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Abstract
A short cut review was carried out to establish whether the addition of intravenous magnesium to standard treatments improved outcome in patients with exacerbations of COPD. Altogether 465 papers were found using the reported search, of which one presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of this best paper are tabulated. A clinical bottom line is stated.
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Report by Rachel Jenner, Specialist Registrar Checked by Richard Body, Senior House Officer
Clinical scenario
A 65 year old man presents to the emergency department with an exacerbation of COPD. You are aware that intravenous magnesium is used as a bronchodilator in acute severe asthma and wonder if it would benefit this patient.
Three part question
In [patients with an exacerbation of COPD] does [the addition of intravenous magnesium to conventional treatments] improve [PEFR or discharge rate or morbidity or mortality]?
Search strategy
Medline 1966-11/03 using the Ovid interface, including non-indexed citations and Medline in progress. [exp Magnesium or magnesium.mp] AND [exp Pulmonary Disease, Chronic Obstructive OR COPD.mp OR COAD.mp OR exp Lung Diseases] LIMIT to human AND English
Search outcome
Altogether 465 papers were found of which one was relevant (see table 4).
Comment(s)
There is only one small study addressing this question and it excludes patients with acute infection, which is one of the commonest causes of exacerabtion of COPD. However, it does show a small significant improvement in PEFR with intravenous magnesium. The clinical significance of this change may be small but seems to show a non-significant trend towards a reduced rate of admission. A larger trial including patients with signs of acutre infection would be helpful.
CLINICAL BOTTOM LINE
Intravenous magnesium is worth considering in patients with an exacerbation of COPD.
Report by Rachel Jenner, Specialist Registrar Checked by Richard Body, Senior House Officer