Use of nebulised magnesium sulphate as an adjuvant in the treatment of acute exacerbations of COPD in adults: a randomised double-blind placebo-controlled trial

Edwards, Llifon; Shirtcliffe, Philippa; Wadsworth, Kirsten; Healy, Bridget; Jefferies, Sarah; Weatherall, Mark; Beasley, Richard

doi:10.1136/thoraxjnl-2012-202225

Cited by 20 publications

(22 citation statements)

References 35 publications

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“…[67] A third trial compared the efficacy of nebulized magnesium sulphate with placebo. [8] The fourth trial evaluated the combined effect of nebulized plus intravenous magnesium sulphate compared to intravenous salbutamol and nebulized ipratropium. [9] Our results are summarised in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…studied 109 patients presenting to the ED with acute exacerbation of COPD in a randomised double-blind placebo-controlled trial. [8] All subjects enrolled were pre-dosed with salbutamol and ipratropium bromide nebulisations, and had FEV 1 <50% predicted post bronchodilator. The treatment arm received 2.5 ml of isotonic magnesium sulphate mixed with 2.5 mg of salbutamol and the placebo arm received 2.5 ml of isotonic saline with 2.5 mg of salbutamol administered by a nebulizer.…”

Section: Resultsmentioning

confidence: 99%

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Magnesium for acute exacerbation of chronic obstructive pulmonary disease: A systematic review of randomised trials

Shivanthan

Rajapakse

2014

Ann Thorac Med

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The efficacy of magnesium sulphate in chronic obstructive pulmonary disease (COPD) was assessed by conducting a systematic review of published randomized clinical trials through extensive searches in MEDLINE and SCOPUS with no date limits, as well as manual review of journals. Outcome measures varied depending on route(s) of administration of magnesium sulphate and medications co-administered. Risk of bias was evaluated and quality of evidence was graded. Four (4) randomized trials were included. All trials had a moderate risk of bias and were of average methodological quality. Magnesium sulphate given intravenously did not seem to have an immediate bronchodilatory effect; however it appears to potentiate the bronchodilatory effect of inhaled beta-2 agonists. Increase in peak expiratory flow rate (PEFR) at 30 and 45 min was greater in those who received magnesium sulphate compared to placebo (P = 0.03), although the mean percentage change in PEFR was just 24%, without significant differences in dyspnoea scores, hospital admission rates, or emergency department readmission rates compared to placebo. Nebulized magnesium sulphate with salbutamol versus nebulized salbutamol with saline placebo showed no significant differences is forced expiratory volume in 1 s (FEV1) measured at 90 min after adjustment for baseline FEV1 (P = 0.34) or differences in the need for hospital admission. Combined inhalational and intravenous magnesium sulphate versus intravenous saline placebo and nebulized ipratropium bromide were comparable in terms of hospital admission, intubation and death, but the ipratropium bromide group showed better bronchodilator effect and improvement in arterial blood gas parameters. Overall, trial evidence for trial evidence for magnesium sulphate in acute exacerbation of COPD is poor, and further well-designed trials are needed.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Magnesium for acute exacerbation of chronic obstructive pulmonary disease: A systematic review of randomised trials

Shivanthan

Rajapakse

2014

Ann Thorac Med

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“…23 Another trial conducted in New Zealand on patients with AECOPD presenting at the emergency department showed that adding nebulized magnesium to nebulized salbutamol in the setting of AECOPD had no effect on FEV1. 24 Importantly, none of the patients included in this trial required admission to the intensive care. It may therefore not be possible to extrapolate this evidence to the critical care setting.…”

Section: Magnesium Sulfatementioning

confidence: 99%

Nonantibiotic Pharmacological Treatment of Severe Chronic Obstructive Pulmonary Disease Exacerbations

Vasques

Camporota

Barrett

2020

Semin Respir Crit Care Med

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Severe, acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are a rapid deterioration of the respiratory symptoms of patients with COPD, requiring hospital admission and escalation of pharmacological and nonpharmacological care including the more severe cases of respiratory failure and admission to an intensive care unit (ICU). These events severely impact patients' quality of life and prognosis. This review will describe the nonantibiotic, pharmacological treatment options available for critically ill patients with AECOPD. The aim of treatment is to alleviate symptoms, improve patient's functional and respiratory status, reduce mortality, reduce the risk or the duration of invasive mechanical ventilation, and prevent reexacerbations. Inhaled bronchodilators (i.e., short-acting β2-agonists and anticholinergics) and systemic corticosteroids are the main drugs used in the treatment of AECOPD. These drugs are also used in the treatment of stable COPD and in the treatment of AECOPD patients in the non-ICU or community setting. Other drugs are essentially only used in the ICU setting such as inhaled anesthetic agents, ketamine, intravenous methylxanthines, and magnesium. Finally, recently developed drugs, such as the specific phosphodiesterase-4 inhibitors, may play a role in the prevention of relapsing AECOPD following a critical event than the treatment of the exacerbation itself. Although they significantly improve the survival of critically ill patients with AECOPD, none of available drugs, alone or combined, is able to significantly modify the prognosis of patients with COPD. This remains an open challenge for the current and future generations of researchers and clinicians.

