| Introduction. Despite the multitude of the available treatment options, the incidence and mortality from asthma continue to increase. Approximately 30% of patients do not adequately respond to beta2-agonists in the emergency department and may require hospital admission. In search for additional treatment options, there has been an increased interest in the bronchodilatory effects of intravenous and nebulized magnesium sulfate (MgSO4).;Objective. To compare the efficacy and safety of adding nebulized MgSO4 to standardized therapy with albuterol over that of albuterol alone in patients with mild to moderate acute asthma exacerbations.;Methods. In this double-blind, placebo-controlled trial, adult patients undergoing an acute asthma attack were randomized to receive either nebulized MgSO4 (384 mg in 6 mL) or an equal volume of placebo (normal saline) after each dose of preservative-free nebulized albuterol (2.5 mg/3mL) every 20 minutes for the first hour of the study. Spirometry and monitoring of vital signs (heart rate, respiratory rate, blood pressure), and pulse oximetry were performed at baseline and every 20 minutes for 2 hours. Serum magnesium levels were drawn at baseline, after the last study drug dose, and at the completion of the study. The percent-predicted forced expiratory volume in the first second (FEV1) improvement was chosen as a primary efficacy endpoint. Secondary efficacy endpoints included improvement in percent-predicted peak expiratory flow rate (PEFR) and the rate of hospital discharge.;Results. Seventy-four patients were randomized to each of the study groups (37 patients in each group). There were no statistically significant differences in the baseline patient characteristics with the exception of age, height, and weight. Twenty patients were administered nebulized albuterol in an ambulance prior to the study entry. Nine patients in the MgSO4 group and five patients in the control group were missing monitoring data at ≤ 3 time points. There were no statistically or clinically significant differences between the two study groups in either primary or secondary efficacy endpoints. There were no significant differences in the vital signs or serum magnesium levels at any point during the study. The most common reported adverse events were dizziness, headache, somnolence, bitter taste of the study drug, and burning in the throat.;Conclusion. The combination of nebulized MgSO4 and albuterol provides no additional benefit over the standard therapy with albuterol alone in adult patients with mild-to-moderate asthma exacerbations. |
