https://doi.org/10.4081/monaldi.2023.2664
Clinical outcomes of children with acute asthma managed with intravenous magnesium sulphate outside intensive care setting
Submitted: June 14, 2023
Accepted: August 28, 2023
Published: September 12, 2023
Accepted: August 28, 2023
Abstract Views: 1280
PDF_early view: 856
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Asthma in children constitutes a well-known respiratory condition with significant mortality. In poorly controlled asthma, multiple adjunct therapies including magnesium sulphate (MgSO4), are recommended to decrease the likelihood of intubation; however, limited evidence exists to support their routine usage in day-to-day situations. Aim of this study is to determine the outcomes of pediatric patients treated with magnesium sulphate during exacerbations of asthma admitted at a tertiary care unit. A retrospective study was conducted at The Aga Khan University Hospital, Karachi, Pakistan from January 2019 to December 2021. Patients aged 6 years to 15 years presented with acute asthma through Emergency Room (ER) having clinical respiratory score (CRS) more than five, admitted in high-dependency unit (HDU) were included in the study. Patients who were started on magnesium sulfate within 24 hours of admission were categorized in magnesium sulfate (MS) group. Patients receiving all standard acute asthma treatment but were not started on magnesium therapy within 24 hours of admission were categorized in the non-magnesium sulfate (non-MS) group. Different outcome variables were compared between the groups. A total of 110 patients with asthma were enrolled. Fifty-four patients were categorized into MS group while 56 were included in non-MS group. Fewer patients were transferred from HDU to pediatric intensive care unit (PICU) (24.07%) in MS group compared to non-MS group (42.85%), (p=0.02). In MS group, the mean number of days spent on oxygen in HDU were 2.38±0.81, while non-MS group spent more days (3.10±0.84 (p<0.01). This study demonstrates that for pediatric patients with severe asthma exacerbations, administration of IV MgSO4 (within 24 hours) is beneficial and results in fewer admissions to PICU and reduces the mean number of days spent on oxygen therapy.
Song P, Adeloye D, Salim H, et al. Global, regional, and national prevalence of asthma in 2019: a systematic analysis and modelling study. J Glob Health 2022;12:04052.
DOI: https://doi.org/10.7189/jogh.12.04052
Khan MA. Monthly and seasonal prevalence of asthma and chronic obstructive pulmonary disease in the District Dera Ismail Khan, Khyber Pakhtunkhwa, Pakistan. Egypt J Bronchol 2022;16:63.
DOI: https://doi.org/10.1186/s43168-022-00166-2
Singh S, Salvi S, Mangal DK, et al. Prevalence, time trends and treatment practices of asthma in India: the Global Asthma Network study. ERJ Open Res 2022;8:00528-2021.
DOI: https://doi.org/10.1183/23120541.00528-2021
Oland AA, Booster GD, Bender BG. Psychological and lifestyle risk factors for asthma exacerbations and morbidity in children. World Allergy Organ J 2017;10:35.
DOI: https://doi.org/10.1186/s40413-017-0169-9
Sullivan PW, Ghushchyan VH, Campbell JD, et al. Measuring the cost of poor asthma control and exacerbations. J Asthma 2017;54:24-31.
DOI: https://doi.org/10.1080/02770903.2016.1194430
Castillo JR, Peters SP, Busse WW. Asthma exacerbations: pathogenesis, prevention, and treatment. J Allergy Clin Immunol Pract 2017;5:918-927.
DOI: https://doi.org/10.1016/j.jaip.2017.05.001
Craig VL, Bigos D, Brilli RJ. Efficacy and safety of continuous albuterol nebulization in children with severe status asthmaticus. Pediatr Emerg Care 1996;12:1-5.
National Asthma Education and Prevention Program, Third Expert Panel on the Diagnosis and Management of Asthma. Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. Section 5, Managing Exacerbations of Asthma. Bethesda: National Heart, Lung, and Blood Institute (US); 2007. Available from: https://www.ncbi.nlm.nih.gov/books/NBK7228/
Cheuk DK, Chau TC, Lee SL. A meta-analysis on intravenous magnesium sulphate for treating acute asthma. Arch Dis Child 2005;90:74-7.
DOI: https://doi.org/10.1136/adc.2004.050005
Cairns CB, Kraft M. Magnesium attenuates the neutrophil respiratory burst in adult asthmatic patients. Acad Emerg Med 1996;3:1093-7.
DOI: https://doi.org/10.1111/j.1553-2712.1996.tb03366.x
Nayani K, Naeem R, Munir O, et al. The clinical respiratory score predicts paediatric critical care disposition in children with respiratory distress presenting to the emergency department. BMC Pediatr 2018;18:339.
