Nebulized magnesium sulfate in the management of acute exacerbations of asthma

To evaluate the efficacy and safety of nebulized magnesium sulfate in the treatment of acute exacerbations of asthma.

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.

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.

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.

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.