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Nebulised magnesium sulfate fails to prevent admission to hospital in those with acute refractory asthma

Although intravenous magnesium given to children with acute, severe asthma reduces the need for hospitalisation, it is unclear whether nebulising the drug provides a similar benefit.

A team from the Department of Paediatric Emergency Medicine, Toronto, Canada, undertook a randomised, placebo-controlled trial to determine if nebulised magnesium sulfate could reduce the need for hospitalisation among a group of children, admitted to an emergency department with acute, severe asthma. All children received standardised therapy which included an oral corticosteroid, inhaled albuterol and ipratropium bromide given via a metered dose inhaler or nebuliser. Children were eligible for inclusion in the trial if they continued with persistent moderate to severe asthma, one hour after this initial therapy. Their disease severity was assessed using the paediatric respiratory assessment measure (PRAM) score. This 12-point measurement tool (with higher scores indicating higher asthma disease severity), provides an objective score of asthma exacerbation severity, to help clinicians decide whether or not to admit a child into hospital. Children were required to have a score of 5 or more to be included in the trial. The study protocol involved all children being randomised to receive three consecutive nebulisation treatments with albuterol and either nebulised magnesium or saline. The primary outcome for the study was physicians’ decision to hospitalise a child for persistent respiratory distress or the need for supplemental oxygen within 24 hours of randomisation. A secondary outcome was the change in PRAM score from baseline to 240 minutes.


A total of 818 children with a median age of 5 years (63% male), were randomised to nebulised magnesium sulfate (410) or albuterol and saline (408). Overall, 178 of those given magnesium sulfate (43.5%) were hospitalised compared to 194 (47.7%) of those given saline. (absolute difference = -4.2%, 95% CI -11% to 2.8%, p = 0.26). In addition, there was no significant difference in changes from baseline in the PRAM scores (difference = 0.14 points, 95% CI -0.23 to 0.50, p = 0.46). The authors concluded that the use of nebulised magnesium with albuterol was no better than saline and did not reduce hospital admissions in children with refractory acute asthma.

Citation Schuh S et al. Effect of nebulised magnesium vs placebo added to albuterol on hospitalisation among children with refractory acute asthma treated in the emergency department. A randomised clinical trial JAMA 2020 doi:10.1001/jama.2020.19839

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