Question 5: Magnesium Sulphate for Acute Asthma in children

Abstract

Most children who present to the emergency department with acute asthma, respond well to inhaled β₂-agonists (spacer or nebuliser), oxygen (if required) and systemic steroids. Guidelines across the world agree on this simple, straight forward evidenced based approach. In children with more severe asthma attacks and those who do not respond to initial treatment, the evidence base for the secondary level treatment is less clear. Many regimens exist for the next step. Intravenous Magnesium Sulphate (MgSO₄) is now used frequently in these situations and some centres are starting to use nebulized MgSO₄ as part of the initial maximal inhaled therapy options. This paper examines the role of MgSO₄ in acute asthma in children. It focusses on how MgSO₄ might work, what are the current recommendations for use and then what is the current evidence base to support its use. We have presented the evidence for the use of both nebulized and intravenous MgSO₄. At the end of the paper we have suggested future directions for research in this area. Our aim is to present a synthesis of the current role of MgSO₄ in the management of an acute asthma attack.

Keywords: Magnesium sulphate; Pharmacology; Severe asthma attacks.