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Research ArticlePractice

Magnesium for treatment of asthma in children

Marcela Davalos Bichara and Ran D. Goldman
Canadian Family Physician September 2009, 55 (9) 887-889;
Marcela Davalos Bichara
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Ran D. Goldman
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  • For correspondence: rgoldman@cw.bc.ca
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ABSTRACT

QUESTION Magnesium is considered adjuvant therapy for moderate to severe asthma exacerbations in adults, but can it be used to treat children?

ANSWER Magnesium seems to be beneficial in the treatment of moderate to severe asthma in children. It is a safe drug to administer, but there have been minor side effects reported, such as epigastric or facial warmth, flushing, pain and numbness at the infusion site, dry mouth, malaise, and hypotension. Owing to its bronchodilating and anti-inflammatory effects, magnesium is an encouraging adjuvant therapy for pediatric patients who do not respond to conventional treatment in acute severe exacerbations. Future studies should focus on establishing the optimal dosage for maximal benefits and the best route of administration. Magnesium should also be considered as a prophylactic treatment.

Asthma is one of the most common conditions among adults and children. In 2005, 15.7 million adults (7.2%) and 6.5 million children (8.9%) had asthma in the United States. In 2004 in Canada, asthma resulted in 1.8 million emergency department visits, with a 10% to 25% admission rate to hospital and 3780 deaths. Asthma is responsible for millions of lost school days every year.1–4

Canadian recommendations for the management of asthma, including in children and youth, were published in 2005.5 They suggest the use of short-acting β2-agonists for symptom relief. Oral or inhaled corticosteroids should be administered to reduce inflammation. Anticholinergics (eg, ipratropium bromide) can be added, which act synergistically with β2-agonists to reduce hospitalizations.6

Magnesium and asthma

Magnesium is the fourth most abundant ion in the human body, with a distribution of 50% in bones, 49% intracellularly in all body organs, and 1% in blood serum. Magnesium is absorbed by the small intestine, and is eliminated through renal excretion and perspiration.7

Magnesium has a role in several enzymatic reactions, helping maintain cellular homeostasis.4,8 Its role in asthma has not been clearly defined, but there have been studies to explain its mechanisms of action.

In 1912, Trendelenburg observed magnesium’s bronchodilator effects in cows; in 1936, Rosello and Pla demonstrated the same on patients. In vitro studies demonstrated the role of magnesium in the relaxation of bronchial cells.9 In smooth muscle, magnesium decreases intracellular calcium by blocking its entry and its release from the endoplasmic reticulum and by activating sodium-calcium pumps. Furthermore, inhibition of calcium’s interaction with myosin results in muscle cell relaxation. Magnesium also stabilizes T cells and inhibits mast cell degranulation, leading to a reduction in inflammatory mediators. In cholinergic motor nerve terminals, magnesium depresses muscle fibre excitability by inhibiting acetylcholine release. Lastly, magnesium stimulates nitric oxide and prostacyclin synthesis, which might reduce asthma severity.9,10

Clinical trials

A total of 9 trials—8 randomized double-blinded studies9,11–17 and 1 retrospective chart review18—were published in the literature. The retrospective chart review identified 40 asthma patients between the ages of 2 months and 15 years that were admitted to a pediatric intensive care unit in Florida. Before the use of magnesium, 15 of the 40 patients with severe asthma needed intubation. After magnesium was used, no patients required additional ventilation. There were no cardiovascular adverse events reported.18

Five randomized trials studied the use of 25- to 75-mg/kg doses of intravenous (IV) magnesium sulfate,11–13,15,17 with a total of 182 patients between the ages of 1 and 18 years. Some children received concurrent medications, such as steroids, aminophylline, and albuterol. Four of the trials found IV magnesium to be effective.12,13,15,17 Outcome measures were different in these studies and included improved clinical asthma score,13,15 percentage of peak expiratory flow rate (PEFR),12,13,15 oxygen saturation, forced expiratory volume in 1 second, and forced vital capacity.12 A decrease in hospital admissions was also found.12 A more recent study17 concluded that using a higher dose of magnesium sulfate resulted in a faster and longer improvement in pulmonary function (ie, pulmonary function test results and PEFR), and a higher discharge rate in children who did not respond to β2-agonists. One study found no evidence to support the use of IV magnesium sulfate as an adjuvant therapy for moderate to severe asthma exacerbations; there was no difference in the clinical improvement and hospitalization rates between the placebo and magnesium groups.11

