Abstract
Aim: To evaluate the effectiveness of intravenous magnesium sulphate in the treatment of acute asthmatic attacks in children by meta-analysis.
Methods: A systematic and comprehensive search of the literature was performed to identify controlled clinical trials of magnesium sulphate in paediatric acute asthma which evaluated outcomes of hospitalisation or short term pulmonary function tests or symptom scores. Unpublished data were searched by personal contacts with authors and specialists. Two reviewers independently assessed trial qualities and synthesised data. Heterogeneity among studies was evaluated by the Cochrane Q test. Outcome data were pooled by random or fixed effect models depending on presence or absence of heterogeneity.
Results: Five randomised placebo controlled trials involving a total of 182 patients were identified. They compared intravenous magnesium sulphate to placebo in treating paediatric patients with moderate to severe asthmatic attacks in the emergency department, with co-therapies of inhaled ß2 agonists and systemic steroids. The studies were of high quality with results judged to be valid. Four studies showed that magnesium sulphate was effective, while one study found it ineffective. There was no significant heterogeneity in the primary outcome of hospitalisation. In the fixed effect model, magnesium sulphate is effective in preventing hospitalisation (OR 0.290, 95% CI 0.143 to 0.589). The number needed to treat is 4 (95% CI 3 to 8). Secondary outcomes of short term pulmonary function tests and clinical symptom scores also showed significant improvement.
Conclusion: Intravenous magnesium sulphate probably provides additional benefit in moderate to severe acute asthma in children treated with bronchodilators and steroids.
Full Text
The Full Text of this article is available as a PDF (142.2 KB).
Figure 1.
Forrest plot of odds ratio of hospitalisation.
Figure 2.
Funnel plot of precision by effect size.
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Ciarallo L., Brousseau D., Reinert S. Higher-dose intravenous magnesium therapy for children with moderate to severe acute asthma. Arch Pediatr Adolesc Med. 2000 Oct;154(10):979–983. doi: 10.1001/archpedi.154.10.979. [DOI] [PubMed] [Google Scholar]
- Ciarallo L., Sauer A. H., Shannon M. W. Intravenous magnesium therapy for moderate to severe pediatric asthma: results of a randomized, placebo-controlled trial. J Pediatr. 1996 Dec;129(6):809–814. doi: 10.1016/s0022-3476(96)70023-9. [DOI] [PubMed] [Google Scholar]
- DEL CASTILLO J., ENGBAEK L. The nature of the neuromuscular block produced by magnesium. J Physiol. 1954 May 28;124(2):370–384. doi: 10.1113/jphysiol.1954.sp005114. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Devi P. R., Kumar L., Singhi S. C., Prasad R., Singh M. Intravenous magnesium sulfate in acute severe asthma not responding to conventional therapy. Indian Pediatr. 1997 May;34(5):389–397. [PubMed] [Google Scholar]
- Gürkan F., Haspolat K., Boşnak M., Dikici B., Derman O., Ece A. Intravenous magnesium sulphate in the management of moderate to severe acute asthmatic children nonresponding to conventional therapy. Eur J Emerg Med. 1999 Sep;6(3):201–205. doi: 10.1097/00063110-199909000-00005. [DOI] [PubMed] [Google Scholar]
- Jadad A. R., Moore R. A., Carroll D., Jenkinson C., Reynolds D. J., Gavaghan D. J., McQuay H. J. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996 Feb;17(1):1–12. doi: 10.1016/0197-2456(95)00134-4. [DOI] [PubMed] [Google Scholar]
- McLean R. M. Magnesium and its therapeutic uses: a review. Am J Med. 1994 Jan;96(1):63–76. doi: 10.1016/0002-9343(94)90117-1. [DOI] [PubMed] [Google Scholar]
- Monem G. F., Kissoon N., DeNicola L. Use of magnesium sulfate in asthma in childhood. Pediatr Ann. 1996 Mar;25(3):136, 139-44. doi: 10.3928/0090-4481-19960301-06. [DOI] [PubMed] [Google Scholar]
- Rowe B. H., Edmonds M. L., Spooner C. H., Camargo C. A. Evidence-based treatments for acute asthma. Respir Care. 2001 Dec;46(12):1380–1391. [PubMed] [Google Scholar]
- Scarfone R. J., Loiselle J. M., Joffe M. D., Mull C. C., Stiller S., Thompson K., Gracely E. J. A randomized trial of magnesium in the emergency department treatment of children with asthma. Ann Emerg Med. 2000 Dec;36(6):572–578. doi: 10.1067/mem.2000.111060. [DOI] [PubMed] [Google Scholar]
- Skobeloff E. M. An ion for the lungs. Acad Emerg Med. 1996 Dec;3(12):1082–1084. doi: 10.1111/j.1553-2712.1996.tb03363.x. [DOI] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.