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Debiazzi MS, Bonatto RC, Campos FJ, Martin JG, Fioretto JR, Hansen MLDN, Luz AMDA, de Carvalho HT. Inhaled magnesium versus inhaled salbutamol in rescue treatment for moderate and severe asthma exacerbations in pediatric patients. J Pediatr (Rio J) 2024:S0021-7557(24)00054-8. [PMID: 38693043 DOI: 10.1016/j.jped.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 05/03/2024] Open
Abstract
OBJECTIVE To compare the effectiveness of inhaled Magnesium Sulfate associated with Salbutamol versus Inhaled Salbutamol alone in patients with moderate and severe asthma exacerbations. METHOD Clinical, prospective and randomized study with patients between 3 and 14 years of age divided into two groups: one to receive inhaled salbutamol associated with magnesium sulfate (GSM), the other to receive inhaled salbutamol alone (GS). The sample consisted of 40 patients, 20 patients in each group. Severity was classified using the modified Wood-Downes score, with values between 4 and 7 classified as moderate and 8 or more classified as severe. RESULTS Post-inhalation scores decreased both in patients who received salbutamol and magnesium and in those who received salbutamol alone, with no statistically significant difference between the groups. CONCLUSIONS Despite the benefits when administered intravenously, inhalation of the drug alone or in combination did not reduce the severity of the exacerbation.
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Affiliation(s)
- Michelle Siqueira Debiazzi
- Faculdade de Medicina de Botucatu, Departamento de Pediatria, Universidade Estadual Paulista "Júlio de Mesquita Filho" (UNESP), Botucatu, SP, Brazil
| | - Rossano César Bonatto
- Faculdade de Medicina de Botucatu, Departamento de Pediatria, Universidade Estadual Paulista "Júlio de Mesquita Filho" (UNESP), Botucatu, SP, Brazil
| | - Fábio Joly Campos
- Faculdade de Medicina de Botucatu, Departamento de Pediatria, Universidade Estadual Paulista "Júlio de Mesquita Filho" (UNESP), Botucatu, SP, Brazil
| | - Joelma Gonçalves Martin
- Faculdade de Medicina de Botucatu, Departamento de Pediatria, Universidade Estadual Paulista "Júlio de Mesquita Filho" (UNESP), Botucatu, SP, Brazil
| | - José Roberto Fioretto
- Faculdade de Medicina de Botucatu, Departamento de Pediatria, Universidade Estadual Paulista "Júlio de Mesquita Filho" (UNESP), Botucatu, SP, Brazil
| | - Maria Letícia das Neves Hansen
- Faculdade de Medicina de Botucatu, Departamento de Pediatria, Universidade Estadual Paulista "Júlio de Mesquita Filho" (UNESP), Botucatu, SP, Brazil
| | - Arthur Martins de Araújo Luz
- Faculdade de Medicina de Botucatu, Departamento de Pediatria, Universidade Estadual Paulista "Júlio de Mesquita Filho" (UNESP), Botucatu, SP, Brazil
| | - Haroldo Teófilo de Carvalho
- Faculdade de Medicina de Botucatu, Departamento de Pediatria, Universidade Estadual Paulista "Júlio de Mesquita Filho" (UNESP), Botucatu, SP, Brazil.