Inhaled magnesium sulfate has also been investigated in 2 randomized double-blinded trials with 102 children in total. In one trial participating children were between 5 and 17 years of age,14 and in the other the children had a mean age of 10.8 years.16 Patients in one trial received concomitant therapy with β2-adrenergic receptor agonists and corticosteroids,14 and in the second trial, only the control group received β2-adrenergic receptor agonists.16 Nebulized magnesium sulfate was found to provide short-term bronchodilation.14,16

Of interest, asthma exacerbations have been related to magnesium deficiency. In one study9 300 mg of oral magnesium daily was given for asthma prevention for 2 months to 37 patients between the ages of 7 and 19 years. Both the treatment and placebo groups received inhaled fluticasone and salbutamol as needed. Children in the magnesium group had fewer asthma exacerbations and used less salbutamol compared with the placebo group. Bronchial reactivity to methacholine and the allergen-induced skin responses were also reduced.

To evaluate the effectiveness of IV magnesium sulfate in children, a meta-analysis19 analyzed 5 trials,11–13,15,17 with a total of 182 patients. There were favourable effects with the use of magnesium sulfate in addition to β2-agonists and systemic steroids. It appears effective in relieving symptoms, and there was no evidence to suggest that the greater the dosage the better the results. The outcome showed that IV magnesium sulfate was effective in reducing hospitalization rates with an absolute risk reduction of 0.26 (95% confidence interval 0.12 to 0.39); when used as an adjunct therapy there was a reduction in asthma symptoms and an 85% reduction in risk of persistent bronchoconstriction, with a PEFR of less than 60%.

Several clinical trials in adults and children were summarized in 2 recent reviews.4,8 Rowe et al4 examined the effect of IV magnesium sulfate and Blitz et al8 studied its inhaled form in the treatment of asthma exacerbations. Both included randomized or pseudo-randomized trials in patients presenting with acute asthma. Patients experiencing severe exacerbations benefited from inhaled or IV magnesium sulfate as an adjuvant therapy to inhaled β2-agonists.

Safety

Magnesium sulfate is generally a safe drug to administer. In one trial there were some minor side effects reported, such as epigastric or facial warmth, flushing, pain and numbness at the infusion site, dry mouth, and malaise.13 Hypotension was also documented with rapid infusion. Toxicity might result in abnormalities in cardiac conduction, absent reflexes, muscle weakness, and respiratory depression.20

Magnesium sulfate seems to be beneficial in the treatment of moderate to severe asthma in children. Its bronchodilating and anti-inflammatory effects are encouraging as an adjuvant therapy for pediatric patients who do not respond to conventional treatment in acute severe exacerbations.

Conclusion

The role of magnesium in the bronchial tissues is not completely understood. Current recommendations do not support the addition of magnesium as part of the management of children with mild or moderate asthma. Future studies should focus on elucidating the role of magnesium in children, while for severe asthma there is a need to establish the optimal dosage and the most effective route of administration.

PRETx

Child Health Update is produced by the Pediatric Research in Emergency Therapeutics (PRETx) program at the BC Children’s Hospital in Vancouver, BC. Ms Davalos Bichara is a member and Dr Goldman is Director of the PRETx program. The mission of the PRETx program is to promote child health through evidence-based research in therapeutics in pediatric emergency medicine.

Do you have questions about the effects of drugs, chemicals, radiation, or infections in children? We invite you to submit them to the PRETx program by fax at 604 875-2414; they will be addressed in future Child Health Updates. Published Child Health Updates are available on the Canadian Family Physician website (www.cfp.ca).

