A randomized clinical trial of nebulized magnesium sulfate in addition to albuterol in the treatment of acute mild-to-moderate asthma exacerbations in adults

Study Objective: We sought to compare the efficacy and safety of nebulized magnesium sulfate (MgSO4) plus albuterol with that of albuterol alone in adult patients with mild-to-moderate acute asthma exacerbations. Methods: Patients were randomized to receive nebulized MgSO4 (384 mg in 6 mL of sterile water) or an equal volume of placebo (normal saline solution) in a double-blind fashion after each dose of nebulized albuterol administered (2.5 mg/3 mL) every 20 minutes for the first hour of the study. Spirometry was performed at baseline and every 20 minutes for 2 hours. Monitoring for safety included vital signs, pulse oximetry, and serum magnesium levels. Improvement in percent predicted forced expiratory volume in 1 second was chosen as a primary efficacy end point. Results: Among 74 patients enrolled, 37 were randomized to each of 2 study groups. There were no statistically or clinically significant differences between the 2 study groups in percent predicted forced expiratory volume in 1 second at any point during the trial or overall. There were no significant differences in vital signs, pulse oximetry, or serum magnesium levels at any point during the study. Conclusion: The combination of nebulized MgSO4 and albuterol provides no benefit in addition to that provided by therapy with albuterol in adult patients with mild-to-moderate asthma exacerbations. The efficacy of nebulized MgSO4 in patients with severe asthma exacerbations remains unknown. [Bessmertny O, DiGregorio RV, Cohen H, Becker E, Looney D, Golden J, Kohl L, Johnson T. A randomized clinical trial of nebulized magnesium sulfate in addition to albuterol in the treatment of acute mild-to-moderate asthma exacerbations in adults. Ann Emerg Med. June 2002;39:585-591.]