Article type
Year
Abstract
Introduction/Objective: To determine the effect of intravenous magnesium sulfate for the treatment of patients with acute exacerbations of asthma managed in the emergency department.
Methods: Computerised searches were conducted using the Cochrane Airways Review Group "Asthmi and Wheez" RCT register (standardized searches of EMBASE, MEDLINE, CINAHL; supplemented by hand searching the top 20 respiratory journals) and the CC Controlled Trials Register. Bibliographic searches, communication with primary authors and communications with content experts were used to identify other published, unpublished, or "in progress" trials. No language restrictions were applied. Randomised, double blind, controlled trials that compared a single dose or continuous infusions of magnesium to a placebo in addition to standard care (systemic corticosteroids, oxygen, intensive beta-agonist care, etc.) in the ED treatment of acute asthma were eligible. The main outcomes assessed were changes in pulmonary functions(% predicted FEV-1 and absolute PEFR) after treatment, admission rates, and adverse effects caused by magnesium. Data extraction and quality assessments were conducted independently by two reviewers using standard forms and validated assessment criteria. Results from similar studies were pooled as weighted means differences (WMD) or odds ratios (OR) with 95% confidence intervals (95% Cl) using a random effects model.
Results: From 90 identified references, and alternative search strategies, 27 potentially relevant articles were identified and 6 were included. A total of 618 patients have been studied in these six trials (313 with IV magnesium; 305 with placebo). Overall, admission to hospital was not reduced with IV magnesium use when all studies were pooled (OR = 0.58; 95% Cl: 0.21,1.6). Based on data from four studies of patients with seven asthma exacerbations, admissions were reduced in those receiving IV magnesium (OR = 0.10, 95% Cl: 0.031 to 0.30). Patients receiving magnesium demonstrated non-significant improvements in PEFR (WMD = 30.4; 95% Cl: - 1.9, 62.7) and % predicted FEV-1 (WMD = 2.9; 95% Cl: -1.6, 7.0). Once again, benefit was more pronounced for those patients in the severe subgroup (PEFR WMD: 56.6; 95% Cl: 36.4, 76.8; and % predicted FEV-1:7.1; 95% Cl: 0.3, 13.7). The magnesium treatment was generally very well tolerated.
Discussion: There is insufficient evidence to support the routine use of magnesium sulfate in a patients with exacerbations of asthma presenting to the emergency department. However, magnesium appeared to be beneficial in patients who present with severe exacerbations of asthma. Use of this safe, generally tolerated and inexpensive, agent should be considered in severe asthmatic exacerbations.
Methods: Computerised searches were conducted using the Cochrane Airways Review Group "Asthmi and Wheez" RCT register (standardized searches of EMBASE, MEDLINE, CINAHL; supplemented by hand searching the top 20 respiratory journals) and the CC Controlled Trials Register. Bibliographic searches, communication with primary authors and communications with content experts were used to identify other published, unpublished, or "in progress" trials. No language restrictions were applied. Randomised, double blind, controlled trials that compared a single dose or continuous infusions of magnesium to a placebo in addition to standard care (systemic corticosteroids, oxygen, intensive beta-agonist care, etc.) in the ED treatment of acute asthma were eligible. The main outcomes assessed were changes in pulmonary functions(% predicted FEV-1 and absolute PEFR) after treatment, admission rates, and adverse effects caused by magnesium. Data extraction and quality assessments were conducted independently by two reviewers using standard forms and validated assessment criteria. Results from similar studies were pooled as weighted means differences (WMD) or odds ratios (OR) with 95% confidence intervals (95% Cl) using a random effects model.
Results: From 90 identified references, and alternative search strategies, 27 potentially relevant articles were identified and 6 were included. A total of 618 patients have been studied in these six trials (313 with IV magnesium; 305 with placebo). Overall, admission to hospital was not reduced with IV magnesium use when all studies were pooled (OR = 0.58; 95% Cl: 0.21,1.6). Based on data from four studies of patients with seven asthma exacerbations, admissions were reduced in those receiving IV magnesium (OR = 0.10, 95% Cl: 0.031 to 0.30). Patients receiving magnesium demonstrated non-significant improvements in PEFR (WMD = 30.4; 95% Cl: - 1.9, 62.7) and % predicted FEV-1 (WMD = 2.9; 95% Cl: -1.6, 7.0). Once again, benefit was more pronounced for those patients in the severe subgroup (PEFR WMD: 56.6; 95% Cl: 36.4, 76.8; and % predicted FEV-1:7.1; 95% Cl: 0.3, 13.7). The magnesium treatment was generally very well tolerated.
Discussion: There is insufficient evidence to support the routine use of magnesium sulfate in a patients with exacerbations of asthma presenting to the emergency department. However, magnesium appeared to be beneficial in patients who present with severe exacerbations of asthma. Use of this safe, generally tolerated and inexpensive, agent should be considered in severe asthmatic exacerbations.