The use of magnesium in bronchial asthma: a new approach to an old problem

Abstract

Magnesium deficiency is a common electrolyte disorder in patients with acute severe asthma, but intracellular magnesium content better reflects its homeostasis than does its serum concentration. Magnesium takes part in many metabolic processes in the organism, including energy metabolism, protein and nucleic acid synthesis, cell cycle, the binding of substances to the plasma membrane, and maintenance of cytoskeletal and mitochondrial integrity. It also modulates ion transport and influences intracellular calcium concentration. Maintenance of the cells' transmembrane gradient depends on the presence of magnesium, and hypomagnesemia may result in an increase in neuromuscular cell excitability. Magnesium is a cation modulating the smooth muscle contractility of different tissues: hypomagnesemia causes their contraction and hypermagnesemia their relaxation. Suggestions of a positive influence of magnesium in the treatment of asthma exacerbation have been known for a long time, but research results differ. A single dose of intravenous magnesium sulfate given to patients with acute asthma exacerbation has been shown to be safe, but its efficiency is still under discussion. According to the Global Initiative for Asthma GINA-2005, magnesium sulfate administration is not recommended for routine treatment, but it is permitted in patients with severe asthma exacerbation not responding to treatment (evidence category A). Recommendations of the British Thoracic Society allow one dose of magnesium sulfate to patients with acute severe asthma exacerbation and inadequate initial response to broncho-dilating inhalation treatment (evidence category A). Future investigations should help to establish the indications for magnesium use in the treatment of acute asthma exacerbations as well as the magnesium dose and the scheme of its administration.

17q21 locus and ORMDL3: an increased risk for childhood asthma

“…The association of decreased de novo sphingolipid synthesis with alterations in cellular magnesium homeostasis and the altered contractile sensitivity to magnesium could provide a mechanistic link of decreased de novo sphingolipid synthesis to smooth muscle function. Asthma has been associated with lower intracellular magnesium concentrations (68,69), and intravenous or nebulized magnesium sulfate (MgSO 4 ) is used to treat asthma exacerbations (68,70). This therapeutic approach has been very controversial with variable efficacy.…”

Magnesium sulfate for acute asthma in adults: a systematic literature review

“…It also may increase the bronchodilator effect of β 2 -agonist by increasing the receptor affinity [5]. Historically, in the literature, the first description on the clinical use of magnesium for asthma was reported in 1936 [6]. In 1987, Okayama et al [7] reported rapid bronchodilating effects of intravenous (IV) MgSO 4 infusion in 10 asthma patients.…”

“…The Cochrane review examined the safety of 2 g magnesium to find out its minimal risk of significant adverse reaction [20]. A RCT [6] using 2 g reported no major toxicities but only minor ones in 58% of patients (sensation of flushing, mild fatigue and burning sense at IV site). In a trial using 1.2 g bolus [13], the rate of minor side effect was 8% (headache, flushing and dizziness).…”

‘Magnesium’-the master cation-as a drug—possibilities and evidences

“…Mg 2? deficiency is reported in serum and intracellular components of asthma patients (Kowal et al 2007;Shaikh et al 2016). Mg 2?…”

“…In 1936, magnesium is administrated for the first time for the treatment purpose in asthma patients by Victor Haury. Nebulized magnesium is also reported to improve respiratory function (Kowal et al 2007;Song and Chang 2012;Mohammed and Goodacre 2007;Kokotajlo et al2014). The anti-asthmatic effect of Mg 2?…”