Treatment of Acute Severe Asthma by Intravenous Magnesium Sulfate in Patients Non-responsive to Established Therapy

Abstract

Objective: To appraise the use of magnesium sulfate in improving pulmonary function thereby eliminating the need for hospitalization during severe asthma attack. Methods: A Randomized Placebo controlled trial was performed at the Liaquat University Hospital, Pulmonary ward Jamshoro / Hyderabad. Patients between the ages of 18-60, reporting to the emergency or intensive care unit were recruited to participate in the study after signing of the consent form. Inclusion criteria was, acute asthmatics with forced expulsion volume (FEV)1 < 30% on arrival at the emergency department. As an emergency treatment, all patients received nebulized salbutamol. Ipratropium Bromide and intravenous hydrocortisone herni succinate. A total of two gram (2gm) of intravenous magnesium sulfate or placebo were administrated 30 minutes after arrival at emergency department. Change in FEV 1 at 180 minutes was used to measure the efficacy of magnesium sulfate instead of conventional therapy. Data was analyzed using statistical software. Results: A total of 44 participants were recruited for the study. The mean FEV1 was measured at the time of admission to the emergency department. The mean FEV measured post-emergency department arrival was found to be 24.9%. Patients receiving magnesium sulfate showed an FEV of 46.2% in comparison to 41.5% in group treated with the placebo. Patients with lower initial FEV1 showed the most different after magnesium sulfate infusion, where FEV1 increased from < 25%.The effect of magnesium Sulfate compared to placebo was greater in patients with a lower initial FEV 1, where FEV 1 increased from < 25% expected, to 47.2% predicted in group treated with Magnesium as compared to 36.8% expected in the group treated with placebo. Administration of magnesium sulfate to patients with FEV1 > 25 resulted in increase in FEV1 that was comparable to the placebo group (52.2% in magnesium sulfate group compared to 55.6% in placebo group). Conclusion: Our results indicated that inclusion of magnesium sulfate to the therapeutic regimen facilitated pulmonary function by significantly improving FEV1 in server acute asthma patients that were previously non-responsive to conventional treatment.