PURPOSE:Background: Though studies have shown that inhaled Magnesium Sulphate(MgS04) has additive effect on pulmonary function to beta-2 agonists, its additive benefit in face of combination tharapy with beta-2-agonists and ipratropium(standard therapy of severe acute exacerbation of asthma) remains unclear. Aim:To evaluate the role of inhaled MgSo4 when used as an adjunct to standard therapy of severe exacerbations of asthma.
METHODS:Randomized,single blinded,placebo-controlled study was carried out in an Emergency department of a tertiary referral centre in India. Patients aged 18–60 years presenting with acute asthma and FEV1 < 30 % predicted (pred.) were included. All patients received IV Hydrocortisone on arrival. In group 1 (controls), patients were nebulised with salbutamol and ipratropium using isotonic saline as vehicle thrice at 20 minutes interval. In group 2 patients were nebulised similarly, but using isotonic MgSO4 (3ml of 3.2 gm%)as vehicle. FEV1 was evaluated at baseline and at 30 minutes interval till end of study (120 minutes). The primary efficacy end point was FEV1% pred. at 120 mins and pooled discharge rate (derived from comparing proportion of groups attaining PEFR >60% pred and relief in dyspnea at 30, 60, 90, 120 minutes).
RESULTS:Both groups of 30 patients each, were matched with respect to demographic and pulmonary parameters at baseline (Baseline FEV1% : 22.3+4.7% in group 2 vs. 22+5.2% in group1, p=0.87). At 120 minutes,there was a higher mean FEV1 % pred (60.3+4.8% vs. 57.7+4.5%) and %improvement from baseline (of 37.97+2.52% vs35.77+3.16%), in group 2 as compared to group1 (Mean Difference=2.2%, C.I.0.32–4.08, p=0.02). The pooled discharge rate in group 2 with respect to group 1 was positive but non-significant. (log rank.=1.07, p=0.1).
CONCLUSION:Inhaled MgSO4 improves pulmonary function but does not reduce admission rates, when used as an adjunct to standard therapy in severe acute asthma.
CLINICAL IMPLICATIONS:Isotonic MgSO4 can be act as an effective adjunct when used as a vehicle for nebulisation instead of normal saline in severe exacerbations of asthma..
DISCLOSURE:Shailendra Gaur, No Financial Disclosure Information; No Product/Research Disclosure Information