DOI: https://doi.org/10.1186/s12887-018-1317-2
Liu X, Yu T, Rower JE, et al. Optimizing the use of intravenous magnesium sulfate for acute asthma treatment in children. Pediatr Pulmonol 2016;51:1414-21.
DOI: https://doi.org/10.1002/ppul.23482
Global Initiative for Asthma (GINA). Global Strategy for Asthma Management and Prevention, 2022. Available from: https://ginasthma.org/gina-reports/
Rothe T, Spagnolo P, Bridevaux PO, et al. Diagnosis and management of asthma - The Swiss Guidelines. Respiration 2018;95:364-80.
DOI: https://doi.org/10.1159/000486797
Forno E, Celedón JC. Predicting asthma exacerbations in children. Curr Opin Pulm Med 2012;18:63-9.
DOI: https://doi.org/10.1097/MCP.0b013e32834db288
Griffiths B, Kew KM. Intravenous magnesium sulfate for treating children with acute asthma in the emergency department. Cochrane Database Syst Rev 2016;4:CD011050.
DOI: https://doi.org/10.1002/14651858.CD011050.pub2
Song WJ, Chang YS. Magnesium sulfate for acute asthma in adults: a systematic literature review. Asia Pac Allergy 2012;2:76-85.
DOI: https://doi.org/10.5415/apallergy.2012.2.1.76
DeLaroche AM, Mowbray FI, Bohsaghcheghazel M, et al. Early versus delayed administration of intravenous magnesium sulfate for pediatric asthma. Am J Emerg Med 2021;50:36-40.
DOI: https://doi.org/10.1016/j.ajem.2021.07.003
Johnson PN, Drury AS, Gupta N. Continuous magnesium sulfate infusions for status asthmaticus in children: a systematic review. Front Pediatr 2022;10:853574.
DOI: https://doi.org/10.3389/fped.2022.853574
Gross Júnior M, Lago PM, Santana JCB, et al. Use of magnesium sulfate in continuous infusion in patients with severe acute asthma, in a pediatric emergency room. Pediatr Pulmonol 2021;56:1924-30.
DOI: https://doi.org/10.1002/ppul.25393
Irazuzta JE, Chiriboga N. Magnesium sulfate infusion for acute asthma in the emergency department. J Pediatr (Rio J) 2017;93:S19-25.
DOI: https://doi.org/10.1016/j.jped.2017.06.002
Bidwell J. IV magnesium sulfate for treating children with acute asthma in the ED. Am J Nurs 2017;117:59.
DOI: https://doi.org/10.1097/01.NAJ.0000512299.03394.8a
Forster BL, Thomas F, Arnold SR, Snider MA. Early intravenous magnesium sulfate administration in the emergency department for severe asthma exacerbations. Pediatr Emerg Care 2023;39:524-9.
DOI: https://doi.org/10.1097/PEC.0000000000002890
Schuh S, Freedman SB, Zemek R, et al. Association between intravenous magnesium therapy in the emergency department and subsequent hospitalization among pediatric patients with refractory acute asthma: secondary analysis of a randomized clinical trial. JAMA Netw Open 2021;4:e2117542.
DOI: https://doi.org/10.1001/jamanetworkopen.2021.17542
Bloch H, Silverman R, Mancherje N, et al. Intravenous magnesium sulfate as an adjunct in the treatment of acute asthma. Chest 1995;107:1576-81.
DOI: https://doi.org/10.1378/chest.107.6.1576
Baudin F, Buisson A, Vanel B, et al. Nasal high flow in management of children with status asthmaticus: a retrospective observational study. Ann Intensive Care 2017;7:55.
DOI: https://doi.org/10.1186/s13613-017-0278-1
Okayama H, Aikawa T, Okayama M, et al. Bronchodilating effect of intravenous magnesium sulfate in bronchial asthma. JAMA 1987;257:1076-8.
DOI: https://doi.org/10.1001/jama.257.8.1076
Johnson MD, Zorc JJ, Nelson DS, et al. Intravenous magnesium in asthma pharmacotherapy: variability in use in the PECARN Registry. J Pediatr 2020;220:165-174.e2.
DOI: https://doi.org/10.1016/j.jpeds.2020.01.062
Reference.medscape.com [Internet]. Magnesium sulfate (Rx). Available from: https://reference.medscape.com/drug/mgso4-magnesium-sulfate-344444#4
Hicks MA, Tyagi A. Magnesium sulfate. In: StatPearls [Internet]. Treasure Island: StatPearls; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554553/
Ethics Approval
Approval was received by the Ethics Review Committee at Aga Khan University HospitalHow to Cite
Aziz, Danish Abdul, Muhammad Aqib Sajjad, and Haissan Iftikhar. 2023. “Clinical Outcomes of Children With Acute Asthma Managed With Intravenous Magnesium Sulphate Outside Intensive Care Setting”. Monaldi Archives for Chest Disease, September. https://doi.org/10.4081/monaldi.2023.2664.
