ABSTRACT
A recent study of magnesium sulfate in children with acute severe asthma is of interest. The investigators compared the efficacy of intravenous magnesium sulfate 25 mglkg (maximum of 2 g) given over 20 min with placebo in 31 children with acute asthma in an emergency department (114). The improvement in FEV 1 was 34% over baseline 30 min following the infusion of magnesium sulfate and 75% at 90 min following the infusion, compared with no change and 5% for placebo at similar time periods. Patients were entered only if they had not achieved 60% of predicted PEF after three nebulizations of 0.15 mglkg per dose of albuterol. Unfortunately, as with the previous studies in adults (I 04, I 05,11 0), the investigators did not continue aggressive administration of inhaled ~2 agorusts. Although the improvements in FEV 1 seem large, they are represented as percentage improvement over baseline and only represent further incremental improvements of 10 and 25% of predicted FEV 1 respectively. Thus, it remains to be determine whether the addition of magnesium sulfate to the currently recommended optimal inhaled ~2 agonist therapy adds additional bronchodilation or improves outcome in children with acute severe asthma.
