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A randomised, double blind, placebo controlled trial of intravenous (IV) magnesium sulphate (2 g/50 ml normal saline) was performed during standard treatment of 248 patients seen in the emergency department with acute severe asthma (FEV1 <30% predicted). Exclusion criteria were intubation, inability to perform spirometric tests, and hospital admission. The magnesium treated group had a higher FEV1 % predicted and a lower pulse rate at 240 minutes with no difference in admission or readmission rates. The effect of magnesium was greatest for patients with FEV1 <20%. No major adverse effects were noted. Limitations of the study included lack of use of ipratropium bromide or continuous dosing of β2 agonists and failure to measure peak flow.
Intravenous magnesium may provide a useful addition to the pharmacotherapy of acute severe asthma in patients with very low FEV1.