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Aerosolized Magnesium Sulfate for Acute Asthma

A Systematic Review

      Background

      The use of MgSO4 is one of numerous treatment options available during exacerbations of asthma. While the efficacy of therapy with IV MgSO4 has been demonstrated, little is known about inhaled MgSO4.

      Objectives

      A systematic review of the literature was performed to examine the effect of inhaled MgSO4 in the treatment of patients with asthma exacerbations in the emergency department.

      Methods

      Randomized controlled trials were eligible for inclusion and were identified from the Cochrane Airways Group “Asthma and Wheez*” register, which consists of a combined search of the EMBASE, CENTRAL, MEDLINE, and CINAHL databases and the manual searching of 20 key respiratory journals. Reference lists of published studies were searched, and a review of the gray literature was also performed. Studies were included if patients had been treated with nebulized MgSO4 alone or in combination with β2-agonists and were compared to the use of β2-agonists alone or with an inactive control substance. Trial selection, data extraction, and methodological quality were assessed by two independent reviewers. The results from fixed-effects models are presented as standardized mean differences (SMDs) for pulmonary functions and the relative risks (RRs) for hospital admission. Both are displayed with their 95% confidence intervals (CIs).

      Results

      Six trials involving 296 patients were included. There was a significant difference in pulmonary function between patients whose treatments included nebulized MgSO4 and those whose did not (SMD, 0.30; 95% CI, 0.05 to 0.55; five studies). There was a trend toward a reduced number of hospitalizations in patients whose treatments included nebulized MgSO4 (RR, 0.67; 95% CI, 0.41 to 1.09; four studies). Subgroup analyses demonstrated that lung function improvement was similar in adult patients and in those patients who received nebulized MgSO4 in addition to a β2-agonist.

      Conclusions

      The use of nebulized MgSO4, particularly in addition to a β2-agonist, in the treatment of an acute asthma exacerbation appears to produce benefits with respect to improved pulmonary function and may reduce the number of hospital admissions.

      Abbreviations:

      CI (confidence interval), ED (emergency department), PEF (peak expiratory flow), RCT (randomized controlled trial), RR (relative risk), SMD (standardized mean difference)
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