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Clinical Investigations: AsthmaIntravenous Magnesium Sulfate as an Adjunct in the Treatment of Acute Asthma
Section snippets
Patient Selection
Patients aged 18 to 65 years presenting with acute asthma to the ED of two teaching hospitals (Long Island Jewish Medical Center and Queens Hospital Center), between August 1990 and December 1991, were considered for the study. Asthma was defined by the criteria set out by the American Thoracic Society.14 Patients were excluded if they had a history of congestive heart failure, diabetes mellitus, angina, chronic renal insufficiency, temperature >38° C, pneumonia, or if pregnant. Patients
Results
One hundred forty-nine patients originally were randomized into the study; however, 135 were included in the final statistical analysis. Among the 14 patients who were excluded, 12 were enrolled more than once, 1 had irreversible airway disease, and 1 had congestive heart failure. Four patients were included as an intent to treat analysis because the study protocol was violated. Violations include 1 patient who received epinephrine, 1 patient who received theophylline, 1 patient with subsequent
Discussion
This study failed to demonstrate significant benefit from the use of 2 g of IV MgSO4 as an adjunct to a standardized treatment protocol for asthma in a diverse group of asthmatics. However, it does demonstrate significant improvement in the subgroup of patients presenting to the ED with severe airway obstruction. Improvement was demonstrated by a decrease in hospital admission rate and an increase in FEV1. We did not demonstrate benefit from MgSO4 in patients with more moderate airway
Conclusion
In summary, our data indicate that when 2 g of MgSO4 is given as an adjunct to standardized asthma therapy, there is no improvement in pulmonary function or admission rates in patients presenting to the ED. However, when patients with severe asthma are analyzed separately, there is a significant improvement in FEV1 and hospital admission rate when magnesium is received. Thus, confirming these results in the most severe patients would support the routine use of MgSO4 in patients with severe
ACKNOWLEDGMENTS
We would like to express special consideration to Pamela Arsove, MD, FACEP, for her contribution in the design and implementation of the study. We would also like to express our appreciation to Rich Thailer, PA, for computer work; Bernadette Belcastro and Denise Foti, for secretarial work; Neal Richmond, MD, and Dawn Williamson, MD, for patient recruitment; and Michael Borenstein, PhD, and Ruth Bernstein Hyman, PhD, for statistical analysis.
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Limitations of the results from randomized clinical trials involving intravenous and nebulised magnesium sulphate in adults with severe acute asthma
2019, Pulmonary Pharmacology and TherapeuticsCitation Excerpt :Considering the efficacy from the included RCTs in the Rowe et al. meta-analysis [2] evaluating the adult population, 2 g (1.2 g) IV MgSO4 reduced hospital admissions in severe acute asthma [16,17], while the results regarding the pulmonary function tests are contradictory (Table 2) [16–19]. Bloch et al. [16] reported no difference in hospital admissions after 2 g IV MgSO4 vs placebo, in patients with mild to moderate acute asthma (Table 2). All patients received SABA and some received CS (those who had < 40% of predicted FEV1 or those who had received oral prednisone within 6 months).
Hypermagnesemia is a strong independent risk factor for mortality in critically ill patients: Results from a cross-sectional study
2015, European Journal of Internal MedicineIntravenous and nebulized magnesium sulfate for treating acute asthma in adults and children: A systematic review and meta-analysis
2013, Respiratory MedicineCitation Excerpt :RevMan software (version 5.1) was used for all statistical analyses. After reviewed by two independent reviewers, our searches generated 194 reports prior to October 18, 2011, of which 25 studies (16 intravenous, 9 nebulized)4,7–30 met the inclusion criteria. The flow of identified studies through the selection process is shown in Fig. 1.
Magnesium sulfate treatment for acute severe asthma in adults—a systematic review and meta-analysis
2023, Frontiers in Allergy
Supported in part by the Nina Weisman Pulmonary Research Fund.
revision accepted November 16.