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

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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.

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Data availability

No datasets were generated or analysed during the current study.

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Acknowledgements

We thank Dr. Rhanderson Cardoso and Dr. Julyana Dantas for their continuous support and guidance on this project.

Author information

Authors and Affiliations

  1. Centro Universitario Lusiada, Rua Oswaldo Cruz, 179 - Boqueirão, Santos, SP, 11045-101, Brazil

    Luísa Cunha

  2. Universitat Internacional de Catalunya, Barcelona, Spain

    Meritxell Roca Mora

  3. Faisalabad Medical University, Faisalabad, Punjab, Pakistan

    Farhan Afzal

  4. Faculdade de Medicina de Petropolis, Petropolis, RJ, Brazil

    Giulia M. Cesar

  5. Universidade Federal de Ouro Preto, Ouro Preto, MG, Brazil

    Catharina Ribeiro Guimarães

  6. State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil

    Julia Pereira Muniz Pontes

  7. Universidade Federal de Santa Maria, Santa Maria, RS, Brazil

    Gabriel Grando Alves

  8. Pediatrics Department, Centro Universitário Lusíada, Santos, SP, Brazil

    Antonio Carlos Fonseca Silveira

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  1. Luísa Cunha
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Contributions

All authors contributed to the study conception and design. L.C., M.M., F.A. and G.C. prepared study material. L.C. and G.C. screened databases for reports. L.C., M.M. and F.A. extracted data from studies and L.C. performed statistical analysis. L.C., M.M. and G.A. performed bias assessment. L.C. and J.P. prepared figures and tables 1-3. L.C., A.S. and C.G. wrote the main manuscript text and all authors reviewed the manuscript.

Corresponding author

Correspondence to Luísa Cunha.

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This is a systematic review and meta-analysis. No ethical approval was required as no new patient data was collected.

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All authors report no relationships that could be construed as a conflict of interest. All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

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Communicated by Peter de Winter

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Cunha, L., Mora, M.R., Afzal, F. et al. Standard medical therapy with vs. without nebulised magnesium for children with asthma decompensation. Eur J Pediatr (2024). https://doi.org/10.1007/s00431-024-05517-3

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