Asia Pac Allergy.  2012 Jan;2(1):76-85. 10.5415/apallergy.2012.2.1.76.

Magnesium sulfate for acute asthma in adults: a systematic literature review

• Song WJ
• Chang YS

• KMID: 2397414
• DOI: http://doi.org/10.5415/apallergy.2012.2.1.76

Abstract

Magnesium sulfate (MgSOâ‚„) has been considered as an adjunct therapy for severe and life-threatening asthma exacerbation. The literature search was performed using MEDLINE, EMBASE, Cochrane Library and Google Scholar to summarize the current state of knowledge regarding magnesium therapy in acute exacerbation of adult asthma. A total of 16 trials and 4 meta-analyses were identified. As results, intravenous MgSOâ‚„ was beneficial in severe exacerbation, but evidence for nebulized magnesium was insufficient. However, larger trials are required to draw confirmative conclusions on the efficacy. Regarding the safety concern, the risk of major toxicity appears to be very low at usual doses described in the literature. Additionally, results from 4 surveys were examined on the gaps between knowledge and practice, and on the barrier to the use of MgSOâ‚„ at emergency departments. This literature review summarized the up-to-date evidence on the issues regarding the use of MgSOâ‚„ for acute asthma. We expect more studies to be conducted for evidence making in the Asian-Pacific regions.

Keyword

Asthma; Magnesium sulfate; Emergency treatment; Review

MeSH Terms

Adult*
Asthma*
Emergency Service, Hospital
Emergency Treatment
Humans
Magnesium Sulfate*
Magnesium*
Magnesium
Magnesium Sulfate

Reference

1. Spivey WH, Skobeloff EM, Levin RM. Effect of magnesium chloride on rabbit bronchial smooth muscle. Ann Emerg Med. 1990; 19:1107–1112.

2. Gourgoulianis KI, Chatziparasidis G, Chatziefthimiou A, Molyvdas PA. Magnesium as a relaxing factor of airway smooth muscles. J Aerosol Med. 2001; 14:301–307.

3. Bois P. Effect of magnesium deficiency on mast cells and urinary histamine in rats. Br J Exp Pathol. 1963; 44:151–155.

4. Del Castillo J, Engbaek L. The nature of the neuromuscular block produced by magnesium. J Physiol. 1954; 124:370–384.

5. Classen HG, Jacob R, Schimatschek H. Interaction of magnesium with direct and indirect-acting sympathomimetic amines. Magnes Bull. 1987; 9:80–87.

6. Kowal A, Panaszek B, Barg W, Obojski A. The use of magnesium in bronchial asthma: a new approach to an old problem. Arch Immunol Ther Exp (Warsz). 2007; 55:35–39.

7. Okayama H, Aikawa T, Okayama M, Sasaki H, Mue S, Takishima T. Bronchodilating effect of intravenous magnesium sulfate in bronchial asthma. JAMA. 1987; 257:1076–1078.

8. McNamara RM, Spivey WH, Skobeloff E, Jacubowitz S. Intravenous magnesium sulfate in the management of acute respiratory failure complicating asthma. Ann Emerg Med. 1989; 18:197–199.

9. Skobeloff EM, Spivey WH, McNamara RM, Greenspon L. Intravenous magnesium sulfate for the treatment of acute asthma in the emergency department. JAMA. 1989; 262:1210–1213.

10. Global Strategy for Asthma Management and Prevention. Global Initiative for Asthma (GINA). Updated 2010. Available from: http://www.ginasthma.com.

11. Expert Panel Report 3 (EPR3): Guidelines for the Diagnosis and Management of Asthma : summary report 2007. National Asthma Education and Prevention Program (National Heart Lung and Blood Institute). Bethesda, MD: U.S. Dept. of Health and Human Services, National Institues of Health, National Heart, Lung, and Blood Institute;Updated 2008. Available from: http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm.

12. British Guideline on the Management of Asthma 2008. British Thoracic Society, Scottish Intercollegiate Guidelines Network. Revised 2011. Available from: http://www.brit-thoracic.org.uk/guidelines/asthmaguidelines.aspx.

13. Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, McQuay HJ. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996; 17:1–12.

14. Green SM, Rothrock SG. Intravenous magnesium for acute asthma: failure to decrease emergency treatment duration or need for hospitalization. Ann Emerg Med. 1992; 21:260–265.

