OPTIMIZING THE USE OF MAGNESIUM SULFATE FOR MANAGING ACUTE ASTHMA IN PEDIATRIC PATIENTS
Keywords:
Asthma, Pediatric, Magnesium Sulfate, Acute Exacerbation, Bronchodilator, Anti-inflammatory, Treatment Optimization, Clinical GuidelinesAbstract
Asthma is one of the most common chronic illnesses affecting children worldwide. It's marked by sudden episodes of wheezing, coughing, chest tightness, and difficulty breathing. Despite advancements in understanding and treating asthma, managing acute asthma attacks remains a major challenge in pediatric healthcare. Traditional treatments include short-acting beta-agonists, systemic corticosteroids, and oxygen therapy. Yet, these methods sometimes fall short, requiring additional measures. Magnesium sulfate (MgSO4) has emerged as a promising supplementary treatment due to its ability to relax muscles, reduce inflammation, and widen the airways. This paper reviews the effectiveness, safety, and best practices for using MgSO4 to manage acute asthma in children.
The literature reveals that MgSO4 works by blocking the calcium pathways that cause airway constriction, thus helping to open the airways and reduce inflammation. Numerous studies, including randomized controlled trials and observational research, have shown that MgSO4 can improve lung function, reduce hospital admissions, and lessen the need for extra bronchodilator treatments. However, there's still no clear agreement on the best doses, methods of administration, and criteria for selecting patients.
Key findings show that both intravenous and nebulized MgSO4 are effective for acute asthma. Research indicates that MgSO4 can quickly improve lung function and correct oxygen levels. Despite these benefits, there's a risk of side effects, like low blood pressure and electrolyte imbalances, which means careful monitoring and tailored dosing are essential.
This paper also highlights gaps in current research, especially concerning the safety and long-term effects of MgSO4. It emphasizes the need for further studies to refine dosing protocols and develop comprehensive guidelines for its use in pediatric asthma care. Personalized treatment plans that consider factors such as the child's age, severity of asthma, and other health conditions are crucial for optimizing MgSO4 therapy.
Research methodology includes a systematic review of existing literature and prospective cohort studies to evaluate various dosing protocols and their outcomes. We'll collect data on demographics, clinical characteristics, and treatment responses, using statistical analysis to compare the effectiveness and safety of different protocols. This approach aims to provide evidence-based recommendations for healthcare providers, enhancing the management of acute asthma in children.
Conclusion, optimizing MgSO4 use in pediatric asthma management has great potential to improve clinical outcomes and reduce healthcare burdens. This review underscores the need for standardized treatment guidelines and further research to ensure the safe and effective use of MgSO4, ultimately benefiting children's health and healthcare systems.
References
Tesse, R., et al., Treating pediatric asthma according guidelines. 2018. 6: p. 234
Asher, M.I., et al., Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases One and Three repeat multicountry cross-sectional surveys. 2006. 368(9537): p. 733-743.
Sullivan, P.W., et al., The national cost of asthma among school-aged children in the United States. 2017. 119(3): p. 246-252. e1.
Hughes, R., et al., Use of isotonic nebulised magnesium sulphate as an adjuvant to salbutamol in treatment of severe asthma in adults: randomised placebo-controlled trial. 2003. 361(9375): p. 2114-2117.
Amantéa, S.L., et al., Controversies in the pharmacological management of acute asthma in children. 2002. 78(Suppl 2): p. S151-60.
Cheuk, D., T. Chau, and S.J.A.o.d.i.c. Lee, A meta-analysis on intravenous magnesium sulphate for treating acute asthma. 2005. 90(1): p. 74-77.
Griffiths, B. and K.M.J.C.D.o.S.R. Kew, Intravenous magnesium sulfate for treating children with acute asthma in the emergency department. 2016(4).
Johnson, M.D., et al., Intravenous magnesium in asthma pharmacotherapy: variability in use in the PECARN registry. 2020. 220: p. 165-174. e2.
Jones, L. and S.J.E.M.J. Goodacre, Magnesium sulphate in the treatment of acute asthma: evaluation of current practice in adult emergency departments. 2009. 26(11): p. 783-785.
Özdemir A, Doğruel D. Efficacy of Magnesium Sulfate Treatment in Children with Acute Asthma. Med Princ Pract. 2020;29(3):292-298. doi: 10.1159/000506595. Epub 2020 Feb 19. PMID: 32069472; PMCID: PMC7315220.