Footnotes

  • Competing interests

    None declared

  • Copyright© the College of Family Physicians of Canada

References

  1. ↵
    National Institutes of HealthNational Heart, Lung, and Blood InstituteExpert panel report 2. Guidelines for the diagnosis and management of asthmaNo. 97-4051Bethesda, MDNational Institutes of Health1997Available from: www.nhlbi.nih.gov/guidelines/archives/epr-2/asthgdln_archive.pdfAccessed 2009 Jul 8
  2. American Lung Association [website]Childhood asthma overviewWashington, DCAmerican Lung Association2008Available from: www.lungusa.org/site/c.dvLUK9O0E/b.22782/Accessed 2009 Jul 8
  3. United States Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health StatisticsFaststats. AsthmaAtlanta, GACenters for Disease Control and Prevention2009Available from: www.cdc.gov/nchs/fastats/default.htmAccessed 2009 Jul 8
  4. ↵
    RoweBHBretzlaffJABourdonCBotaGWCamargoCAJrMagnesium sulfate for treating exacerbations of acute asthma in the emergency departmentCochrane Database Syst Rev20002CD001490
  5. ↵
    BeckerALemièreCBérubéDBouletLPDucharmeFMFitzGeraldMSummary of recommendations from the Canadian Asthma Consensus guidelines, 2003CMAJ20051736 SupplS311
    OpenUrlFREE Full Text
  6. ↵
    MannixRBachurRStatus asmathicus in childrenCurr Opin Pediatr20071932817
    OpenUrlCrossRefPubMed
  7. ↵
    Office of Dietary Supplements, NIH Clinical Center, National Institutes of HealthMagnesiumBethesda, MANational Institutes of Health2009Available from: http://ods.od.nih.gov/factsheets/Magnesium.aspAccessed 2009 Jul 9
  8. ↵
    BlitzMBlitzSBeaselyRDinerBMHughesRKnoppJAInhaled magnesium sulfate in the treatment of acute asthmaCochrane Database Syst Rev20054CD003898
  9. ↵
    Gontijo-AmaralCRibeiroMAGontijoLSCondino-NetoARibeiroJDOral magnesium supplementation in asthmatic children: a double-blind randomized placebo-controlled trialEur J Clin Nutr 20076115460Epub 2006 Jun 21
    OpenUrlCrossRefPubMed
  10. ↵
    SkobeloffEMSpiveyWHMcNamaraRMGreensponLIntravenous magnesium sulfate for the treatment of acute asthma in the emergency departmentJAMA1989262912103
    OpenUrlCrossRefPubMed
  11. ↵
    ScarfoneRJLoiselleJMJoffeMDMullCCStillerSThompsonKA randomized trial of magnesium in the emergency department treatment of children with asthmaAnn Emerg Med20003665728
    OpenUrlCrossRefPubMed
  12. ↵
    CiaralloLSauerAHShannonMWIntravenous magnesium therapy for moderate to severe pediatric asthma: results of a randomized, placebo-controlled trialJ Pediatr1996129680914
    OpenUrlCrossRefPubMed
  13. ↵
    DeviPRKumarLSinghiSCPrasadRSinghMIntravenous magnesium sulfate in acute severe asthma not responding to conventional therapyIndian Pediatr199734538997
    OpenUrlPubMed
  14. ↵
    MahajanPHaritosDRosenbergNThomasRComparison of nebulized magnesium sulfate plus albuterol to nebulized albuterol plus saline in children with acute exacerbations of mild to moderate asthmaJ Emerg Med2004271215
    OpenUrlCrossRefPubMed
  15. ↵
    GürkanFHaspolatKBosnakMDikiciBDermanOEceAIntravenous magnesium sulphate in the management of moderate to severe acute asthmatic children nonresponding to conventional therapyEur J Emerg Med1999632015
    OpenUrlPubMed
  16. ↵
    MeralACokerMTanacRInhalation therapy with magnesium sulfate and salbutamol sulfate in bronchial asthmaTurk J Pediatr199638216975
    OpenUrlPubMed
  17. ↵
    CiaralloLBrousseauDReinertSHigher-dose intravenous magnesium therapy for children with moderate to severe acute asthmaArch Pediatr Adolesc Med20001541097983
    OpenUrlCrossRefPubMed
  18. ↵
    GloverMLMachadoCTotapallyBRMagnesium sulfate administered via continuous intravenous infusion in pediatric patients with refractory wheezingJ Crit Care20021742558
    OpenUrlCrossRefPubMed
  19. ↵
    CheukDKChauTCLeeSLA meta-analysis on intravenous magnesium sulphate for treating acute asthmaArch Dis Child2005901747
    OpenUrlAbstract/FREE Full Text
  20. ↵
    MonemGFKissoonNDeNicolaLUse of magnesium sulfate in asthma in childhoodPediatr Ann199625313613944
    OpenUrlPubMed
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Canadian Family Physician: 55 (9)
Canadian Family Physician
Vol. 55, Issue 9
1 Sep 2009
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Magnesium for treatment of asthma in children
Marcela Davalos Bichara, Ran D. Goldman
Canadian Family Physician Sep 2009, 55 (9) 887-889;

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