Intravenous magnesium sulfate administration reduces the frequency of hospitalization in adults presenting refractory asthma attacks resistant to conventional treatment in the emergency department

SOURCE
Kew KM, Kirtchuk L, Michell CI. (2014). Intravenous magnesium sulfate for treating adults with acute asthma. Cochrane Database Syst Rev 5:CD010909

CONTEXT
In asthma attacks resistant to conventional treatment (inhaled beta-2-mimetics and ipratropium), magnesium sulfate (MgSO4) is often used without any validated data in the literature.

CLINICAL QUESTION
Is the use of MgSO4 intravenously to treat an asthma attack resistant to conventional treatment in adults effective and safe?

BOTTOM LINE
The hospitalization rate is significantly reduced in patients treated with MgSO4 intravenously compared to placebo (high level of evidence), which corresponds to reduce seven hospitalizations per 100 adults treated. Heart rate and lung function are significantly improved by MgSO4. The other evaluation criteria (admission to intensive care, duration of hospitalization, readmission) did not show any significant difference in case of treatment by MgSO4 or not. Although secondary effects such as flush, headache, nausea, hypotension and fatigue have been reported, no statistical analysis could be performed.

CAVEAT
A single infusion of 1.2 to 2 g of MgSO4 intravenously in adults with refractory asthma attacks to first-line treatments is justified. However, the various meta-analyses carried out showed the existence of moderate to significant heterogeneity that could not be removed by the subgroup analyses.

AUTHOR INFORMATION

Daniel MEYRAN
Bataillon de Marins Pompiers de Marseille, groupement santé
Marseille, France
daniel.meyran@me.com

Julie DUMOUCHEL
Centre Hospitalo-Universitaire de TOURS
Tours, France
dumouchel.julie76@yahoo.fr

Tanveer Ahmed YADGIR
Fatima College of Health Sciences
Al Ain, United Arab Emirates
drtanveer2008@gmail.com