IV Magnesium Sulfate in the Treatment of Acute Severe Asthma

Silverman, Robert A.; Osborn, Harold H; Runge, Jeffrey W; Gallagher, E. John; Chiang, William K.; Feldman, James A.; Gaeta, Theodore J.; Freeman, Katherine; Levin, Bruce; Mancherje, Noel; Scharf, Steven M.

doi:10.1378/chest.122.2.489

Cited by 175 publications

(76 citation statements)

References 28 publications

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“…19 Magnesium causes relaxation of bronchial smooth muscle independent of serum magnesium level, with only minor side effects (flushing, lightheadedness). A Cochrane meta-analysis of 7 studies concluded that IV magnesium sulfate improves pulmonary function and reduces hospital admissions, particularly for patients with the most severe exacerbations of asthma.…”

Section: Magnesium Sulfatementioning

confidence: 99%

Part 12: Cardiac Arrest in Special Situations

Hoek¹,

Morrison²,

Shüster³

et al. 2010

Circulation

650

437

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Section: Magnesium Sulfatementioning

confidence: 99%

Part 12: Cardiac Arrest in Special Situations

Hoek¹,

Morrison²,

Shüster³

et al. 2010

Circulation

650

437

View full text Add to dashboard Cite

“…From current data, magnesium sulfate is likely to improve bronchospasm and consequent clinical symptoms and reduce hospitalization in children with moderate to severe acute asthma when added to classic therapy. 121 Some studies [122][123][124] have shown clinical improvement in patients with severe asthma receiving intravenous magnesium infusion.…”

Section: Magnesium Sulfatementioning

confidence: 99%

Severe Acute Asthma Exacerbation in Children: A Stepwise Approach for Escalating Therapy in a Pediatric Intensive Care Unit

Nievas

Anand

2013

The Journal of Pediatric Pharmacology and Therapeutics

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OBJECTIVES An increasing prevalence of pediatric asthma has led to increasing burdens of critical illness in children with severe acute asthma exacerbations, often leading to respiratory distress, progressive hypoxia, and respiratory failure. We review the definitions, epidemiology, pathophysiology, and clinical manifestations of severe acute asthma, with a view to developing an evidence-based, stepwise approach for escalating therapy in these patients. METHODS Subject headings related to asthma, status asthmaticus, critical asthma, and drug therapy were used in a MEDLINE search , supplemented by a manual search of personal files, references cited in the reviewed articles, and treatment algorithms developed within Le Bonheur Children's Hospital. RESULTS Patients with asthma require continuous monitoring of their cardiorespiratory status via noninvasive or invasive devices, with serial clinical examinations, objective scoring of asthma severity (using an objective pediatric asthma score), and appropriate diagnostic tests. All patients are treated with β-agonists, ipratropium, and steroids (intravenous preferable over oral preparations). Patients with worsening clinical status should be progressively treated with continuous β-agonists, intravenous magnesium, helium-oxygen mixtures, intravenous terbutaline and/or aminophylline, coupled with high-flow oxygen and non-invasive ventilation to limit the work of breathing, hypoxemia, and possibly hypercarbia. Sedation with low-dose ketamine (with or without benzodiazepines) infusions may allow better toleration of non-invasive ventilation and may also prepare the patient for tracheal intubation and mechanical ventilation, if indicated by a worsening clinical status. CONCLUSIONS Severe asthma can be a devastating illness in children, but most patients can be managed by using serial objective assessments and the stepwise clinical approach outlined herein. Following multidisciplinary education and training, this approach was successfully implemented in a tertiary-care, metropolitan children's hospital. INDEX TERMS asthma, child, critical care, infant, respiratory failure, status asthmaticus J Pediatr Pharmacol Ther 2013;18(2):88-104

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“…Intravenous (Noppen et al, 1990;Ciarallo et al, 1996;Silverman et al, 2002) or inhaled magnesium (Plaisance et al, 1994) has been shown to be beneficial for the control of acute asthma in adults and children. There are two studies about oral magnesium supplementation in adult patients.…”

Section: Introductionmentioning

confidence: 99%

Oral magnesium supplementation in asthmatic children: a double-blind randomized placebo-controlled trial

et al. 2006

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Objective: To investigate the long-term effect of oral magnesium supplementation on clinical symptoms, bronchial reactivity, lung function and allergen-induced skin responses in children and adolescents with moderate persistent asthma. Design: A double-blind randomized parallel placebo-controlled study. Setting and subjects: The patients were recruited from the Pediatric Outpatient Clinic, Division of Pulmonology, Allergy and Immunology, and followed at the Center for Investigation in Pediatrics at State University of Campinas Hospital, Brazil. Thirtyseven out of 72 patients met the study criteria. There were no dropouts. Intervention: The 37 patients (aged 7-19 years, 19 males) were randomized in two groups: magnesium (n ¼ 18, 300 mg/day) and placebo (n ¼ 19), during 2 months. Both patient groups received inhaled fluticasone (250 mg twice a day) and salbutamol as needed. The primary outcome was bronchial reactivity evaluated with methacholine challenge test (PC20). Results: After a follow-up of 2 months, the methacholine PC20 for testing bronchial reactivity has augmented significantly in the magnesium group only. The skin responses to recognized antigens have also decreased in patients treated with magnesium. The forced vital capacity (FVC), the forced expiratory volume at first second (FEV1), the forced expiratory flow at 25-75 and the FEV1/FVC ratio were similar in both groups. The magnesium group presented fewer asthma exacerbations and used less salbutamol compared to the placebo group. Conclusions: Oral magnesium supplementation helped to reduce bronchial reactivity to methacholine, to diminish their allergen-induced skin responses and to provide better symptom control in pediatric patients with moderate persistent asthma treated with inhaled fluticasone.

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IV Magnesium Sulfate in the Treatment of Acute Severe Asthma

Cited by 175 publications

References 28 publications

Part 12: Cardiac Arrest in Special Situations

Part 12: Cardiac Arrest in Special Situations

Severe Acute Asthma Exacerbation in Children: A Stepwise Approach for Escalating Therapy in a Pediatric Intensive Care Unit

Oral magnesium supplementation in asthmatic children: a double-blind randomized placebo-controlled trial

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