Magnesium sulphate in acute severe asthma in children (MAGNETIC): a randomised, placebo-controlled trial
Powell C., Kolamunnage-Dona R., Lowe J., Boland A., Petrou S., Doull I., Hood K., Williamson P., Grp MAGNETICS.
Background Little evidence is available for the effect of nebulised magnesium sulphate (MgSO4) in acute asthma in children. We assessed the effect of MgSO4 treatment in children with severe acute asthma. Methods In this randomised placebo-controlled, multi-centre, parallel trial, we enrolled children (aged 2-16 years) with severe acute asthma who did not respond to standard inhaled treatment from 30 hospitals in the UK. Children were randomly allocated (1: 1) to receive nebulised salbutamol and ipratropium bromide with either 2.5 mL of isotonic MgSO4 (250 mmol/L; 151 mg per dose; MgSO4 group) or 2.5 mL of isotonic saline (placebo group) on three occasions at 20-min intervals. Randomisation was done with a computer-generated randomisation sequence, with random block sizes of two to four. Both patients and researchers were masked to treatment allocation. The primary outcome measure was the Yung Asthma Severity Score (ASS) at 60 min post-randomisation. We used a statistical significance level of p<0.05 for a between-group difference, but regarded a between-group difference in ASS of 0.5 as the minimal clinically significant treatment effect. Analysis was done by intention to treat. This trial is registered with controlled-trials.com, number ISRCTN81456894. Findings Between Jan 3, 2009, and March 20, 2011, we recruited and randomly assigned 508 children to treatment: 252 to MgSO4 and 256 to placebo. Mean ASS at 60 min was lower in the MgSO4 group (4.72 [SD 1.37]) than it was in the placebo group (4.95 [SD 1.40]; adjusted difference -0.25, 95% CI -0.48 to -0.02; p=0.03). This difference, however, was not clinically significant. The clinical effect was larger in children with more severe asthma exacerbation (p=0.03) and those with symptoms present for less than 6 h (p=0.049). We detected no difference in the occurrence of adverse events between groups. Interpretation Overall, nebulised isotonic MgSO4, given as an adjuvant to standard treatment, did not show a clinically signifi cant improvement in mean ASS in children with acute severe asthma. However, the greatest clinical response was seen in children with more severe attacks (SaO(2)<92%) at presentation and those with preceding symptoms lasting less than 6 h.