A comparative pilot study of the efficacy and safety of nebulized magnesium sulfate and intravenous magnesium sulfate in children with severe acute asthma

Abstract

Introduction: Severe asthma attacks are life-threatening, and require serious medical attention. Intravenous MgSO₄ is an efficient medication, proven to improve outcomes. To date, most research has focused on administration of nebulized MgSO₄ in adults with critical asthma. However, its benefits for treating childhood asthma has been little investigated. This study compared the clinical efficacy and adverse effects of nebulized MgSO₄ and intravenous MgSO₄ in the treatment of children with severe acute asthma.

Method: A prospective, open-label, randomized, controlled pilot study was conducted in children with severe asthma exacerbation admitted at the Queen Sirikit National Institute of Child Health. Twenty-eight patients were randomized to receive three intermittent doses of nebulized or intravenous MgSO4. The Modified Wood's Clinical Asthma Score was determined prior to, and at 20, 40, 60, 120, 180 and 240 minutes after treatment administration. The length of hospital stay was also recorded.

Results: Fifteen patients received nebulized isotonic MgSO₄ and 13 were administered intravenous MgSO₄. There were no differences in the baseline characteristics of the two groups, including their initial asthma severity scores (4.87 ± 0.92 vs. 5.0 +0.82; p = 0.69). No statistically significant differences between the two groups were identified at 60 minutes (2.47 ± 0.83 vs. 2.77 ± 0.93; p = 0.37) until 240 minutes. The length of hospital stay for both groups was also similar (4.0 ±1.2 vs. 4.54 ± 2.7; p = 0.51). No adverse effects from MgSO₄ administration were observed among the participants.

Conclusions: In this small sample size we demonstrated that nebulized MgSO₄ and intravenous MgSO₄ are both clinically beneficial and safe for Thai children suffering from severe asthma exacerbation.