Role of nebulised magnesium sulfate in treating acute asthma in children: a systematic review and meta-analysis

Abstract

Objectives: To review the efficacy of nebulised magnesium sulfate (MgSO₄) in acute asthma in children.

Methods: The authors searched Medline, Embase, Web of Science and Cochrane Library for randomised controlled trials (RCTs) published until 15 December 2023. RCTs were included if they compared the efficacy and safety of nebulised MgSO₄ as a second-line agent in children presenting with acute asthma exacerbation. A random-effects meta-analysis was performed, and the Risk of Bias V.2 tool was used to assess the biases among them.

Results: 10 RCTs enrolling 2301 children with acute asthma were included. All trials were placebo controlled and administered nebulised MgSO₄/placebo and salbutamol (±ipratropium bromide). There was no significant difference in Composite Asthma Severity Score between the two groups (6 RCTs, 1953 participants; standardised mean difference: -0.09; 95% CI: -0.2 to +0.02, I²=21%). Children in the MgSO₄ group have significantly better peak expiratory flow rate (% predicted) than the control group (2 RCTs, 145 participants; mean difference: 19.3; 95% CI: 8.9 to 29.8; I²=0%). There was no difference in the need for hospitalisation, intensive care unit admission or duration of hospital stay. Adverse events were minor, infrequent (7.3%) and similar among the two groups.

Conclusions: There is low-certainty evidence that nebulised MgSO₄ as an add-on second-line therapy for acute asthma in children does not reduce asthma severity or a need for hospitalisation. However, it was associated with slightly better lung functions. The current evidence does not support the routine use of nebulised MgSO₄ in paediatric acute asthma management.

Prospero registration number: CRD42022373692.

Keywords: Adolescent Health; Child Health.

Figure 1

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram.

Figure 2

Risk of bias of included studies A). Judgments about each risk of bias item; b) Risk of bias summary.

Figure 3

Forest plot showing comparison of Composite Asthma Severity Score (A) and Asthma Severity Score (B) in children with and without inhaled MgSO₄. MgSO₄, magnesium sulfate; PRAM, Pediatric Respiratory Assessment Measure.

Figure 4

Forest plot showing comparison of pulmonary function test (A) and physiological parameters (B) in children with and without inhaled MgSO₄. FEV₁, forced expiratory volume in 1 s; MgSO₄, magnesium sulfate.