6236 Effect of nebulized magnesium sulphate in children with acute exacerbation of bronchial asthma

Objectives This study aimed to compare the clinical outcome of nebulized isotonic magnesium sulphate along with standard treatment in hospitalized children with acute exacerbation of asthma who received standard treatment only. Methods A randomized double blind, controlled clinical trial was conducted in medical units of Yankin Children's Hospital from November 2021 to January 2023. Total ninety-three children who met the inclusion criteria were recruited and randomly assigned to receive either combination of nebulized MgSO4 and salbutamol or combination of nebulized salbutamol and normal saline. Pediatric Respiratory Assessment Measure (PRAM) score was used to assess improvement before and after intervention.1 2 Each group received either nebulized MgSO4 or nebulized salbutamol for three times at 20 min interval.1–3 The changes in score and other short-term measures such as additional requirement for intravenous bronchodilators and additional nebulized salbutamol and length of stay in hospital were observed. Results The major findings of the study were an overall faster reduction in the symptomatic scores as measured with PRAM scores, hospital stay and requirement of additional nebulizer doses in children who received combination of nebulized MgSO4 and salbutamol compared to those who received combination of nebulized salbutamol and normal saline. In this study, post-inhalation clinical severity score was significantly lower than pre-inhalation values for both groups during study period. Improvement percentage of clinical severity score was better in study group than control group. However, additional intravenous bronchodilator requirement is not different between two study groups. The mean length of stay in hospital also differed significantly between the two groups 1.48 ± .781 days in nebulized Magnesium Sulphate and salbutamol combination group and 4.63 ± 2.727 days in nebulized salbutamol and saline group. Conclusion This study clearly demonstrated that the study group was superior in improvement of severity clinical score and also shorter length of stay in hospital. In addition, there was no difference in safety profile between two groups. References Alansari K, Ahmed W, Davidson BL, Alamri M, Zakaria I, Alrifaai M. Nebulized magnesium for moderate and severe pediatric asthma: A randomized trial: Pediatr Pulmonol: 2015;50: 1191–1199. Gourgoulianis KI, Chatziparasidis G, Chatziefthimiou A, Molyvdas PA. Magnesium as a relaxing factor of airway smooth muscles. Journal of Aerosol Medicine 2001a;14:301–307. Powell C, Kolamunnage-Dona R, Lowe J, Boland A, Petrou S, Doull I, Hood K, Williamson P. Magnesium sulphate in acute severe asthma in children (MAGNETIC): a randomised, placebo-controlled trial. The Lancet Respiratory Medicine 2013;1:301–30. Powell CVE, Kolamunnage-Dona R, Lowe J, Boland A, Petrou S, Doull I, et al. (2013) MAGNEsium Trial In Children (MAGNETIC): a randomised, placebo-controlled trial and economic evaluation of nebulised magnesium sulphate in acute severe asthma in children. Health Technol Assess 2013;17(45). Schuh S, Sweeney J, Rumantir M, Coates AL, Willan AR, Stephens D, Atenafu EG, Finkelstein Y, Thompson G, Zemek R. Pediatric Emergency Research Canada (PERC) Network. Effect of Nebulized Magnesium vs placebo added to albuterol on hospitalization among children with refractory acute asthma treated in the emergency department. JAMA 2020;324:2038–2047.