Aslan M, Çitlak HK, Topal E, Bağ HG, Kaplan F. Nebulize magnezyum sülfatın çocuklarda astım atakları üzerine etkisi. Anadolu KliniğI Tıp Bilimleri Dergisi. 2023;28(3):259-265. doi:10.21673/anadoluklin.1288549
Daengsuwan T, Watanatham S. A comparative pilot study of the efficacy and safety of nebulized magnesium sulfate and intravenous magnesium sulfate in children with severe acute asthma. Asian Pac J Allergy Immunol. 2017 Jun;35(2):108-112. doi: 10.12932/AP0780. PMID: 27996280.
Kokotajlo S, Degnan L, Meyers R, Siu A, Robinson C. Use of intravenous magnesium sulfate for the treatment of an acute asthma exacerbation in pediatric patients. J Pediatr Pharmacol Ther. 2014 Apr;19(2):91-7. doi: 10.5863/1551-6776-19.2.91. PMID: 25024668; PMCID: PMC4093670.
Schuh S, Freedman SB, Zemek R, et al. Association between intravenous magnesium therapy in the emergency department and subsequent hospitalization among pediatric patients with refractory acute asthma. JAMA Network Open. 2021;4(7):e2117542. doi:10.1001/jamanetworkopen.2021.17542
DeSanti, R.L., et al., The effectiveness of magnesium sulfate for status asthmaticus outside the intensive care setting. 2018. 53(7): p. 866-871.
Nebulized Magnesium Sulphate as an Adjunct Therapy in the Management of Children Presenting with Acute Exacerbation of Asthma. Pakistan Journal of Medical & Health Sciences 12(2):673-674, vol. 12, no. 2, 2018, pjmhsonline.com/2018/april_june/pdf/554.pdf. Accessed 12 June 2024..
Graff DM, Stevenson MD, Berkenbosch JW. Safety of prolonged magnesium sulfate infusions during treatment for severe pediatric status asthmaticus. Pediatric Pulmonology. 2019;54(12):1941-1947. doi:10.1002/ppul.24499
Johnson, M.D., et al., Intravenous magnesium in asthma pharmacotherapy: variability in use in the PECARN registry. 2020. 220: p. 165-174. e2.
Schuh, S., et al., Effect of nebulized magnesium vs placebo added to albuterol on hospitalization among children with refractory acute asthma treated in the emergency department: a randomized clinical trial. 2020. 324(20): p. 2038-2047.
Wongwaree S, Daengsuwan T. Comparison efficacy of randomized nebulized magnesium sulfate and ipratropium bromide/fenoterol in children with moderate to severe asthma exacerbation. Asian Pacific Journal of Allergy and Immunology. January 2019. doi:10.12932/ap-190717-0118
Ehsan S, Haresh S, Tarar SH. Effectiveness of Intravenous Magnesium Sulfate in Children Presenting to the Emergency Department with Acute Exacerbation of Asthma. Pakistan Journal of Health Sciences. February 2023:61-65. doi:10.54393/pjhs.v4i02.552
Kapuscinski CA, Stauber SD, Hutchinson DJ. Escalation in therapy based on intravenous magnesium sulfate dosing in pediatric patients with asthma exacerbations. the Journal of Pediatric Pharmacology and Therapeutics. 2020;25(4):314-319. doi:10.5863/1551-6776-25.4.314
DeLaroche AM, Mowbray FI, Bohsaghcheghazel M, Zalewski K, Obudzinski K. Early versus delayed administration of intravenous magnesium sulfate for pediatric asthma. the American Journal of Emergency Medicine. 2021;50:36-40. doi:10.1016/j.ajem.2021.07.003
Aziz DA, Sajjad MA, Iftikhar H. Clinical outcomes of children with acute asthma managed with intravenous magnesium sulphate outside intensive care setting. Monaldi Archives for Chest Disease Pulmonary Series/Monaldi Archives for Chest Disease/Monaldi Archives for Chest Disease Cardiac Series. September 2023. doi:10.4081/monaldi.2023.2664
Siddiqui H, Siddiqui SA, Yadav RK, et al. Nebulized Salbutamol with or without Magnesium Sulphate in the Management of Acute Asthma in Children in India: A Randomized Controlled Trial. Journal of Tropical Pediatrics. 2022;68(5). doi:10.1093/tropej/fmac070
PABON, H., G. MONEM, and N.J.P.e.c. KISSOON, Safety and efficacy of magnesium sulfate infusions in children with status asthmaticus. 1994. 10(4): p. 200-203.
Rovsing AH, Savran O, Ulrik CS. Magnesium sulfate treatment for acute severe asthma in adults-a systematic review and meta-analysis. Front Allergy. 2023 Jul 28;4:1211949. doi: 10.3389/falgy.2023.1211949. PMID: 37577333; PMCID: PMC10420062.