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Standard medical therapy with vs. without nebulised magnesium for children with asthma decompensation
Luísa Cunha1, Meritxell Roca Mora2, Farhan Afzal3
1Centro Universitario Lusiada, Rua Oswaldo Cruz, 179 - Boqueirão, Santos, SP, 11045-101, Brazil. luisacunha.marin@hotmail.com.
Insights
Nebulized magnesium sulfate offers a small but significant improvement in respiratory rate and peak expiratory flow rate for pediatric asthma exacerbations when added to standard medical therapy. This adjunct treatment did not increase adverse events in children.
Area of Science:
- Pediatric Pulmonology
- Clinical Pharmacology
Background:
- Magnesium sulfate exhibits bronchodilating properties and is used intravenously for asthma exacerbations.
- Evidence for nebulized magnesium as an adjunct therapy in pediatric asthma exacerbations is limited.
Purpose of the Study:
- To compare clinical and functional outcomes in children with asthma exacerbations receiving nebulized magnesium sulfate plus standard medical therapy (SMT) versus SMT alone.
Main Methods:
- Systematic search of PubMed, Embase, and Cochrane Library for randomized clinical trials (RCTs).
- Included 12 RCTs with 2484 children, analyzing outcomes like respiratory rate, heart rate, peak expiratory flow rate (PEFR), forced expiratory volume (FEV1), oxygen saturation, and need for intravenous bronchodilators.
Main Results:
- Children receiving magnesium showed a statistically significant improvement in % predicted PEFR (mean difference [MD] 5.33%) and a lower respiratory rate (MD -0.70 respirations/minute).
- % predicted FEV1, heart rate, asthma severity scores, oxygen saturation, and need for IV bronchodilators were not significantly different between groups.
Conclusions:
- Nebulized magnesium sulfate with SMT provides a statistically significant, albeit small, improvement in PEFR and respiratory rate for pediatric asthma exacerbations.
- The addition of nebulized magnesium did not appear to increase adverse events.
Abstract:
Pediatric asthma is a common condition, and its exacerbations can be associated with significant morbidity and mortality. The role of nebulised magnesium as adjunct therapy for children with asthma exacerbations is still unclear. To compare clinical and functional outcomes for children with asthma exacerbation taking either nebulised magnesium sulfate added to standard medical therapy (SMT) versus SMT alone. PubMed, Embase, and Cochrane Library were systematically searched for randomised clinical trials (RCT) comparing the use of SMT with vs. without nebulised magnesium. The outcomes were respiratory rate, heart rate, % predicted peak expiratory flow rate (PEFR), % predicted forced expiratory volume (FEV1), peripheral O2 saturation, asthma severity scores, and need for intravenous (IV) bronchodilator use. Twelve RCTs and 2484 children were included. Mean age was 5.6 (range 2-17) years old, mean baseline % predicted FEV1 was 69.6%, and 28.66% patients were male. Children treated with magnesium had a significantly higher % predicted PEFR (mean difference [MD] 5.33%; 95% confidence interval [CI] 4.75 to 5.90%; p < 0.01). Respiratory rate was significantly lower in the magnesium group (MD -0.70 respirations per minute; 95% CI -1.24 to -0.15; p < 0.01). Need for IV bronchodilators, % predicted FEV1, heart rate, asthma severity scores, and O2 saturation were not significantly different between groups.
Conclusion:
In children with asthma exacerbation, treatment with nebulised magnesium and SMT was associated with a statistically significant, but small improvement in predicted PEFR and respiratory rate, as compared with SMT alone.
What Is Known:
• Magnesium sulfate has bronchodilating properties and aids in the treatment of asthma exacerbation when administered intravenously. • There is no significant evidence of benefit of nebulised magnesium as an adjunct therapy to the standard medical treatment for children with asthma exacerbations.
What Is New:
• Our study suggests nebulised magnesium sulfate may have a statistically significant, but small benefit in respiratory rate and peak expiratory flow rate. The addition of nebulised magnesium does not seem to increase adverse events.
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