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“…Günümüze değin literatürde KOAH alevlenmelerinde IV, nebül veya her iki yolla birlikte uygulanan MS'nin etkinliğini değerlendiren yalnızca beş plasebo kontrollü çalışma bulunmaktadır (7)(8)(9)(10)(11). Bu çalışmaların üç tanesinde, MS tedavisinin PEFR ve/ veya FEV 1 ile ölçülen hava yolu obstrüksiyonu deği-şikliği yönünden standart medikal tedaviye ek katkı sağlamadığı saptanmıştır (9-11).…”

Section: Uygulanan öLçümler Ve Takip Parametreleriunclassified

“…Bu doz önceki bir astım çalışması baz alınarak belirlendi (17). KOAH alevlenmelerinde nebül MS tedavisinin etkinliğinin değerlendirildiği diğer çalışmalarda da aynı dozun kullanıldığı görülmektedir (9,10). KOAH alevlenmelerinde nebül MS için optimum doz konusunda da henüz yeterli veri bulunmamaktadır.…”

Section: Uygulanan öLçümler Ve Takip Parametreleriunclassified

Efficiency of nebulised magnesium sulphate in infective exacerbations of chronic obstructive pulmonary disease

Cömert¹,

Kıyan²,

Okumuş³

et al. 2016

Tuberk Toraks

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ÖZET [-%23.8 (13.6)], plasebo grubuna [-%9.4 (12.9)] kıyasla anlamlı üstünlük saptandı (p= 0.002). Birinci günde MS grubunda plasebo grubuna kıyasla 10. dakika [4.7 (7.5) ve -3.5 (6.0) Magnezyum, kalsiyum aracılıklı bronş düz kası kasıl-masını, kolinerjik sinir uçlarından asetilkolin ve mast hücrelerinden histamin salınımını engelleme gibi farklı mekanizmalarla bronkodilatör etki gösterebilen bir katyondur (3,4). Magnezyumun solunum kas fonksiyonları üzerine faydalı etkileri olduğu da saptanmıştır (5). Bugün için uluslararası klavuzlarda intravenöz (IV) yolla uygulanan magnezyum sülfat (MS)'ın standart medikal tedaviye yanıt alınamayan ağır astım ataklarında ek tedavi yöntemi olarak kullanılabileceği belirtilmektedir (6). KOAH alevlenmelerinde kullanımıy-sa henüz tavsiye edilmemektedir (1). KOAH alevlenmelerinde MS'nin etkinliğini inceleyen farklı metodolojilerin kullanıldığı az sayıda klinik çalışmada çeliş-kili sonuçlar elde edildiği görülmektedir (Tablo 1).Nebül MS, ucuz ve kolay uygulanabilir olması, yan etkilerinin azlığı nedeniyle KOAH alevlenmelerinde ümit verici yeni bir tedavi yöntemi olabilir. Bu çalış-mayı hastanede tedavisi gereken KOAH alevlenmelerinde standart medikal tedaviye ek olarak nebül yoluyla uygulanan MS'nin etkinliğini incelemeye yönelik olarak planladık. [-23.8% (13.6)] compared with the placebo group [-9.4% (12.9)] (p= 0.002). The % changes in PEFRs at 10 minutes [4.7 (7.5) and -3.5 (6.0) MATERYAL ve METOD Hastaların Seçimi

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Use of nebulised magnesium sulphate as an adjuvant in the treatment of acute exacerbations of COPD in adults: a randomised double-blind placebo-controlled trial

Cited by 20 publications

References 35 publications

Magnesium for acute exacerbation of chronic obstructive pulmonary disease: A systematic review of randomised trials

Magnesium for acute exacerbation of chronic obstructive pulmonary disease: A systematic review of randomised trials

Nonantibiotic Pharmacological Treatment of Severe Chronic Obstructive Pulmonary Disease Exacerbations

Efficiency of nebulised magnesium sulphate in infective exacerbations of chronic obstructive pulmonary disease

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