15. Singh AK, Gaur S, Kumar R. A randomized controlled trial of intravenous magnesium sulphate as an adjunct to standard therapy in acute severe asthma. Iran J Allergy Asthma Immunol. 2008; 7:221–229.

16. Kokturk N, Turktas H, Kara P, Mullaoglu S, Yilmaz F, Karamercan A. A randomized clinical trial of magnesium sulphate as a vehicle for nebulized salbutamol in the treatment of moderate to severe asthma attacks. Pulm Pharmacol Ther. 2005; 18:416–421.

17. Mohammed S, Goodacre S. Intravenous and nebulised magnesium sulphate for acute asthma: systematic review and meta-analysis. Emerg Med J. 2007; 24:823–830.

18. Gallegos-Solórzano MC, Pérez-Padilla R, Hernández-Zenteno RJ. Usefulness of inhaled magnesium sulfate in the coadjuvant management of severe asthma crisis in an emergency department. Pulm Pharmacol Ther. 2010; 23:432–437.

19. Bradshaw TA, Matusiewicz SP, Crompton GK, Innes JA, Greening AP. Intravenous magnesium sulphate provides no additive benefit to standard management in acute asthma. Respir Med. 2008; 102:143–149.

20. Rowe BH, Bretzlaff JA, Bourdon C, Bota GW, Camargo CA Jr. Magnesium sulfate for treating exacerbations of acute asthma in the emergency department. Cochrane Database Syst Rev. 2000; CD001490.

21. Rodrigo G, Rodrigo C, Burschtin O. Efficacy of magnesium sulfate in acute adult asthma: a meta-analysis of randomized trials. Am J Emerg Med. 2000; 18:216–221.

22. Blitz M, Blitz S, Beasely R, Diner BM, Hughes R, Knopp JA, Rowe BH. Inhaled magnesium sulfate in the treatment of acute asthma. Cochrane Database Syst Rev. 2005; CD003898.

23. Aggarwal P, Sharad S, Handa R, Dwiwedi SN, Irshad M. Comparison of nebulised magnesium sulphate and salbutamol combined with salbutamol alone in the treatment of acute bronchial asthma: a randomised study. Emerg Med J. 2006; 23:358–362.

24. Elliott JP, Lewis DF, Morrison JC, Garite TJ. In defense of magnesium sulfate. Obstet Gynecol. 2009; 113:1341–1348.

25. Mathew R, Altura BM. Magnesium and the lungs. Magnesium. 1988; 7:173–187.

26. Tiffany BR, Berk WA, Todd IK, White SR. Magnesium bolus or infusion fails to improve expiratory flow in acute asthma exacerbations. Chest. 1993; 104:831–834.

27. McLaughlin SA, McKinney PE. Antacid-induced hypermagnesemia in a patient with normal renal function and bowel obstruction. Ann Pharmacother. 1998; 32:312–315.

28. Onishi S, Yoshino S. Cathartic-induced fatal hypermagnesemia in the elderly. Intern Med. 2006; 45:207–210.

29. Schoeffel RE, Anderson SD, Altounyan RE. Bronchial hyperreactivity in response to inhalation of ultrasonically nebulised solutions of distilled water and saline. Br Med J (Clin Res Ed). 1981; 283:1285–1287.

30. Boulet LP, Legris C, Thibault L, Turcotte H. Comparative bronchial responses to hyperosmolar saline and methacholine in asthma. Thorax. 1987; 42:953–958.

31. Hill J, Britton J. Dose-response relationship and time-course of the effect of inhaled magnesium sulphate on airflow in normal and asthmatic subjects. Br J Clin Pharmacol. 1995; 40:539–544.

32. Britton J, Pavord I, Richards K, Wisniewski A, Knox A, Lewis S, Tattersfield A, Weiss S. Dietary magnesium, lung function, wheezing, and airway hyperreactivity in a random adult population sample. Lancet. 1994; 344:357–362.

33. McLean RM. Magnesium and its therapeutic uses: a review. Am J Med. 1994; 96:63–76.

34. Kazaks AG, Uriu-Adams JY, Albertson TE, Shenoy SF, Stern JS. Effect of oral magnesium supplementation on measures of airway resistance and subjective assessment of asthma control and quality of life in men and women with mild to moderate asthma: a randomized placebo controlled trial. J Asthma. 2010; 47:83–92.

35. Gontijo-Amaral C, Ribeiro MA, Gontijo LS, Condino-Neto A, Ribeiro JD. Oral magnesium supplementation in asthmatic children: a double-blind randomized placebo-controlled trial. Eur J Clin Nutr. 2007; 61:54–60.

