Can nebulized magnesium reduce hospitalizations because of asthma?

Intravenous magnesium has been used to decrease hospitalizations because of refractory acute asthma, although it does have some safety concerns. A report in JAMA looks at whether using nebulized magnesium in the emergency department could be effective in reducing hospitalization among children who were in moderate or severe respiratory distress after being administered evidence-based standardized initial therapy.¹

The investigators ran a randomized double-blind parallel-group clinical trial from September 2011 to November 2019 in 7 tertiary-care pediatric emergency departments across Canada. Each participant was an otherwise healthy child aged 2 to 17 years who had moderate to severe asthma as defined by a Pediatric Respiratory Assessment Measure score of 5 or greater following standard treatment. Standard treatment was a 1-hour treatment with an oral corticosteroid and 3 inhaled albuterol and ipratropium treatments.

A total of 818 met criteria and volunteered to participate with 2 dropping out, 409 of the children were given magnesium and 407 received a placebo. Following the emergency department, 178 of the 409 children administered magnesium were hospitalized versus 194 of the 407 children who were given placebo (difference, −4.2%; absolute risk difference 95% [exact] CI, −11% to 2.8%); P = .26). No significant between-group differences changes were seen from baseline to 240 minutes in the Pediatric Respiratory Assessment Measure score (difference of changes, 0.14 points [95% CI, −0.23 to 0.50]; P = .46); respiratory rate (0.17 breaths/min [95% CI, −1.32 to 1.67]; P = .82); oxygen saturation (−0.04% [95% CI, −0.53% to 0.46%]; P = .88); systolic blood pressure (0.78 mm Hg [95% CI, −1.48 to 3.03]; P = .50); or mean number of additional albuterol treatments (magnesium: 1.49, placebo: 1.59; risk ratio, 0.94 [95% CI, 0.79 to 1.11]; P = .47). The adverse event of either nausea/vomiting or sore throat/nose happened in 17 of the children who were given magnesium and 5 of the children who were given the placebo.

The researchers concluded that using nebulized magnesium along with albuterol did not have the impact of reducing hospitalization rate for asthma that would put it in line with intravenous magnesium.

Reference

1. Schuh S, Sweeney J, Rumantir M, et al. Asthma treated in the emergency department: a randomized clinical trial. JAMA. 2020;324(20):2038-2047. doi:10.1001/jama.2020.19839