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Aerosolized magnesium sulfate for acute asthma: a systematic review
Maurice Blitz1, Sandra Blitz, Rodney Hughes
1Department of Emergency Medicine, 1G1.43 WMC, 8440-112 Street, Edmonton, Alberta, Canada T6G 2B7.
Background:
The use of MgSO(4) is one of numerous treatment options available during exacerbations of asthma. While the efficacy of therapy with IV MgSO(4) has been demonstrated, little is known about inhaled MgSO(4).
Objectives:
A systematic review of the literature was performed to examine the effect of inhaled MgSO(4) in the treatment of patients with asthma exacerbations in the emergency department.
Methods:
Randomized controlled trials were eligible for inclusion and were identified from the Cochrane Airways Group "Asthma and Wheez*" register, which consists of a combined search of the EMBASE, CENTRAL, MEDLINE, and CINAHL databases and the manual searching of 20 key respiratory journals. Reference lists of published studies were searched, and a review of the gray literature was also performed. Studies were included if patients had been treated with nebulized MgSO(4) alone or in combination with beta(2)-agonists and were compared to the use of beta(2)-agonists alone or with an inactive control substance. Trial selection, data extraction, and methodological quality were assessed by two independent reviewers. The results from fixed-effects models are presented as standardized mean differences (SMDs) for pulmonary functions and the relative risks (RRs) for hospital admission. Both are displayed with their 95% confidence intervals (CIs).
Results:
Six trials involving 296 patients were included. There was a non-significant increase [corrected] in pulmonary function between patients whose treatments included nebulized MgSO(4) and those whose treatments [corrected] did not (SMD, 0.22; 95% CI, -0.02 to 0.47 [corrected] five studies); there was also a trend toward reduced [corrected] hospitalizations in patients whose treatments included nebulized MgSO(4) (RR, 0.67; 95% CI, 0.41 to 1.09; four studies). Subgroup analyses demonstrated that lung function improvement was similar in adult patients and in those patients who received nebulized MgSO(4) in addition to a beta(2)-agonist.
Conclusions:
The use of nebulized MgSO(4), particularly in addition to a beta(2)-agonist, in the treatment of an acute asthma exacerbation appears to produce benefits with respect to improved pulmonary function and may reduce the number of hospital admissions.
Insights
Inhaled magnesium sulfate (MgSO(4)) may improve lung function and reduce hospitalizations for acute asthma exacerbations. This benefit is particularly noted when MgSO(4) is used with beta(2)-agonists.
Area of Science:
- Pulmonology
- Emergency Medicine
- Pharmacology
Background:
- Magnesium sulfate (MgSO(4)) is a known treatment for asthma exacerbations.
- While intravenous MgSO(4) efficacy is established, inhaled MgSO(4) research is limited.
Purpose of the Study:
- To systematically review the literature on inhaled MgSO(4) for treating asthma exacerbations in emergency departments.
- To evaluate the impact of nebulized MgSO(4) on pulmonary function and hospital admission rates.
Main Methods:
- Systematic review of randomized controlled trials identified through comprehensive database and journal searches.
- Included studies compared nebulized MgSO(4) (alone or with beta(2)-agonists) against beta(2)-agonists alone or placebo.
- Data extraction and quality assessment by two independent reviewers; meta-analysis using fixed-effects models.
Main Results:
- Six trials with 296 patients were analyzed.
- A non-significant increase in pulmonary function was observed with inhaled MgSO(4) (SMD, 0.22; 95% CI, -0.02 to 0.47).
- A trend towards reduced hospitalizations was noted (RR, 0.67; 95% CI, 0.41 to 1.09), with similar lung function improvements in adults and when combined with beta(2)-agonists.
Conclusions:
- Nebulized magnesium sulfate, especially when combined with beta(2)-agonists, shows promise in treating acute asthma exacerbations.
- This treatment approach may lead to improved pulmonary function and fewer hospital admissions.
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