36. Zervas E, Papatheodorou G, Psathakis K, Panagou P, Georgatou N, Loukides S. Reduced intracellular Mg concentrations in patients with acute asthma. Chest. 2003; 123:113–118.

37. Rowe BH, Camargo CA Jr. The use of magnesium sulfate in acute asthma: rapid uptake of evidence in North American emergency departments. J Allergy Clin Immunol. 2006; 117:53–58.

38. Schuh S, Macias C, Freedman SB, Plint AC, Zorc JJ, Bajaj L, Black KJ, Johnson DW, Boutis K. North American practice patterns of intravenous magnesium therapy in severe acute asthma in children. Acad Emerg Med. 2010; 17:1189–1196.

39. Jones LA, Goodacre S. Magnesium sulphate in the treatment of acute asthma: evaluation of current practice in adult emergency departments. Emerg Med J. 2009; 26:783–785.

40. Babl FE, Sheriff N, Borland M, Acworth J, Neutze J, Krieser D, Ngo P, Schutz J, Thomson F, Cotterell E, Jamison S, Francis P. Paediatric acute asthma management in Australia and New Zealand: practice patterns in the context of clinical practice guidelines. Arch Dis Child. 2008; 93:307–312.

41. Ohta K, Makino S, Adachi M, Kihara N, Nakajima S, Nishima S, Fukuda T, Miyamoto T. Prospective survey on safety evaluation of injectable methylxanthines in Japan. Allergol Int. 2006; 55:295–299.

42. Silverman RA, Osborn H, Runge J, Gallagher EJ, Chiang W, Feldman J, Gaeta T, Freeman K, Levin B, Mancherje N, Scharf S. IV magnesium sulfate in the treatment of acute severe asthma: a multicenter randomized controlled trial. Chest. 2002; 122:489–497.

43. Bijani K, Moghadamnia AA, Islami Khalili E. Intravenous magnesium sulfate as an adjunct in the treatment of severe asthmatic patients non-responding to conventional therapy. Acta Medica Iranica. 2001; 39:219–221.

44. Porter RS, Nester BA, Braitman LE, Geary U, Dalsey WC. Intravenous magnesium is ineffective in adult asthma, a randomized trial. Eur J Emerg Med. 2001; 8:9–15.

45. Boonyavorakul C, Thakkinstian A, Charoenpan P. Intravenous magnesium sulfate in acute severe asthma. Respirology. 2000; 5:221–225.

46. Bloch H, Silverman R, Mancherje N, Grant S, Jagminas L, Scharf SM. Intravenous magnesium sulfate as an adjunct in the treatment of acute asthma. Chest. 1995; 107:1576–1581.

47. Hughes R, Goldkorn A, Masoli M, Weatherall M, Burgess C, Beasley R. Use of isotonic nebulised magnesium sulphate as an adjuvant to salbutamol in treatment of severe asthma in adults: randomised placebo-controlled trial. Lancet. 2003; 361:2114–2117.

48. Bessmertny O, DiGregorio RV, Cohen H, Becker E, Looney D, Golden J, Kohl L, Johnson T. A randomized clinical trial of nebulized magnesium sulfate in addition to albuterol in the treatment of acute mild-to-moderate asthma exacerbations in adults. Ann Emerg Med. 2002; 39:585–591.

49. Nannini LJ Jr, Pendino JC, Corna RA, Mannarino S, Quispe R. Magnesium sulfate as a vehicle for nebulized salbutamol in acute asthma. Am J Med. 2000; 108:193–197.

50. Asthma Management Handbook. National Asthma Council Australia. 2006. Available from: http://www.nationalasthma.org.au/uploads/handbook/370-amh2006_web_5.pdf.

51. Jindal SK, Gupta D, Aggarwal AN, Agarwal R. Guidelines for management of asthma at primary and secondary levels of health care in India. Indian J Chest Dis Allied Sci. 2005; 47:309–343.

52. Ohta K, Yamaguchi M, Akiyama K, Adachi M, Ichinose M, Takahashi K, Nishimuta T, Morikawa A, Nishima S. Japanese guideline for adult asthma. Allergol Int. 2011; 60:115–145.

53. Korean Asthma Management Guideline for Adults. Korean Academy of Asthma, Allergy and Clinical Immunology. Revised 2011. Available from: http://www.allergy.or.kr/file/2011_new.pdf.