MAGNETIC is a double blind randomised placebo controlled study in acute asthma. Children between 2 and 16 years with acute severe asthma were randomized to receive standard care of three doses of nebulised salbutamol and ipratropium bromide every 20 minutes in the first hour with either placebo or nebulised magnesium (250 mmol/L, 151 mg/dose). Primary outcome was asthma severity score (ASS; 0-9) at 60 minutes post treatment; secondary outcomes were length of stay (LOS), need for intravenous (IV) bronchodilator treatment, need for PICU/intubation, stepping down of treatment at one hour, number of additional salbutamol administrations and serious adverse events. 506 children (median age 4.0 years; 58% male) were recruited from 30 centres. 251 children received treatment A and 255 children, treatment B. There were no clinical differences in baseline characteristics and no severe serious adverse events in either group. Primary and secondary outcomes Outcome Treatment A Treatment B Difference between proportions (A – B) (95% CI) p value Mean ASS T60 (SD) 4.72 (1.38) 4.95 (1.41) –0.27 (–0.50, –0.03) 0.03 Mean (SD) LOS (hours) 32 (25) 35 (27) –2.94 (–7.52, 1.64) 0.20 Need for IV treatment (%) 24/250 (10) 29/251 (12) –0.02 (–0.08, 0.04) 0.57 Additional salbutamol doses (IQR) 8 (2–13) 8 (3–14) 0.00 (–1, 1) 0.35 n=248 n=250 PICU/intubation (%) 18/243 (7) 7/252 (3) 0.05 (0.00, 0.10) 0.03 Step down to spacer treatment at one hour (%) 203/248 (82) 205/250 (82) 0.00 (–0.07, 0.07) 0.94 n=250 n=250 There was no clinically significant difference in asthma severity score at 60 minutes post treatment. Treatment B significantly reduces the likelihood of intubation and need for intensive care admission.
Colin Powell (Thu,) studied this question.