Efficacy of nebulized magnesium sulfate in the treatment of acute exacerbation of asthma in children
DOI:
https://doi.org/10.3329/bjp.v1i2.492Keywords:
Asthma, Nebulization, PEFR, SalbutamolAbstract
A double-blind randomized controlled trial was conducted to examine the efficacy of nebulized magnesium sulfate in the treatment of acute exacerbation of asthma in children. Thirty patients received nebulized salbutamol (0.15 mg/kg; minimum dose 2.5 mg) with 2.0 ml of isotonic magnesium sulfate solution and another 30 patients received same dose of salbutamol with 2.0 ml of normal saline on 3 occasions at 20 minute intervals. Mean percent of predicted peak expiratory flow rate (PEFR) detected in both group at 0 minute were not significantly different. But from 10 minute up to 60 minute, the values were significantly different among the groups. Mean respiratory rate at 0 and 10 minute were similar in both groups and from 20 up to 60 minute, respiratory rate improvement were significantly different. Arterial oxygen saturation (SaO2) at presentation was not significantly different. But from 10 min up to 60 minute differences were significant. With single dose of nebulization, in the magnesium sulfate with salbutamol group, by 20 minute almost all (29 out of 30) patient achieved at least 60% of predicted PEFR. Within this 20 minute, from control group none could achieve 60% of predicted PEFR. After 2nd dose of nebulization control group started achieving 60% PEFR value. Regarding response criteria, with 2nd dose of nebulization, at 30 and 40 minute 9 (30.0%) and 17 (56.7%) patient from magnesium sulfate with salbutamol group showed good response (PEFR ? 70% predicted). But within this first 40 minutes time, none could show good response in control group. With 3rd dose of nebulization all from magnesium sulfate group showed good response but even at 60 minute, 4 (13.3%) patient in control group failed to be included as good responder. So, it is evident that nebulization by isotonic magnesium sulfate solution with salbutamol provide early and better response as compared to conventional approach (salbutamol plus normal saline) in acute exacerbation of asthma in children.
Downloads
1006
1414 Read
181
References
Blitz M, Blitz S, Hughes R, Diner B, Beasley R, Knopp J, Rowe BH. Aerosolized magnesium sulfate for acute asthma. Chest 2005; 128: 337?44.
Bloch H, Silverman R, Mancherje N, Grant S, Jagminas L, Scharf SM. Intravenous magnesium sulfate as an adjunct in the treatment of acute asthma. Chest 1995; 107: 1576-81.
Boonyavorakul C, Thakkinstian A, Charoenpan P. Intravenous magnesium sulfate in acute severe asthma. Respirology 2000; 5: 21-25.
Dagg KD, Clayton RA, Thomson LJ, Chalmers GW, McGrath JC, Thomson NC. The effect of acute alteration in oxygen tension on the bronchodilator response to salbutamol in vitro and in vivo in man. Pulm Pharmacol Ther. 2001; 14: 99-05.
Expert panel report-2: Guidelines for the diagnosis and management of asthma 1997, National Institutes of Health, National Heart, Lung and Blood Institute, USA.
GINA. Global strategy for asthma management and prevention. 2005. Available at: http://www.ginasthma.org.
Hughes R, Goldkorn A, Masoli M, Weatherall M, Burgess C, Beasley R. Use of isotonic nebulised magnesium sulfate as an adjuvant to salbutamol in treatment of severe asthma in adults: Randomised placebo-controlled trial. Lancet 2003; 361: 2114-17.
Kokturk N, Turktas H, Kara P, Mulloglu S, Yilmaz F, Karamercan A. A randomized clinical trial of magnesium sulfate as a vehicle for nebulized salbutamol in the treatment of moderate to severe asthma attacks. Pulm Pharmacol Ther. 2005; 18: 416-21.
Mangat HS, D'Souza GA, Jacob MS. Nebulized magnesium sulfate versus nebulized salbutamol in acute bronchial asthma: A clinical trial. Eur Respir J. 1998; 12: 341-44.
Mollick MKA. Comparison of nebulized magnesium sulfate plus salbutamol vs saline plus salbutamol in the treatment of acute asthma. MD Thesis, National Institute of Diseases of the Chest & Hospital, Mahakhali, Dhaka, Bangladesh, 2003.
Nannini LJJ. Which PEF value is the best? Chest 1995; 107: 1475-76.
Nannini LJJ, Pendino JC, Corna RA, Mannarino S, Quispe R. Magnesium sulfate as a vehicle for nebulized salbutamol in acute asthma. Am J Med. 2000; 108: 193-97.
Santana JC, Baretto SSM, Piva JP, Garcia PCR. 2001, Controlled study on intravenous magnesium sulfate or salbutamol in early treatment of severe acute asthma attack in children. J Pediatr (Rio J). 2001; 77: 279-87.
Silverman RA, Osborn H, Runge J, Gallagher EJ, Chiang W, Feldman J, Gaeta T, Freeman K, Levin B, Mancherje N, Scharf S. IV magnesium sulfate in the treatment of acute severe asthma. A multicenter randomized controlled trial. Chest 2002; 122: 489-97.
Yamamoto LG, Wiebe RA, Rosen LM, Ringwood JW, Uechi CM, Beardsly ES, Toshi AS, Sugimoto SP, MacPherson KA, Young-Sasaki WM. Oxygen saturation changes during the pediatric emergency department treatment of wheezing. Am J Emerg Med. 1992; 10: 274-84.
Additional Files
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