Copyright (c) 2023 The Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Similar Articles
- Gabriele Valli, Francesca De Marco, Maria Teresa Spina, Valentina Valeriano, Antonello Rosa, Valentina Minerva, Enrico Mirante, Maria Pia Ruggieri, Francesco Rocco Pugliese, A pilot study on the application of the current European guidelines for the management of acute coronary syndrome without elevation of ST segment (NSTEMI) in the Emergency Department setting in the Italian region Lazio , Monaldi Archives for Chest Disease: Vol. 82 No. 4 (2014): Cardiac series
- Muhammad Ijaz, Muhammad Jaffar Khan, Jawad Khan, . Usama, Association of clinical characteristics of patients presenting with influenza like illness or severe acute respiratory illness with development of acute respiratory distress syndrome , Monaldi Archives for Chest Disease: Vol. 87 No. 1 (2017)
- Vishal Chopra, Hardik Jain, Akhil D. Goel, Siddharth Chopra, Ashrafjit S. Chahal, Neha Garg, Vidhu Mittal, Correlation of aspergillus skin hypersensitivity with the duration and severity of asthma , Monaldi Archives for Chest Disease: Vol. 87 No. 3 (2017)
- F. Novelli, F. Costa, M. Latorre, L. Malagrinò, A. Celi, B. Vagaggini, P. Paggiaro, Tiotropium: a new therapeutic option in asthma , Monaldi Archives for Chest Disease: Vol. 79 No. 3-4 (2013): Pulmonary series
- Claudio F. Donner, Sandro Amaducci, Elena Bacci, Sandra Baldacci, Maria L. Bartoli, Gianfranco M. Beghi, Alida Benfante, Sara Brighindi, Lucio Casali, Daniela Castiglia, Mario Cazzola, Alessandro Celi, Silvana Cianchetti, Giorgio Colombo, Claudia Crimi, Federico L. Dente, Giuseppe Di Maria, Annalisa Di Maria, Manuela Latorre, Federico Lavorini, Sara Maio, Claudia Mannini, Riccardo Messina, Pier Luigi Paggiaro, Patrizia Pignatti, David Price, Nicola Scichilone, Marzia Simoni, Antonio Spanevello, Martina Stagno d’Alcontres, Shawna Tan, Roberto Torchio, Giovanni Viegi, Dina Visca, Emiel F.M. Wouters, Shaylynn Yu Hui Xin, Inhalation therapy in the next decade: Determinants of adherence to treatment in asthma and COPD , Monaldi Archives for Chest Disease: Vol. 88 No. 1 (2018)
- Massimiliano Polastri, Lara Pisani, Andrea Dell'Amore, Stefano Nava, Revolving door respiratory patients: A rehabilitative perspective , Monaldi Archives for Chest Disease: Vol. 87 No. 3 (2017)
- I. Blanco, H. Canto, J. Flóres, C. Camblor, V. Cárcaba, F.J. de Serres, S. Janciauskiene, E.F. Bustillo, Long-term augmentation therapy with Alpha-1 Antitrypsin in an MZ-AAT severe persistent asthma , Monaldi Archives for Chest Disease: Vol. 69 No. 4 (2008): Pulmonary series
- G. Caramori, M. Fabbri, D. Paioli, F. Falcone, C. Severino, G. Felisatti, O. Arar, I.M. Adcock, K. Fan Chung, P.J. Barnes, A. Ciaccia, A. Papi, Asthma is not a common cause of severe chronic respiratory failure in non-smokers: ALOT study , Monaldi Archives for Chest Disease: Vol. 63 No. 2 (2005): Pulmonary series
- G. Balzano, S. Fuschillo, E. De Angelis, C. Gaudiosi, A. Mancini, M. Caputi, Persistent airway inflammation and high exacerbation rate in asthma that starts at menopause , Monaldi Archives for Chest Disease: Vol. 67 No. 3 (2007): Pulmonary series
- C. Incorvaia, C. Pravettoni, M. Mauro, M.-R. Yacoub, F. Tarantini, G.G. Riario-Sforza, Effectiveness of omalizumab in a patient with severe asthma and atopic dermatitis , Monaldi Archives for Chest Disease: Vol. 69 No. 2 (2008): Pulmonary series
You may also start an advanced similarity search for this article.
