INTRAVENOUS MAGNESIUM FOR TREATING ACUTE EXACERBATIONS OF ASTHMA IN CHILDREN: A SYSTEMATIC REVIEW

Abstract

INTRODUCTION: Inhaled bronchodilators and systemic corticosteroids are the mainstay of treatment for acute exacerbations of asthma. A systematic review of the use of magnesium has been published, but the results are incomplete and the recommendation is “weak.” OBJECTIVE: The objective of this study was to determine the effect of intravenous magnesium in children with acute asthma. METHODS: Randomized, controlled trials were identified by searching the Cochrane, Medline, Embase, CINAHL, and ProQuest databases. Other sources were used to identify “gray literature.” Randomized, controlled trials in which children with an acute exacerbation of asthma were treated with intravenous magnesium versus placebo were included. Data were extracted from the full papers, and methodologic quality was assessed using a scale from 0 to 5. RESULTS: Six studies involving 215 patients were included. Hospital stay was reduced in the magnesium-treated group. The percentage improvement in the percentage predicted peak expiratory flow rate was 43.5% greater in the treatment group. Significant differences were also seen in the forced expiratory volume in 1 second (weighted mean difference: 74.5%) and the forced vital capacity (weighted mean difference: 64.5%). There was improvement in asthma scores in 3 of the 4 studies that reported this outcome. There were no clinically significant differences in vital signs. No major adverse events were reported. CONCLUSIONS: Intravenous magnesium is safe and beneficial as adjuvant therapy in the treatment of children with moderate to severe acute asthma. Magnesium should be for children who have moderate to severe acute exacerbations of asthma that do not respond to nebulized β-2 agonist.