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Aziz DA, Sajjad MA, Iftikhar H. Clinical outcomes of children with acute asthma managed with intravenous magnesium sulphate outside intensive care setting. Monaldi Arch Chest Dis 2023. [PMID: 37700686 DOI: 10.4081/monaldi.2023.2664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/28/2023] [Indexed: 09/14/2023] Open
Abstract
Asthma in children constitutes a well-known respiratory condition with significant mortality. In poorly controlled asthma, multiple adjunct therapies including magnesium sulphate (MgSO4), are recommended to decrease the likelihood of intubation; however, limited evidence exists to support their routine usage in day-to-day situations. Aim of this study is to determine the outcomes of pediatric patients treated with magnesium sulphate during exacerbations of asthma admitted at a tertiary care unit. A retrospective study was conducted at The Aga Khan University Hospital, Karachi, Pakistan from January 2019 to December 2021. Patients aged 6 years to 15 years presented with acute asthma through Emergency Room (ER) having clinical respiratory score (CRS) more than five, admitted in high-dependency unit (HDU) were included in the study. Patients who were started on magnesium sulfate within 24 hours of admission were categorized in magnesium sulfate (MS) group. Patients receiving all standard acute asthma treatment but were not started on magnesium therapy within 24 hours of admission were categorized in the non-magnesium sulfate (non-MS) group. Different outcome variables were compared between the groups. A total of 110 patients with asthma were enrolled. Fifty-four patients were categorized into MS group while 56 were included in non-MS group. Fewer patients were transferred from HDU to pediatric intensive care unit (PICU) (24.07%) in MS group compared to non-MS group (42.85%), (p=0.02). In MS group, the mean number of days spent on oxygen in HDU were 2.38±0.81, while non-MS group spent more days (3.10±0.84 (p<0.01). This study demonstrates that for pediatric patients with severe asthma exacerbations, administration of IV MgSO4 (within 24 hours) is beneficial and results in fewer admissions to PICU and reduces the mean number of days spent on oxygen therapy.
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Affiliation(s)
- Danish Abdul Aziz
- Department of Paediatrics and Child Health, Aga Khan University Hospital, Karachi.
| | - Muhammad Aqib Sajjad
- Department of Paediatrics and Child Health, Aga Khan University Hospital, Karachi.
| | - Haissan Iftikhar
- Department of Otolaryngology, University Hospitals Birmingham, NHS Foundation Trust, Birmingham.
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Simone L, Zemek R, Roland D, Lyttle MD, Craig S, Dalziel SR, Gravel J, Finkelstein Y, Curtis S, Freedman SB, Plint AC, Schuh S. International practice patterns of IV magnesium in paediatric acute asthma. Emerg Med J 2023; 40:200-201. [PMID: 36344238 DOI: 10.1136/emermed-2022-212642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Laura Simone
- Emergency Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Damian Roland
- Health Sciences, University of Leicester, Leicester, UK.,Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Mark D Lyttle
- Emergency Department, Bristol Royal Children's Hospital, Bristol, UK
| | - Simon Craig
- Division of Pediatric Emergency Medicine, Monash Medical Centre Clayton, Clayton, Victoria, Australia
| | - Stuart R Dalziel
- Emergency Medicine, Starship Children's Hospital, Auckland, New Zealand
| | - Jocelyn Gravel
- Department of Pediatrics, CHU SainteJustine, Montreal, Québec, Canada
| | - Yaron Finkelstein
- Division of Emergency Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sarah Curtis
- University of Alberta, Edmonton, Alberta, Canada
| | | | - Amy C Plint
- Emergency Medicine, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Suzanne Schuh
- Division of Pediatric Emergency Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
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Navanandan N, Thompson T, Pyle L, Florin TA. Defining Treatment Response for Clinical Trials of Pediatric Acute Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:1450-1458.e1. [PMID: 36621607 PMCID: PMC10164688 DOI: 10.1016/j.jaip.2022.12.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/12/2022] [Accepted: 12/19/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND An agreed-upon definition of treatment response for clinical trials of pediatric acute asthma does not exist, limiting meaningful comparisons among therapeutic interventions and advances in asthma management. OBJECTIVE To develop a consensus definition of treatment response for clinical trials of pediatric acute asthma. METHODS A multidisciplinary panel of 22 experts participated in a Web-based modified Delphi process to achieve consensus on a definition of treatment response. Round 1 consisted of closed- and open-ended questions in which panelists ranked measures of treatment response developed by literature review, suggested additional measures, and explained their responses. In rounds 2 and 3, panelists reviewed summary statistics of the panel's rating from prior rounds and reconsidered their rankings. In round 3, pairwise ranking was performed to determine the ranked importance of components. Consensus was defined as 70% or greater agreement among panelists choosing Likert-scale values of 1 to 6 (extremely unimportant to extremely important) and an interquartile range less than 2. RESULTS Drawing on results from the expert panel, we developed a definition of treatment response that includes Clinical Severity Score, need for additional therapies, and hospitalization. Clinical Severity Score encompassed most ranked criteria (eg, respiratory distress, wheeze) for a treatment response definition. Panelists recommended that a valid and pragmatic severity score be used consistently across institutions. Panelists also achieved consensus on the top 10 criteria that appropriately classify need for hospitalization. CONCLUSIONS This consensus definition of treatment response can be used in clinical trials of children with acute asthma to standardize outcome measurement and report meaningful outcomes.
