Use of nebulised magnesium sulphate as an adjuvant in the treatment of acute
exacerbations of COPD in adults: a randomised double-blind placebo-controlled
trial.
Author(s): Edwards L(1), Shirtcliffe P, Wadsworth K, Healy B, Jefferies S, Weatherall M,
Beasley R; Magnesium COPD Study Team.
Affiliation(s): Author information:
(1)Medical Research Institute of New Zealand, Wellington, New Zealand.
Publication date & source: 2013, Thorax. , 68(4):338-43
BACKGROUND: Intravenous magnesium has been shown to cause bronchodilation in
acute severe asthma and in small trials in acute exacerbations of chronic
obstructive pulmonary disease (AECOPD). There is also some evidence of benefit
from nebulised magnesium in acute severe asthma. Our hypothesis was that adjuvant
magnesium treatment administered via repeated nebulisation was effective in the
management of AECOPD.
METHODS: In this randomised double-blind placebo-controlled trial, we approached
161 patients with AECOPD presenting to the emergency departments at two New
Zealand hospitals with a forced expiratory volume in 1 s (FEV1) <50% predicted 20
min after initial administration of salbutamol 2.5 mg and ipratropium 500 µg via
nebulisation. Patients received 2.5 mg salbutamol mixed with either 2.5 ml
isotonic magnesium sulphate (151 mg per dose) or 2.5 ml isotonic saline (placebo)
on three occasions at 30 min intervals via nebuliser. The primary outcome measure
was FEV1 at 90 min.
RESULTS: 116 patients were randomised, 52 of whom were randomly allocated to the
magnesium adjuvant group. At 90 min the mean (SD) FEV1 in the magnesium group
(N=47) was 0.78 (0.33) l compared with 0.81 (0.30) l in the saline group (N=61)
(difference -0.026 l (95% CI -0.15 to 0.095, p=0.67). No patients required
non-invasive ventilation. There were 43/48 admissions to hospital in the
magnesium group and 56/61 in the saline group (RR 0.98, 95% CI 0.86 to 1.10,
p=0.69).
CONCLUSIONS: Nebulised magnesium as an adjuvant to salbutamol treatment in the
setting of AECOPD has no effect on FEV1. Australian New Zealand Clinical Trials
Registry ACTRN12608000167369.
|