found that the use of steroids early in the treatment of asthmatic exacerbations reduces admissions in adults (common OR 0.47; 95% confidence interval (CI) 0.27, 0.79) and children (OR 0.06-0.42). They found steroids effective in preventing relapse in the outpatient treatment of asthmatic exacerbations (OR 0.15; CI 0.05, 0.44). Oral and intravenous steroids appear to have equivalent effects on pulmonary function in acute exacerbations (ES -0.07; CI -0.39, 0.25). The authors conclude that overall, steroid therapy provides important benefits to patients presenting to emergency departments with acute exacerbations of asthma. Further research into dosage, alternative routes of administration, and alternative outcome measures is needed.     

The management of exacerbations of acute asthma in primary care

There are more than five million people with asthma in the UK (National Asthma Campaign, 2001). Many patients, including those with mild asthma, will at some point experience a deterioration in their asthma control and the severity of this will vary.     

The therapeutic potentials of magnesium sulfate in bronchial asthma]

Twelve patients with preasthma (PA) and 27 bronchial asthma (BA) patients were examined for the effect of magnesium sulphate aerosol on bronchial sensitivity and reactivity to acetylcholine (ACC) and graded physical exercise (GPE) as well as on bronchial patency recorded by general plethysmography and pneumotachography. Inhalation of the drug was established to exert no bronchodilatory action but reduced, as compared with placebo, nonspecific hyperreactivity of the bronchial tree and blocked the ACC induced increment of histamine in the exhaled air condensate. The data obtained allow bronchial smooth muscles and mast cells to be regarded as targets for magnesium sulphate. The drug properties discovered may serve a prerequisite for its use in the combined treatment of BA patients and those with PA.     

Management of asthma exacerbations

The 1997 Expert Panel Report 2 from the National Asthma Education and Prevention Program* details principles and goals for managing asthma exacerbations, based on scientific literature and the opinion of the panel. The panel's recommendations are summarized here, along with approaches to the evaluation and management of patients with asthma exacerbations. Methods to assess and classify the severity of asthma exacerbations are discussed, and treatment objectives for mild, moderate, and severe exacerbations are presented, along with a discussion of postinfectious acute airway hyperresponsiveness. A review of pharmacologic agents used in the treatment of asthma exacerbations is also included. Key points in the management of asthma exacerbations include the notion that early treatment is the best strategy for management. Important elements of early treatment include recognition of early signs of worsening asthma, a written action plan to guide patient self-management, appropriate intensification of therapy, and prompt communication between patient and provider about deterioration in asthma control. Other key points include the use of inhaled beta 2-adrenergic agonists to provide prompt relief of airflow obstruction, the early use of systemic corticosteroids for patients with moderate to severe exacerbations or for patients who fail to respond promptly and completely to an inhaled beta 2-adrenergic agonist, and monitoring response to therapy with serial measurements of lung function.