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Clinical InvestigationsASTHMAIV Magnesium Sulfate in the Treatment of Acute Severe Asthma: A Multicenter Randomized Controlled Trial
Section snippets
Study Patients
Patients between the ages of 18 years and 60 years presenting with acute asthma to the EDs of eight teaching hospitals were considered for enrollment. Patients were eligible if asthma was diagnosed in the past by a clinician and asthma medication was used during the previous 6 months. Patients were included if they had an FEV1 ≤ 30% predicted on presentation to the ED, were willing to remain in the ED for 4 h, and were able to give written informed consent. Exclusion criteria were a history of
Study Population
A total of 254 patient visits were randomized. Six patients were inadvertently enrolled twice, having appeared in different hospitals participating in the study, and only the first entry was included in the data analysis. The 248 remaining patients formed the intent-to-treat population. A number of patients randomized had protocol violations and were retained in the intent-to-treat data set. These included three patients whose initial FEV1 was > 30% predicted, three patients with chronic lung
Discussion
This multicenter trial demonstrates that 2 g of IV magnesium sulfate when administered as an adjunct to standard therapy improves pulmonary function in patients presenting to the ED with severe asthma. Overall, patients receiving magnesium had a final FEV1 of 48.2% predicted, compared to 43.5% predicted for patients receiving placebo. Patients with the most severe airway compromise on ED arrival had the greatest response to magnesium, and patients with an FEV1 on ED arrival closer to 30%
Appendix
The following investigators also participated in the trial: Thomas Kwiatkowski, Pamela Arsove, Helen Bloch, Boris Gabinskiy, Barbara Kirrane, Ruth Paiano, Scott Wolfson, and Adam Green, Long Island Jewish Medical Center; Mark Sprague, Jason Ganz, Robert Malin, Philip Hanline, and Bradley Spiegel, Lincoln Hospital Medical Center; Janet Carter and Marlow Price, Carolinas Medical Center; David Iacometta, Daniel Katzman, John Muratori, Dominick Fratello, Brian Blaufeux, and David Held, Jacobi
References (36)
- et al.
Bronchodilating effect of intravenous magnesium sulfate in acute severe bronchial asthma
Chest
(1990) - et al.
Intravenous magnesium sulfate in the management of acute respiratory failure complicating asthma
Ann Emerg Med
(1989) - et al.
Intravenous magnesium sulfate in acute, life-threatening asthma
Ann Emerg Med
(1991) - et al.
Intravenous magnesium therapy for moderate to severe pediatric asthma: results of a randomized, placebo-controlled trial
J Pediatr
(1996) - et al.
Intravenous magnesium sulfate as an adjunct in the treatment of acute asthma
Chest
(1995) - et al.
Intravenous magnesium for acute asthma: failure to decrease emergency treatment duration or need for hospitalization
Ann Emerg Med
(1992) - et al.
Magnesium bolus or infusion fails to improve expiratory flow in acute asthma exacerbations
Chest
(1993) - et al.
Rapid infusion of magnesium sulfate obviates need for intubation in status asthmaticus
Am J Emerg Med
(1994) - et al.
Effect of magnesium chloride on rabbit bronchial smooth muscle
Ann Emerg Med
(1990) - et al.
Magnesium: nature’s physiologic calcium blocker
Am Heart J
(1984)
Catecholamine-stimulated GTPase cycle: multiple sites of regulation by β-adrenergic receptor and Mg2+ studied in reconstituted receptor-Gs vesicles
J Biol Chem
Frequently nebulized β-agonists for asthma: effects on serum electrolytes
Ann Emerg
Comparison of 2.5 vs 7.5 mg of inhaled albuterol in the treatment of acute asthma
Chest
Continuous nebulization of albuterol in acute asthma
Chest
Continuous versus intermittent albuterol nebulization in the treatment of acute asthma
Ann Emerg Med
Comparison of intermittent and continuously nebulized albuterol for treatment of asthma in an urban emergency department
Ann Emerg Med
Surveillance for asthma–United States, 1960–1995
MMWR Morb Mortal Wkly Rep
National Asthma Education and Prevention Program
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2019, International Journal of Pediatrics and Adolescent MedicineCitation Excerpt :Some studies obtained minimal evidence supporting the use of nebulized magnesium sulfate, especially in severe cases, depending on the scoring system or pulmonary function results [58–63]. Recommendations: Magnesium sulfate may be given for moderate to severe asthma exacerbations in patients who exhibit minimal responses to bronchodilators and steroids. [64–70]. Recommendations: Insufficient data are available to support recommending the use of inhaled magnesium sulfate for severe asthma exacerbation.
Limitations of the results from randomized clinical trials involving intravenous and nebulised magnesium sulphate in adults with severe acute asthma
2019, Pulmonary Pharmacology and Therapeutics
This study was supported in part by a grant from the Max and Victoria Dreyfus Foundation.
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Dr. Osborn is currently with the Department of Emergency Medicine, Bronx Lebanon Medical Center, Bronx, NY. Dr. Runge is currently with the National Highway Traffic Safety Administration, United States Department of Transportation, Washington, DC. Dr. Gallagher is currently with the Department of Emergency Medicine, Albert Einstein College of Medicine, Bronx, NY. Dr. Gaeta is currently with the Department of Emergency Medicine, New York Methodist Hospital, Brooklyn, NY
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A list of investigators can be found in the Appendix