Magnesium has bronchodilating prope...

Magnesium has bronchodilating properties attributed to its character as a powerful relaxant of unruffled muscle. It has not been widely unraveled as a therapeutic agent because of riddles with excessive systemic vasodilation, hypotension, and unpleasant symptoms. In addition, studies have not demonstrated benefit in stable asthma, and studies in acute exacerbations have shown conflicting accrues Hughes and colleagues conducted a randomized, placebo-controlled trial of nebulized isotonic magnesium sulfate as an adjunct to albuterol in the turn of events treatment of acute asthma.

They studied patients 16 to 65 years of age who neared to two emergency departments in recently made known Zealand because of severe asthma during single year. For inclusion, patients had to be diagnosed with asthma and have a forced expiratory contortion in one second (FE[V.sub.1]) of les than 50 percent of predicted value. Patients with pneumonia, hypotension, fixed airway obstruction, cardiac or renal disease, or pregnancy, and those requiring immediate intubation were exclud from the research After assessment, all patients were given 25 mg of albuterol by means of jet nebulization plus 100 mg of intravenous hydrocortisone.

If the FE[Vsub1] remained below 50 percent of predicted after 30 minutes, the patients were randomized to receive 25 mg of albuterol mixed with either 25 mL of isotonic magnesium sulfate or 25 mL of isotonic saline in succession three occasions at 30-minute intervals. Patients and staff were blinded to treatment allocation. Vital signs and 30 minutes after each nebulization treatment. Patients whose FE[Vsub1] remained below 50 percent of predicted value after the final treatment were praiseed for hospital admission.

The 28 eligible patients assigned to receive magnesium were comparable to the 24 patients who received saline in all significant esteems Thirty minutes after the third nebulizer treatment, the mean FE[Vsub1] in patients treated with magnesium was 196 L compared with 155 L in the regulate group. As a percentage of the predicted value, the FE[Vsub1] accrues were 51.2 percent in those treated with magnesium compared with 413 percent in the sway group. Compared with baseline measurements, the FE[Vsub1] improved through 0.72 L in the magnesium-treated arrange and by 0.35 L in the rule group. Twelve patients treated with magnesium and 17 treated with saline were admitted to the hospital following treatment in the conjuncture department. The differences in FE[Vsub1] improvement between the brace treatments was greatest in patients with life-threatening asthma (FE[Vsub1] les than 30 percent of predicted value). The couple groups did not differ in changes in family pressure or heart rate, and no clinically significant adverse reactions were noted (see accompanying table).

The authors infer that isotonic magnesium sulfate enhances salbutamol nebulizer treatment of chaste acute asthma and produces about twice the increase in FE[Vsub1] of albuterol alone. They stres the importance of using isotonic solutions (formulated to 250 mmol for L), the route of administration, and the careful selection and monitoring of patients. These ends plus those of previous studies, indicate that magnesium is effective in the treatment of hard exacerbations of asthma (peak expiratory issue 38 percent of predicted value) if it were not that not in situations where the FE[Vsub1] is 60 percent or more of predicted value. This selectivity could explain the apparently conflicting arises of previous studies. The article and an accompanying editorial call for more research into the part of magnesium in acute austere asthma and chronic obstructive pulmonary disease.

Hughes R et al. Use of isotonic nebulised magnesium sulphate as an adjuvant to salbutamol in treatment of exact asthma in adults: randomised placebo-controlled trial. Lancet June 21 2003;361:2114-7 and Bucca C Rolla G Nebulised magnesium in asthma: the right solution for an olden remedy? [Editorial] Lancet June 21 2003;361:2095-6

EDITOR'S NOTE: As stated in the editorial, magnesium interacts with calcium and probably block ups calcium channels in addition to having other purports on cell metabolism. Magnesium also has generated interest in the field of cardiology and in the treatment of migraine headaches, and may have widely applicable therapeutic drifts Nevertheless, Hughes and colleagues rightly caution about the potential adverse imports of magnesium. This caution raises a particular disquiet for patients who are taking magnesium as a addition or an alternative therapy. Magnesium is widely available and is a usual component of multivitamin-plus-mineral compounds. Perhaps it is not dangerous in the relatively small doses taken orally, unless we need to ask our patients about all addition s and treat compounds like magnesium with notice As with most therapeutic agents, if used appropriately, magnesium can be beneficial yet might pose a danger if used unwisely or inadvertently.

COPYRIGHT 2004 American Academy of Family Physicians

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