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Nebulised magnesium has no effect on hospitalisation in acute refractory asthma

Giving intravenous magnesium to children with acute, severe asthma has been shown to reduce hospitalisations from an emergency department.

Whether using nebulised magnesium provides similar benefits is largely unknown from currently available studies.

For this study, a team from the Department of Paediatric Emergency medicine, Toronto, Canada, sought to determine if nebulised magnesium sulfate reduced the need for hospitalisation among a group of children, admitted to an emergency department with acute, severe asthma. All children received standardised therapy which included an oral corticosteroid, inhaled albuterol and ipratropium bromide given via a metered dose inhaler or nebuliser. Children who had persistent moderate to severe asthma, one hour after this initial therapy were defined using the paediatric respiratory assessment measure (PRAM) score, which is a 12-point measurement tool (with higher scores indicating higher asthma disease severity), that provides an objective score of asthma exacerbation severity, to help clinicians decide whether or not to admit a child into hospital. For inclusion in the study, participants were randomised to receive 3 consecutive nebulisation treatments with albuterol and either nebulised magnesium or saline and defined by a PRAM score of 5 or more. The primary outcome for the study was physicians’ decision to hospitalise a child for persistent respiratory distress or the need for supplemental oxygen within 24 hours of randomisation. A secondary outcome was the change in PRAM score from baseline to 240 minutes.


A total of 818 children with a median age of 5 years (63% male), were randomised to 3 doses of albuterol and nebulised magnesium sulfate (410) or albuterol and saline (408). Overall, 178 of those given magnesium sulfate (43.5%) were hospitalised compared to 194 (47.7%) of those given saline. (absolute difference = -4.2%, 95% CI -11% to 2.8%, p = 0.26). In addition, there was no significant difference in changes from baseline in the PRAM scores (difference = 0.14 points, 95% CI -0.23 to 0.50, p = 0.46). The authors concluded that the use of nebulised magnesium with albuterol was no better than saline and did not reduce hospital admissions in children with refractory acute asthma.

Citation Schuh S et al. Effect of nebulised magnesium vs placebo added to albuterol on hospitalisation among children with refractory acute asthma treated in the emergency department. A randomised clinical trial. JAMA 2020 doi:10.1001/jama.2020.19839