Annals of Emergency Medicine
Volume 36, Issue 3 , Pages 181-190 , September 2000

Intravenous Magnesium Sulfate Treatment for Acute Asthma in the Emergency Department: A Systematic Review of the Literature

  • Brian H. Rowe, MD, MSc

      Affiliations

    • Division of Emergency Medicine and Department of Public Health Sciences, University of Alberta, Edmonton, Alberta, Canada
  • ,
  • Jennifer A. Bretzlaff, BScN

      Affiliations

    • Department of Emergency Medicine, Sudbury Regional Hospital Corporation, Sudbury, Ontario, Canada
  • ,
  • Chris Bourdon, MD

      Affiliations

    • Department of Emergency Medicine, Sudbury Regional Hospital Corporation, Sudbury, Ontario, Canada
  • ,
  • Gary W. Bota, MD, FRCP

      Affiliations

    • Department of Emergency Medicine, Sudbury Regional Hospital Corporation, Sudbury, Ontario, Canada
  • ,
  • Carlos A. Camargo Jr., MD, DrPH

      Affiliations

    • Department of Emergency Medicine, Massachusetts General Hospital and Channing Laboratory, and Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA.

Received 6 April 1999 ,Revised 28 December 1999 ,Accepted 27 January 2000.

References 

  1. Sears MR. Epidemiological trends asthma. Can Respir J. 1996;3:261–268
  2. Wilkins K, Mao Y. Trends in rate of admission to hospital and death from asthma among children and young adults in Canada during the 1980s. Can Med Assoc J. 1993;148:185–190
  3. Weiss KB, Gergen PJ, Hodgson TA. An economic evaluation of asthma in the United States. N Engl J Med. 1992;326:862–866
  4. Britton J. Asthma’s changing prevalence. BMJ. 1992;304:857–858 [editorial]
  5. Brenner B, Kohn MS. The acute asthmatic patient in the ED: to admit or discharge. In: Am J Emerg Med. 16:1998;p. 69–75
  6. Rowe BH, Keller JL, Oxman AD. Steroid use in the emergency department treatment of asthma exacerbations: a meta-analysis. Am J Emerg Med. 1992;10:301–310
  7. Rowe BH, Bota GW, Pollack CV, et al.  Management of acute asthma among adults presenting to Canadian versus US emergency departments. Ann Emerg Med. 1998;32:S2–S3 [abstract]
  8. Krahn MD, Berka C, Langlois P, et al.  Direct and indirect costs of asthma in Canada. Can Med Assoc J. 1996;154:821–831
  9. O’Byrne PM. Airway inflammation and the pathogenesis of asthma. Can Respir J. 1994;1:189–195
  10. Chung KF. Inflammatory mediators in asthma. In:  O’Byrne PM editors. Asthma as an Inflammatory Disease. New York, NY: Marcel Dekker; 1990;p. 159–184
  11. McFadden ER, Hejal R. Asthma. Lancet. 1998;345:1215–1220
  12. National Asthma Education Program . Expert Panel Report I1: Guidelines for the Diagnosis and Management of Asthma. 1997. Bethesda, MD: National Institutes of Health; 1997;
  13. Beveridge RC, Grunfeld AF, Hodder RV, et al.  Guidelines for the emergency management of asthma in adults. Can Med Assoc J. 1996;155:25–37
  14. Camargo CA, Woodruff PG. Management of acute asthma in US emergency departments: the Multicenter Asthma Research Collaboration. Am J Resp Crit Care Med. 1998;157:A623; [abstract]
  15. Nowak RM, Hurd SS, Skobeloff EM, et al.  Asthma research: future directions for emergency medicine. Ann Emerg Med. 1996;27:244–249
  16. Plotnick LH, Ducharme FM. Efficacy and safety of combined inhaled anticholinergics and beta-2-agonists in the initial management of acute pediatric asthma (Cochrane Review).. In: Cochrane Library,. Oxford, United Kingdom: Update Software; 1997; issue 1
  17. Qureshi F, Pestian J, Davis P, et al.  Effect of nebulized ipratropium on the hospitalization rates of children with asthma. N Engl J Med. 1998;339:1030–1035
