Does nebulized magnesium added to standard therapy ease asthma exacerbations? | Image Credit: Contemporary Pediatrics

Details

According to a meta-analysis, adding nebulized magnesium sulfate to standard medical therapy (SMT) does indeed lead to a small statistically significant improvement in treatment outcomes in children with asthma exacerbations compared with using SMT alone. However, the effect size of the differences is probably too small to be clinically relevant.

The analysis was based on 12 studies that included 2484 patients, of whom 1248 (50.2%) received nebulized magnesium added to SMT, usually at a dose of 150 mg, though doses ranged from 75 mg to 950 mg. Most studies administered at least 3 nebulizations every 20 minutes in the first hour, while 4 administered a single dose. The mean age of patients was 5.6 years (range 2 to 17 years) and 28.7% were male. Although each study defined SMT differently, all included an inhaledβ-2 agonist as part of treatment.

In children with bronchospasm, the mean respiratory rate was lower in those who had magnesium than those given SMT alone. These findings remained consistent at 40 minutes and 60 minutes after intervention. In addition, peak expiratory flow rate was significantly higher in the magnesium group. But the 2 groups did not differ on peripheral O2 saturation, predicted forced expiratory volume, heart rate, need for IV bronchodilator use, asthma severity scores, or number of hospital admissions or emergency department visits after initial treatment. Incidence of adverse events, which were rare, was similar in the 2 groups.

THOUGHTS FROM DR FARBER

It is important, when reading papers such as this one, to understand that statistical significance is not the same as clinical significance, and nebulized magnesium, although apparently safe, does not appear to be of benefit in routine asthma care. This is another example of how people trying to find a useful therapeutic role for magnesium usually come up short.

Reference

Cunha L, Mora MR, Afzal F, et al. Standard medical therapy with vs. without nebulized magnesium for children with asthma decompensation. Eur J Pediatr. 2024;183(6):2637-2644. doi:10.1007/s00431-024-05517-3