Nebulized Magnesium Sulfate in Acute Moderate to Severe Asthma in Pediatric Patients
A prospective double-blind placebo controlled trial carried out on 60 children known to be asthmatic who presented to the emergency department at Alexandria University of Children’s Hospital at El-Shatby with acute asthma exacerbations to assess the efficacy of adding inhaled magnesium sulfate to β-agonist, compared with β-agonist in saline, in the management of acute asthma exacerbations in children. The participants in the study were divided in two groups; Group A (study group) received inhaled salbutamol solution (0.15 ml/kg) plus isotonic magnesium sulfate 2 ml in a nebulizer chamber. Group B (control group): received nebulized salbutamol solution (0.15 ml/kg) diluted with placebo (2 ml normal saline). Both groups received inhaled solution every 20 minutes that was repeated for three doses. They were evaluated using the Pediatric Asthma Severity Score (PASS), oxygen saturation using portable pulse oximetry and peak expiratory flow rate using a portable peak expiratory flow meter at initially recorded as zero-minute assessment and every 20 minutes from the end of each nebulization (nebulization lasts 5-10 minutes) recorded as 20, 40 and 60-minute assessments. Regarding PASS, comparison showed non-significant difference with p-value 0.463, 0.472, 0.0766 at 20, 40 and 60 minutes. Regarding oxygen saturation, improvement was more significant towards group A starting from 40 min with significant p-value=0.000. At 60 min p-value=0.000. Although mean PEFR significantly improved from zero-min in both groups; however, improvement was more significant in group A with significant p-value = 0.015, 0.001, 0.001 at 20 min, 40 min and 60 min, respectively. The conclusion this study suggests is that inhaled magnesium sulfate is an efficient add on drug to standard β- agonist inhalation used in the treatment of moderate to severe asthma exacerbations.
 Bohn D, Kissoon N.' Acute asthma'. Pediatr Crit Care Med. 2001, Apr; 2(2):151-63.
 Jackson DJ, Sykes A, Mallia P, Johnston SL. Asthma exacerbations: Origin, effect, and prevention. J Allergy Clin Immunol. 2011; 128: 1165-74.
 Roberts G, Newsom D, Gomez K, Raffles A, Saglani S, Begent J, et al. Intravenous salbutamol bolus compared with an aminophylline infusion in children with severe asthma: a randomized controlled trial. Thorax. 2003; 58(4): 306–10.
 Global Initiative for Asthma (GINA): Global strategy for asthma management and prevention. 2009, Available at: http://www.ginasthma.com (Accessed 26 April 2015).
 Øymar K, Halvorsen T. Review; Emergency presentation and management of acute severe asthma in children. Scandi J of Trau, Resus and Emer Med 2009, 17:40.
 Urso D.L. Treatment for acute asthma in the Emergency Department: practical aspects. Eur Rev Med and Pharmacol Sci. 2010; 14(3): 209-14.
 Rau JL. The inhalation of drugs: advantages and problems. Respir Care 2005; 50(3):367–82.
 Blitz M, Blitz S, Hughes R, Diner B, Beasley R, Knopp J, et al. Aerosolized magnesium sulfate for acute asthma: a systematic review. Chest, 2005; 128(1):337-44.
 Torres S, Sticco N, Bosch JJ, Iolster T, Siaba A, RoccaRivarola M, et al. Effectiveness of magnesium sulfate as initial treatment of acute severe asthma in children, conducted in a tertiary-level university hospital. A randomized controlled trial. Arch Argent Pediatr. 2012; 110(4):291-6.
 Powell C, Dwan K, Milan SJ, Beasley R, Hughes R, Knopp-Sihota JA, et al. Inhaled magnesium sulphate in the treatment of acute asthma. Cochrane Database Syst Rev. 2012; (12):1-78.
 Haqq M.A, Rahman H, Khanam S and Mannan M.A. Efficacy of nebulized magnesium sulfate in the treatment of acute exacerbation of asthma in children. Bangladesh J Pharmacol 2006; 1:72-80.
 Akter T, Islam N, Hoque M. A., Khanam S, khan HA, Saha BK. Nebulization by Isotonic Magnesium Sulphate Solution with Salbutamol Provide Early and Better Response as Compared to Conventional Approach (Salbutamol Plus Normal Saline) in Acute Exacerbation of Asthma in Children. Faridpur Med. Coll. J. 2014;9(2):61-67.
 M.Zadeh I, Mohammadi M., Khodabakhsh E. The effect of nebulised salbutamol plus magnesium sulfate in comparison with nebulised salbutamol plus normal saline in acute asthmatic attack in children. JBUMS 2014; 16(3):7-12.
 Sun YX, Gong C H, Liu S, Yuan X P, Yin L J, Yan L, et al. Effect of inhaled MgSO4 on FEV1 and PEF in children with asthma induced by acetylcholine: a randomized controlled clinical trial of 330 cases. J Trop Pediatr. 2014, 60 (2): 141-7.
 Shan Z, Rong Y, Yang W, Wang D,Yao P, Xie J et al. Intravenous and nebulized magnesium sulfate for treating acute asthma in adults and children: A systematic review and meta-analysis. Resp Med 2013; 107, 321:30.
 Joseph LR. The inhalation of drugs: advantages and problems. Respir Care 2005; 50(3):367–82.
 Watanatham S, Pongsamart G, Vangveeravong M, Daengsuwan T. Comparison Efficacy and Safety of Inhaled Magnesium Sulfate to Intravenous Magnesium Sulfate in Childhood Severe Asthma Exacerbation.J of Allergy and Clinc Immunol. 2015; 135(2); 241.
 Khashabi J, Asadolahi S, Karamiyar M, Salari Lak S. Comparison of magnesium sulfate to normal saline as a vehicle for nebulized salbutamol in children with acute asthma: a clinical trial.
 Kose M, Ozturk MA, Poyrazoğlu H, Elmas T, Ekinci D, Tubas F et al. The efficacy of nebulized salbutamol, magnesium sulfate, and salbutamol/magnesium sulfate combination in moderate bronchiolitis. Eur J Pediatr. 2014; 173(9):1157-60.
 Powell C, Kolamunnage-Dona R, Lowe J, Boland A, Petrou S, Doull L. et al. Magnesium sulphate in acute severe asthma in children (MAGNETIC): a randomised, placebo-controlled trial. Embargo. 2013;2213-600(13)70037-7. Published online; http://dx.doi.org/10.1016/S2213-2600(13)70037-7 (Accessed 15 February 2015).