  18. Plotnick LH, Ducharme FM. Should inhaled anticholinergics be added to beta2-agonists for treating acute childhood and adolescent asthma? A systematic review. BMJ. 1998;317:971–977
  19. Stoodley RG, Aaron SD, Dales RE. The role of ipratropium bromide in the emergency management of acute asthma exacerbation: a meta-analysis of randomized clinical trials. Ann Emerg Med. 1999;34:8–18
  20. Cates C. Comparison of holding chambers and nebulisers for beta-agonists in acute asthma (Cochrane Review).. In: Cochrane Library,. Oxford, United Kingdom: Update Software; 1998; issue 1
  21. Littenberg B. Aminophylline treatment in severe, acute asthma: a meta-analysis. JAMA. 1988;259:1678–1684
  22. Goodman DC, Littenberg B, O’Connor GT, et al.  Theophylline in acute childhood asthma: a meta-analysis of its efficacy. Pediatr Pulmonol. 1996;21:211–218
  23. Mathew R, Altura BM. Magnesium and the lungs. Magnesium. 1988;7:173–187
  24. Okayama H, Aikawa T, Okayama M, et al.  Bronchodilating effect of intravenous magnesium sulfate in bronchial asthma. JAMA. 1987;257:1076–1078
  25. Rolla G, Bucca C, Caria E, et al.  Acute effect of intravenous magnesium sulfate on airway obstruction of asthmatic patients. Ann Allergy. 1988;61:388–391
  26. de Valk HW, Struyvenberg A, Van Rign HJM, et al.  Extracellular and intracellular magnesium concentrations in asthmatic patients. Eur Respir J. 1993;6:1122–1125
  27. Magnesium: the mimic/antagonist of calcium. N Engl J Med. 1984;310:1253–1255 [editorial]
  28. Cairns CB, Kraft M. Magnesium attenuates the neutrophil respiratory burst in adult asthmatic patients. Acad Emerg Med. 1996;3:1093–1097
  29. Harari M, Barzillai R, Shani J. Magnesium in the management of asthma: critical review of acute and chronic treatments, and Deutsches Medizinisches Zentrum’s (DMZ’s) clinical experience at the Dead Sea. J Asthma. 1998;35:525–536
  30. Kramer MS, Feinstein AR. Clinical biostatistics. LIV.. The biostatistics of concordance. 1981;29:111–123 Clin Pharmacol Ther.
  31. Mulrow CD, Oxman AD. Cochrane Collaboration Handbook [updated September 1997].. In: Cochrane Library,. Oxford, United Kingdom: Update Software; 1994; issue 1
  32. Jadad AR, Moore RA, Carroll D, et al.  Assessing the quality of reports of randomized clinical trials: is blinding necessary?. Control Clin Trials. 1996;17:1–12
  33. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7:177–188
  34. Laupacis A, Sackett DL, Roberts RS. An assessment of clinically useful measured of the consequences of treatment. N Engl J Med. 1988;318:1728–1733
  35. Olkin L. Statistical and theoretical considerations in meta-analysis. J Clin Epidemiol. 1995;38:133–146
  36. Devi PR, Kumar L, Singhi SC, et al.  Intravenous magnesium sulfate in acute severe asthma not responding to conventional therapy. Indian Pediatr. 1997;34:389–397
  37. Ciarallo L, Sauer AH, Shannon MW. Intravenous magnesium therapy for moderate to severe pediatric asthma: results of a randomized, placebo-controlled trial. J Pediatr. 1996;129:809–814
  38. Skobeloff EM, Spivey WH, McNamara RM, et al.  Intravenous magnesium sulfate for the treatment of acute asthma in the emergency department. JAMA. 1989;262:1210–1213
  39. Green SM, Rothrock SG. Intravenous magnesium for acute asthma: failure to decrease emergency treatment duration or need for hospitalization. Ann Emerg Med. 1992;21:260–265
  40. Bloch H, Silverman R, Mancherje N, et al.  Intravenous magnesium sulfate as an adjunct in the treatment of acute asthma. Chest. 1995;107:1576–1581
