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Magnesium sulphate in the treatment of acute asthma: evaluation of current practice in adult emergency departments

Jones, L.A. and Goodacre, S. (2009) Magnesium sulphate in the treatment of acute asthma: evaluation of current practice in adult emergency departments. Emergency Medicine Journal, 26 (11). pp. 783-785. ISSN 1472-0205


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Background: A recent meta-analysis showed that intravenous and nebulised magnesium sulphate have similar levels of evidence to support their use in the treatment of acute asthma in adults. This consisted of weak evidence of effect on respiratory function and hospital admissions, with wide confidence intervals ranging from no effect to significant positive effects. Current BTS/SIGN guidelines suggest an equivocal role for intravenous magnesium sulphate and no role for nebulised magnesium sulphate. A study was performed to assess what emergency physicians currently do in their management of acute asthma. Method: A postal survey was undertaken of all adult emergency departments within the UK. A structured question naire was sent to all clinical leads in emergency medicine about their current usage of both intravenous and nebulised magnesium sulphate in the treatment of acute asthma.

Results: 180 of the 251 emergency departments in the UK responded (72%). Magnesium sulphate was used in 93%, mostly because it was expected to relieve breathlessness (70%) or reduce HDU/ITU admissions (51%). It was predominantly given to those patients with acute severe asthma (84%) and life-threatening exacerbations (87%), with most stating they would give the drug if there was no response to repeated nebulisers (68%). In comparison, nebulised magnesium sulphate was only used in two emergency departments (1%). The main reason for not administering the drug via a nebuliser was insufficient evidence (51%).

Conclusions: Intravenous magnesium sulphate is widely used for acute asthma, usually for patients with severe or life-threatening asthma who have not responded to initial treatment. Nebulised magnesium sulphate, by contrast, is hardly used at all. The use of intravenous magnesium sulphate is more extensive than current guidelines or available evidence would appear to support.

Item Type: Article
Copyright, Publisher and Additional Information: © 2009 BMJ Publishing. Reproduced in accordance with the publisher's self-archiving policy.
Keywords: Intravenous Magnesium; Metaanalysis
Institution: The University of Sheffield
Academic Units: The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Health and Related Research (Sheffield)
Depositing User: Miss Anthea Tucker
Date Deposited: 04 Nov 2009 11:45
Last Modified: 05 Jun 2014 02:33
Published Version: http://dx.doi.org/10.1136/emj.2008.065938
Status: Published
Publisher: BMJ Publishing Group
Refereed: Yes
Identification Number: 10.1136/emj.2008.065938
URI: http://eprints.whiterose.ac.uk/id/eprint/10089

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