Standard Medical Therapy With vs. Without Nebulised Magnesium for Children with Asthma Decompensation

Abstract

Abstract Background: 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 exacerbation is still unclear. Objective: To compare nebulised magnesium with standard medical therapy (SMT) vs. SMT alone for children with decompensated asthma. Methods: PubMed, Embase, and Cochrane Library were systematically searched for randomised controlled 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. Results: 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 28.7% patients were male. Children treated with magnesium had a significantly higher % predicted PEFR (mean difference [MD] 5.3%; 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 improved % predicted PEFR and led to a marginal improvement in respiratory rate as compared with SMT alone.