What type of study is this?

This is a Meta-Analysis study (also classified as: Systematic Review).

August 17, 2025Open Access

Effectiveness of Intravenous and Nebulized MgSO4 in Children with Asthma Exacerbation: A Systematic Review and Meta-Analysis of Clinical Trials

Key Points

Use of magnesium sulfate significantly reduced hospitalization risk (RR: 0.79) in children with asthma exacerbation, providing a promising second-line treatment option.
308 patients were included in the major findings from fourteen randomized controlled trials evaluating magnesium sulfate efficacy in pediatric asthma.
Meta-analysis assessed multiple outcomes, including severity score and hospital stay length, but found no significant changes in these areas after magnesium sulfate administration.
Results highlight the potential for magnesium sulfate in acute settings, though further studies are needed to confirm other clinical outcome improvements.

Abstract

Background/Objectives: Moderate or severe asthma exacerbations may require pharmacological interventions in addition to standard treatment. In this context, magnesium sulfate has been proposed as a second-line therapeutic option, owing to its physiological effects on bronchial smooth muscle. Therefore, the objective of this meta-analysis is to determine the effectiveness of intravenous or nebulized magnesium sulfate in patients with a moderate-to-severe asthmatic crisis. Methods: This systematic review and meta-analysis included randomized controlled trials published between 1990 and 2024, using the PubMed, Scopus, Science Direct, Web of Science, LILACS, Cochrane Library, Springer, and Scielo databases. The risk of bias was assessed using the RoB 2 tool, the quality of evidence with the Jadad scale, and the certainty of the evidence per outcome was evaluated following the GRADE guidelines. The meta-analysis was developed using the statistical software Jamovi 2.3.28® and RevMan 5.4®. Results: Fourteen studies with a total of 2242 patients with a moderate-to-severe asthmatic crisis were included. Of these, ten studies evaluated the severity score, eight evaluated hospitalization, five evaluated the length of the hospital stay, and three evaluated intensive care unit admission. The meta-analysis demonstrates that the use of magnesium sulfate is associated with a statistically significant reduction in the risk of hospitalization (RR: 0.79, 95% CI: from 0.67 to 0.94, p = 0.02). However, no effects were observed on the severity score (SMD: −0.37, 95% CI: from −0.92 to 0.17, p = 0.16), the length of the hospital stay (SMD: −0.75, 95% CI: from −1.90 to 0.40, p = 0.14), or admission to intensive care units (RR: 0.62, 95% CI: from 0.28 to 1.36, p = 0.23). Subgroup and sensitivity analyses did not yield significant findings or produce any modification of the effect. Conclusions: Magnesium sulfate reduces hospitalizations in moderate-to-severe pediatric asthma, although it does not improve other relevant clinical outcomes.

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