  41. Tiffany BR, Berk WA, Todd IK, et al.  Magnesium bolus or infusion fails to improve expiratory flow in acute asthma exacerbations. Chest. 1993;104:831–834
  42. Silverman R, Osborne H, Runge J, et al.  Magnesium sulfate as an adjunct to standard therapy in acute severe asthma. Acad Emerg Med. 1996;3:467–468 [abstract]
  43. Schiermeyer RP, Finkelstein JA. Rapid infusion of magnesium sulfate obviates need for intubation in status asthmaticus. Am J Emerg Med. 1994;12:164–166
  44. Pabon H, Monem G, Kissoon N. Safety and efficacy of magnesium sulfate infusions in children with status asthmaticus. Pediatr Emerg Care. 1994;10:200–203
  45. Sydow M, Crozier TA, Zielmann S, et al.  High dose intravenous magnesium sulfate in the management of life-threatening status asthmaticus. Intensive Care Med. 1993;19:467–471
  46. Oxman AD, Guyatt GH. A consumer’s guide to subgroup analyses. Ann Intern Med. 1995;116:78–84
  47. Osmond MH, Klassen TP. Efficacy of ipratropium bromide in acute childhood asthma: a meta-analysis. Acad Emerg Med. 1995;7:651–656
  48. Dickersin K, Chan S, Chalmers TC, et al.  Publication bias and clinical trials. Control Clin Trials. 1987;8:343–353
  49. Dickersin K, Scherer R, Lefebvre C. Identifying relevant studies for systematic reviews. BMJ. 1994;309:1286–1291
  50. Oxman AD, Cook DJ, Guyatt GH. Users’ guides to the medical literature: how to use an overview. JAMA. 1994;272:1367–1371
  51. Oxman AD, Guyatt GH. Guidelines for reading literature reviews. Can Med Assoc J. 1988;138:697–703
  52. Mulrow CD. The medical review article: state of the art. Ann Intern Med. 1987;106:485–489
  53. LeLorier J, Gregoire G, Benhaddad A, et al.  Discrepancies between meta-analysis and subsequent large randomized, controlled trials. N Engl J Med. 1997;337:536–542
  54. Jadad AR, Cook DJ, Browman GP. A guide to interpreting discordant systematic reviews. Can Med Assoc J. 1997;156:1411–1416
  55. Moher D, Pham B, Jones A, et al.  Does quality of reports of randomized trials affect estimates of intervention efficacy reported in meta-analyses?. Lancet. 1998;352:609–613
  56. Rowe BH, Travers A, Kelly K, et al.  Nebulized ipratropium bromide in acute pediatric asthma: does it reduce hospital admissions among children presenting to the emergency department?. Ann Emerg Med. 1999;34:75–85
  57. Rowe BH, Alderson P. The Cochrane Collaboration: a resource for clinical problem solving in emergency medicine. Ann Emerg Med. 1999;34:86–90
  58. Wyer PC, Osborne HH. Recombinant tissue plasminogen activator: in my community hospital ED, will early administration of rt-PA to patients with the initial diagnosis of acute ischemic stroke reduce mortality and disability?. Ann Emerg Med. 1997;30:629–638
  59. Rowe BH, Bretzlaff JA, Bourdon C, et al.  Intravenous magnesium sulfate treatment for acute asthma in the emergency department (Cochrane Review).. In: Cochrane Library,. Oxford, United Kingdom: Update Software; 1999; issue 2

 Supported by a Canadian Association of Emergency Physicians Research Grant. Dr. Camargo is supported by grants HL-07427 and HL-03533, respectively, from the National Institutes of Health, Bethesda, MD.

☆☆ Reprints not available from the authors. Address for correspondence: Brian Rowe, MD, Division of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta,1 G1.63 Walter Mackenzie Centre, 8440-112 Street, Edmonton, Alberta T6G 2B7 Canada; 780-407-7047, fax 780-407-3314; E-mail brian.rowe@ualberta.ca.

PII: S0196-0644(00)01321-4

doi: 10.1067/mem.2000.105659

Annals of Emergency Medicine
Volume 36, Issue 3 , Pages 181-190 , September 2000