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Safety and Effectiveness of Magnesium Sulphate for Severe Acute Asthma Management Among Under-five Children:
Teshale Ayele Mega1, Habtamu Gugsa1, Habte Dejenie1
1School of Pharmacy, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia.
Insights
Magnesium sulfate (MgSO4) did not significantly improve respiratory function in children with severe acute asthma. While intravenous MgSO4 showed no benefit over standard care, nebulized MgSO4 appears to be a safer alternative for pediatric asthma management.
Area of Science:
- Pediatric Emergency Medicine
- Respiratory Medicine
- Pharmacology
Background:
- Asthma is a prevalent chronic inflammatory airway disease in children, characterized by hyper-responsiveness and varying symptoms from cough to bronchospasm.
- Current emergency treatment for severe acute asthma includes oxygen, bronchodilators, anticholinergic agents, and corticosteroids.
- Magnesium sulfate (MgSO4) has been explored for asthma treatment, but evidence for its use in children under five remains conflicting.
Purpose of the Study:
- To systematically review the effectiveness and safety of magnesium sulfate (MgSO4) in treating severe acute asthma attacks in pediatric patients.
- To evaluate both intravenous (IV) and nebulized MgSO4 administration routes.
Main Methods:
- A comprehensive literature search identified controlled clinical trials involving IV and nebulized MgSO4 in pediatric patients with acute asthma.
- Three randomized clinical trials were included in the final analysis.
Main Results:
- Intravenous MgSO4 did not demonstrate significant improvement in respiratory function (RR=1.09) or safety compared to conventional treatment (RR=0.38).
- Nebulized MgSO4 also showed no significant effect on respiratory function (RR=1.05) but was found to be more tolerable (RR=0.31).
Conclusions:
- Intravenous MgSO4 is not superior to conventional treatment for moderate to severe acute asthma in children and has no significant adverse effects.
- Nebulized MgSO4 does not significantly impact respiratory function in children under five with moderate to severe acute asthma but presents as a potentially safer treatment option.
Background:
Asthma is the common chronic inflammatory disease affecting children. It is usually associated with airway hyper-responsiveness. Globally, the prevalence of asthma among pediatrics population varies from 10% to 30%. Its symptoms range from chronic cough to life-threatening bronchospasm. At emergency department, all patients with acute severe asthma should initially receive oxygen, nebulized β2-agonists, nebulized anticholinergic agent, and corticosteroids. Though bronchodilators act within minutes, corticosteroids may require hours. Magnesium sulphate (MgSO4) was first considered for treating asthma about 60 years ago. Several case reports were published on its usefulness in decreasing admission and endotracheal intubation. So far, evidence is conflicting to fully employ MgSO4 for asthma management in children under five.
Objective:
This systematic review was aimed to evaluate the effectiveness and safety of MgSO4 in the treatment of severe acute asthmatic attacks in children.
Methods:
A systematic and comprehensive search of literature was performed to identify controlled clinical trials conducted on IV and nebulized MgSO4 in pediatric patients with acute asthma.
Results:
Data generated from three randomized clinical trials were included in the final analysis. In this analysis, intravenous MgSO4 did not improve respiratory function (RR=1.09, 95%CI: 0.81-1.45) and not safer than conventional treatment (RR=0.38, 95%CI: 0.08-1.67). Similarly, use of nebulized MgSO4 showed no significant effect on respiratory function (RR=1.05, 95%CI: 0.68-1.64) and more tolerable (RR=0.31, 95%CI: 0.14-0.68).
Conclusion:
Intravenous MgSO4 may not be superior to conventional treatment in moderate to severe acute asthma among children and neither have significant adverse effects. Similarly, nebulized MgSO4 showed no significant effect on respiratory function in moderate to severe acute asthma in children under five but it seems a safer alternative.
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