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Affiliation(s)
- Nidhya Navanandan
- Section of Emergency Medicine, Children's Hospital Colorado, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colo.
| | - Talia Thompson
- Child Health Biostatistics Core, Children's Hospital Colorado, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colo
| | - Laura Pyle
- Child Health Biostatistics Core, Children's Hospital Colorado, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colo; Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colo
| | - Todd A Florin
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Ill
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Use and abuse of magnesium sulfate in asthmatic exacerbations. An Pediatr (Barc) 2022; 97:213-215. [PMID: 35907776 DOI: 10.1016/j.anpede.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/15/2022] [Indexed: 11/21/2022] Open
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Tanverdi MS, Navanandan N. Intravenous Magnesium for Acute Asthma Exacerbations in Children: To Mag or Not to Mag. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:1247-1248. [PMID: 35526865 DOI: 10.1016/j.jaip.2022.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 06/14/2023]
Affiliation(s)
- Melisa S Tanverdi
- Section of Emergency Medicine, Children's Hospital Colorado, Department of Pediatrics, University of Colorado, Aurora, Colorado
| | - Nidhya Navanandan
- Section of Emergency Medicine, Children's Hospital Colorado, Department of Pediatrics, University of Colorado, Aurora, Colorado.
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Prospective Observational Study of Clinical Outcomes After Intravenous Magnesium for Moderate and Severe Acute Asthma Exacerbations in Children. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:1238-1246. [PMID: 34915226 PMCID: PMC9086103 DOI: 10.1016/j.jaip.2021.11.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/15/2021] [Accepted: 11/22/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND There is limited knowledge regarding whether intravenous magnesium (IV-Mg) improves outcomes in children with acute asthma exacerbations. OBJECTIVE To examine whether IV-Mg improves outcomes in children with moderate and severe exacerbations. METHODS We performed a secondary analysis using data from a prospective observational cohort of children aged 5 to 17 years with moderate and severe exacerbations. Standardized treatment included systemic corticosteroid and inhaled albuterol, with consideration of IV-Mg (75 mg/kg) for patients with insufficient response after 20 minutes. Propensity score (PS) models were used to examine associations of IV-Mg treatment with change in the validated Acute Asthma Intensity Research Score, hospitalization rate, and time to spacing of inhaled albuterol of 4 hours or more among hospitalized participants. RESULTS Among 301 children, median (interquartile range) age was 8.1 (6.4-10.2) years, 170 were Black (57%), 201 were male (67%), and 84 received IV-Mg (28%). In a PS covariate-adjusted multivariable linear regression model, IV-Mg treatment was associated with a 2-hour increase in the Acute Asthma Intensity Research Score (β-coefficient = 0.98; 95% confidence interval [CI], 0.20-1.77), indicating increased exacerbation severity. Three additional PS-based models yielded similar results. Participants receiving IV-Mg had 5.8-fold (95% CI, 2.8-11.9) and 6.8-fold (95% CI, 3.6-12.9) greater odds of hospitalization in PS-based multivariable regression models. Among hospitalized participants, there was no difference in time to albuterol of every 4 hours or more in a PS covariate-adjusted Cox proportional hazards model (hazard ratio = 1.2; 95% CI, 0.8-1.8). CONCLUSIONS Among children with moderate and severe exacerbations, IV-Mg is associated with increased exacerbation severity, increased risk for hospitalization, and no acceleration in exacerbation resolution among hospitalized participants.
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