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A meta-analysis on intravenous magnesium sulphate for treating acute asthma
D K L Cheuk1, T C H Chau, S L Lee
1Department of Pediatrics and Adolescent Medicine, The University of Hong Kong. cheukkl@hkusua.hku.hk
Insights
Intravenous magnesium sulphate likely benefits children with moderate to severe asthma attacks when given with standard treatments. This meta-analysis found it effectively reduces hospitalizations, improving lung function and symptoms.
Area of Science:
- Pediatric Emergency Medicine
- Respiratory Medicine
- Clinical Pharmacology
Background:
- Acute asthma is a common pediatric emergency.
- Standard treatments include inhaled beta2 agonists and systemic steroids.
- The role of adjunctive therapies like magnesium sulphate requires further evaluation.
Purpose of the Study:
- To evaluate the effectiveness of intravenous magnesium sulphate in treating acute asthmatic attacks in children.
- To synthesize evidence from controlled clinical trials through meta-analysis.
Main Methods:
- Systematic literature search for randomized controlled trials (RCTs) of magnesium sulphate in pediatric acute asthma.
- Inclusion of trials assessing hospitalization, pulmonary function, or symptom scores.
- Independent quality assessment and data synthesis by two reviewers.
- Meta-analysis using random or fixed effect models based on heterogeneity.
Main Results:
- Five high-quality RCTs with 182 pediatric patients were analyzed.
- Intravenous magnesium sulphate, as an adjunct to standard therapy, was effective in four of five studies.
- Significant reduction in hospitalizations was observed (OR 0.290, 95% CI 0.143 to 0.589), with a number needed to treat of 4.
- Improvements in pulmonary function tests and clinical symptom scores were also noted.
Conclusions:
- Intravenous magnesium sulphate likely offers additional benefits for children with moderate to severe acute asthma.
- It is a potentially valuable adjunctive treatment when combined with bronchodilators and steroids.
Aim:
To evaluate the effectiveness of intravenous magnesium sulphate in the treatment of acute asthmatic attacks in children by meta-analysis.
Methods:
A systematic and comprehensive search of the literature was performed to identify controlled clinical trials of magnesium sulphate in paediatric acute asthma which evaluated outcomes of hospitalisation or short term pulmonary function tests or symptom scores. Unpublished data were searched by personal contacts with authors and specialists. Two reviewers independently assessed trial qualities and synthesised data. Heterogeneity among studies was evaluated by the Cochrane Q test. Outcome data were pooled by random or fixed effect models depending on presence or absence of heterogeneity.
Results:
Five randomised placebo controlled trials involving a total of 182 patients were identified. They compared intravenous magnesium sulphate to placebo in treating paediatric patients with moderate to severe asthmatic attacks in the emergency department, with co-therapies of inhaled beta2 agonists and systemic steroids. The studies were of high quality with results judged to be valid. Four studies showed that magnesium sulphate was effective, while one study found it ineffective. There was no significant heterogeneity in the primary outcome of hospitalisation. In the fixed effect model, magnesium sulphate is effective in preventing hospitalisation (OR 0.290, 95% CI 0.143 to 0.589). The number needed to treat is 4 (95% CI 3 to 8). Secondary outcomes of short term pulmonary function tests and clinical symptom scores also showed significant improvement.
Conclusion:
Intravenous magnesium sulphate probably provides additional benefit in moderate to severe acute asthma in children treated with bronchodilators and steroids.
