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Intravenous Magnesium Sulfate for Acute Asthma Exacerbation in Children and Adults

 

Am Fam Physician. 2021 Feb 15;103(4):245-246.

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INTRAVENOUS MAGNESIUM SULFATE FOR ACUTE ASTHMA EXACERBATION

BenefitsHarms

NNT = 5 in children (prevented hospital admission)

No adults or children had serious adverse effects

NNT = 21 in adults (prevented hospital admission)

NNT = 13 in adults with life-threatening exacerbations (prevented hospital admission)

22% lower admission rate in children

7% lower admission rate in adults

8% lower admission rate in adults with life-threatening asthma exacerbations


NNT = number needed to treat.

INTRAVENOUS MAGNESIUM SULFATE FOR ACUTE ASTHMA EXACERBATION

BenefitsHarms

NNT = 5 in children (prevented hospital admission)

No adults or children had serious adverse effects

NNT = 21 in adults (prevented hospital admission)

NNT = 13 in adults with life-threatening exacerbations (prevented hospital admission)

22% lower admission rate in children

7% lower admission rate in adults

8% lower admission rate in adults with life-threatening asthma exacerbations


NNT = number needed to treat.

Details for This Review

Study Population: Adults (n = 972, from 11 studies) and children (n = 115, from three studies) who were treated in the emergency department for acute asthma exacerbations

Efficacy End Points: Hospital admission

Harm End Points: Medication adverse effects (bradycardia, hypotension, fatigue, flushing, nausea, or headache)

Narrative:

Adults. The Cochrane review of adults identified 14 studies (n = 2,313) that met the initial inclusion criteria.1 The final analysis included data from 972 adults in 11 studies. Three studies were excluded because both adults and children participated, and data pertaining only to adults were not provided. All participants presented to the emergency department with an asthma exacerbation, although definitions and inclusion criteria varied. In eight of the studies, patients received a single 2-g infusion of intravenous magnesium sulfate; in the remaining three studies, patients received a 1.2-g infusion. All participants were rated for degree of exacerbation severity, which was then verified using British Thoracic Society/Scottish Intercollegiate Guidelines Network (BTS/SIGN) criteria.2 All of the studies included exacerbations of at least moderate severity.

The Cochrane review revealed a significant reduction in hospital admissions in all adults, regardless of asthma severity, who received intravenous magnesium sulfate compared with those who received placebo (50% vs. 57%; number needed to treat [NNT] = 21; odds ratio [OR] = 0.75; 95% CI, 0.60 to 0.92; high-quality evidence). Subgroup analysis of adults who initially presented with life-threatening asthma (based on 2012 BTS/SIGN cr

Author disclosure: No relevant financial affiliations.


Copyright ©2021 MD Aware, LLC (theNNT.com). Used with permission.

This series is coordinated by Christopher W. Bunt, MD, AFP assistant medical editor, and Daniel Runde, MD, from the NNT Group.

A collection of Medicine by the Numbers published in AFP is available at https://www.aafp.org/afp/mbtn.

References

1. Kew KM, Kirtchuk L, Michell CI. Intravenous magnesium sulfate for treating adults with acute asthma in the emergency department. Cochrane Database Syst Rev. 2014;(5):CD010909.

2. British Thoracic Society. Scottish Intercollegiate Guidelines Network. British guideline on the management of asthma. July 2019. Accessed December 10, 2020. https://www.brit-thoracic.org.uk/quality-improvement/guidelines/asthma

3. Griffiths B, Kew KM. Intravenous magnesium sulfate for treating children with acute asthma in the emergency department. Cochrane Database Syst Rev. 2016;(4):CD011050.

 

 

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