Therapeutics effects of inhaled magnesium sulfate combined with adrenergic beta-2 agonist on children with acute asthma: Systematic review and meta-analysis

To review the evidence on the effectiveness of inhaled magnesium sulfate (MgSO4) combined with beta-2 (B2) agonist as compared to inhaled B2 agonist alone in treating pediatric patients with moderate to severe asthma attacks The search was conducted on five electronic databases namely the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, PubMed, Science Direct, and Google Scholar. Eight trials were included in the review. All studies involved a total of 1585 children aged 2–17 years with moderate to severe asthma attacks. The risk of bias was assessed using the Cochrane risk-of-bias tool for randomized trials. Three studies that assessed the effect of inhaled MgSO4 as adjunctive therapy on vital signs revealed no effect of inhaled MgSO4 on vital signs (SMD -0.11, 95% CI 0.27–0.04, p = 0.16, I2 = 68%). Two studies that assessed the effect of inhaled MgSO4 as adjunctive therapy on asthma severity score (ASS) revealed no effect of inhaled MgSO4 on ASS (SMD 0.22, 95% CI 0.01–0.44, Z = 2.01, p = 0.04, I2 = 88%). Two studies that assessed the effect of inhaled MgSO4 as adjunctive therapy on peak expiratory flow rate (PEFR) revealed a large effect of B2 agonist alone on PEFR (SMD 2.02, 95% CI 0.83–3.2, p < 0.001, I2 = 98%). This review does not support the use of inhaled MgSO4 as adjunctive therapy to B2 agonist for asthmatic children. •Efficacey of inhaled MgSO4 combined with inhaled β₂‐agonist for moderate-to-severe acute asthma attacks is lacking clear evidence.•Inhaled MgSO4 with beta-2 agonist was not associated with any adverse events.•More cumalative evidence are needed to support the use of inhaled MgSO4 as an adjuvant therapy for moderate to severe asthmatic attack among children