Standard medical therapy with vs. without nebulised magnesium for children with asthma decompensation

Luísa Cunha; Meritxell Roca Mora; Farhan Afzal; Giulia M Cesar; Catharina Ribeiro Guimarães; Julia Pereira Muniz Pontes; Gabriel Grando Alves; Antonio Carlos Fonseca Silveira

doi:10.1007/s00431-024-05517-3

Standard medical therapy with vs. without nebulised magnesium for children with asthma decompensation

Eur J Pediatr. 2024 Mar 16. doi: 10.1007/s00431-024-05517-3. Online ahead of print.

Authors

Luísa Cunha¹, Meritxell Roca Mora², Farhan Afzal³, Giulia M Cesar⁴, Catharina Ribeiro Guimarães⁵, Julia Pereira Muniz Pontes⁶, Gabriel Grando Alves⁷, Antonio Carlos Fonseca Silveira⁸

Affiliations

¹ Centro Universitario Lusiada, Rua Oswaldo Cruz, 179 - Boqueirão, Santos, SP, 11045-101, Brazil. luisacunha.marin@hotmail.com.
² Universitat Internacional de Catalunya, Barcelona, Spain.
³ Faisalabad Medical University, Faisalabad, Punjab, Pakistan.
⁴ Faculdade de Medicina de Petropolis, Petropolis, RJ, Brazil.
⁵ Universidade Federal de Ouro Preto, Ouro Preto, MG, Brazil.
⁶ State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
⁷ Universidade Federal de Santa Maria, Santa Maria, RS, Brazil.
⁸ Pediatrics Department, Centro Universitário Lusíada, Santos, SP, Brazil.

PMID: 38492031
DOI: 10.1007/s00431-024-05517-3

Abstract

Pediatric asthma is a common condition, and its exacerbations can be associated with significant morbidity and mortality. The role of nebulised magnesium as adjunct therapy for children with asthma exacerbations is still unclear. To compare clinical and functional outcomes for children with asthma exacerbation taking either nebulised magnesium sulfate added to standard medical therapy (SMT) versus SMT alone. PubMed, Embase, and Cochrane Library were systematically searched for randomised clinical trials (RCT) comparing the use of SMT with vs. without nebulised magnesium. The outcomes were respiratory rate, heart rate, % predicted peak expiratory flow rate (PEFR), % predicted forced expiratory volume (FEV1), peripheral O₂ saturation, asthma severity scores, and need for intravenous (IV) bronchodilator use. Twelve RCTs and 2484 children were included. Mean age was 5.6 (range 2-17) years old, mean baseline % predicted FEV1 was 69.6%, and 28.66% patients were male. Children treated with magnesium had a significantly higher % predicted PEFR (mean difference [MD] 5.33%; 95% confidence interval [CI] 4.75 to 5.90%; p < 0.01). Respiratory rate was significantly lower in the magnesium group (MD -0.70 respirations per minute; 95% CI -1.24 to -0.15; p < 0.01). Need for IV bronchodilators, % predicted FEV1, heart rate, asthma severity scores, and O₂ saturation were not significantly different between groups.

Conclusion: In children with asthma exacerbation, treatment with nebulised magnesium and SMT was associated with a statistically significant, but small improvement in predicted PEFR and respiratory rate, as compared with SMT alone.

What is known: • Magnesium sulfate has bronchodilating properties and aids in the treatment of asthma exacerbation when administered intravenously. • There is no significant evidence of benefit of nebulised magnesium as an adjunct therapy to the standard medical treatment for children with asthma exacerbations.

What is new: • Our study suggests nebulised magnesium sulfate may have a statistically significant, but small benefit in respiratory rate and peak expiratory flow rate. The addition of nebulised magnesium does not seem to increase adverse events.

Keywords: Asthma; Bronchodilation; Exacerbation; Magnesium; Pediatrics.