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• Introduction

• Aims of the study

• Patients and Methods

• Results & Discussion

• Conclusions & Recommendations.

Bronchial Asthma

• Asthma is a common chronic disease, causing considerable morbidity.

• It is caused by chronic inflammation of lung airways with increased airway responsiveness and airflow obstruction.

• In 2007, 9.6 million children (13.1%) had been diagnosed with asthma in their lifetimes.

• Boys (14% vs 10%) girls

• Children in poor families (16% vs 10% not poor) are more likely to have asthma.

• Approximately 80% of all asthmatic patients report disease onset prior to 6 yr of age.

Bronchial Asthma

• The rise in asthma and allergic disease among

children is a matter of worldwide concern.

• Many authors have argued that the changes in

diet may have been an important determinant

of increased susceptibility to asthma.

Magnesium

• Magnesium (Mg) is the fourth most abundant ion in the human body; of which 50% is stored in the

• bones, 49% in cells and the remaining 1% in the serum.

• Mg is involved in the structure of many enzymes in the body and plays a role in intracellular reactions.

• Mg is crucial for normal neuromuscular activities.

• Magnesium deficiency is associated with increased contractility of smooth muscle cells including bronchiolar resulting in bronchospasm.

To determine prevalence of

hypomagnesemia among asthmatic children

Comparison between mean Serum

Magnesium levels in Asthmatic and

control group

To determine

association between

mean Serum

Magnesium and BMI

of Asthmatic patients

Comparison between mean Serum

Magnesium levels & duration of

Asthma

.

Aims of the study

To determine association

between mean Serum

Magnesium levels & use of

medications (controller) in

Asthmatics.

To determine

association between

mean Serum

Magnesium levels &

severity of Asthma.

• study location

• Heevi Pediatric Teaching Hospital / Duhok/Kurdistan/Iraq.

• Study Design

• A case – control study

• Duration of Data collection.

• January1st 2014 and January1st 2015

• Selection of the study participants:• 200 participants from both genders ; their

ages range between 1 to 15 years.

• Patient group: 100 asthmatic patients

• Control group: 100 healthy children.

Patients and Methods

• Inclusion Criteria:

• Diagnosis of asthma and severity of disease were identified based on the Global Initiative for Asthma (GINA) guideline criteria.

• Exclusion Criteria:

• Any patient with localized wheezing, dehydration, fever, pneumonia, renal, hepatic or cardiac dysfunction.

Patients and Methods

Data collection

• A pre designed questionnaire was filled and all data were kept confidential.

• For each participant the weight, height and BMI (body mass index) were measured.

Estimation of serum Magnesium

• A blood sample was collected from patients and controls for the measurement of serum Magnesium by using atomic absorption spectrophotometer.

• Normal Serum Mg: (1.5-2.3 mg/dL)

• Magnesium (Mg): level of < 1.5 mg/dl was considered hypomagnesemia

Data Analysis

• SPSS (statistical package for the social sciences) for windows version 19.

• A P-value of less than 0.05 was considered to be statistically significant.

Patients and Methods

The distribution of Age & Gender for both

Asthmatic and controls

Age (years)Asthmatic patients Control Group

No.(%) Male Female No. Male Female

1 - <3 years 40(40%) 27(27%) 13(13%) 25(25%) 18(18%) 7(7%)

3 - <5 years 22(22%) 16(16%) 6(6%) 14(14%) 9(9%) 5(5%)

5 - <10 years 29(29%) 19(19%) 10(10%) 36(36%) 19(19%) 17(17%)

10-15 years 9(9%) 6(6%) 3(3%) 25(25%) 15(15%) 10(10%)

Total 100(100%) 68(68%) 32(32%) 100(100%) 61(61%) 39(39%)

The mean Serum Mg levels in Asthmatic and

control group

GroupsNo.

(%)

Serum Mg

level(mg/dl) P-value

Mean(±SD.)

Asthmatic patient 100 1.91± 0.33

0.01Controls 100 2.03± 0.33

Comparison between Mg levels in Asthmatic

and control group

Serum Magnesium

Asthmatic

patients

Control

group Total

Low S.Mg(<1.5 µg/dl) 9(9%) 1(1%) 10(5%)

Normal S.Mg (1.5-2.3 mg/dL) 91(91%) 99(99%) 190(95%)

Total 100(100%) 100(100%) 200(100%)

X2=8.36 df=2 P=0.01

Comparison between mean Serum Serum

Magnesium levels & severity of Asthma.

Severity of

AsthmaNo. (%)

Serum Mg level(

mg/dl) P-value

Mean(±SD.)

Intermittent 67(67%) 1.96±0.33

0.05

Mild persistent 20 (20%) 1.85±0.26

Moderate

persistent10 (10%) 1.79±0.42

Severe persistent 3(3%) 1.50±0.10

Total 100 (100%) 1.91±0.33

Comparison between mean Magnesium levels &

duration of Asthma.

Duration of Asthma No.(%)

Serum Mg level(

mg/dl) P-value

Mean(±SD.)

< 1 year 28 (28%) 1.97±0.27

0.1

1 - <3 years 48 (48%) 1.91±0.33

3- <5 years 11 (11%) 1.87±0.36

>5 years 13 (13%) 1.72±0.44

Total 100 (100%) 1.91±0.33

The relation between mean Serum

Magnesium and BMI of Asthmatic patients

BMI No.

Serum D3

level(µg/dl)P-

value Mean(±SD.)

Under weight

<5%21(21%) 1.97±0.25

0.3

Normal

5% to 85%57 (57%) 1.90±0.36

Overweight

85% to 95%13 (13%) 1.78±0.30

Obese

>95%9 (9%) 2.00±0.32

Total 100 (100%) 1.91±0.33

The Comparison between mean Serum Magnesium

levels & use of medications (controller) in

Asthmatics.

Drugs No.(%)Serum Mg level ( mg/dl)

P-valueMean(±SD.)

Steroid as controller medications

Used steroid 20 (20%) 1.92±0.370.7

Not used steroid 80 (80%) 1.90±0.30

Bronchodilators as controller medications

Use 31 (31%) 1.91±0.340.9

Not used 59 (59%) 1.90±0.31

Total 100(100%) 1.91±0.33

Prevalence of Low Mg Level in Asthmatic patients

Serum Magnesium level was found to be significantly lower

in asthmatic children as compared to the control group

Ukraine

Egypt

Turkey

No significant differences between patients and controls

Spain

Iran

Possible Explanation of Magnesium Deficiency in Asthmatics

• Magnesium is the cofactor of more than 300 enzymes and is involved in many physiological functions including protein synthesis, intracellular signal distribution and enzyme catalysis.

• Since it is the natural antagonist of calcium, it provides smooth muscle relaxation

• In addition, magnesium suppresses the excitability of muscle fibers by reduction of acetylcholine secretion from motor nerve terminals.

• Moreover, it inhibits production of inflammatory mediators by helping stabilization of T-cells and inhibiting mast cell degranulation.

• Again, it reduces the severity of inflammation in asthma by stimulating nitric oxide and prostacyclin syntheses.

Possible Explanation of Magnesium Deficiency in Asthmatics

• Although the cause of hypomagnesemia in patients with bronchial asthma was unknown,

• It may be related to either low magnesium intake in asthmatics or increased urinary loss of magnesium, as a side effect of therapy with b2- agonist, corticosteroid, and theophylline.

CONCLUSION AND

RECOMMENDATIONS

Conclusions

• Asthmatic Patients have significantly lower mean Serum Mg levels compared with healthy controls.

• There is significant difference between mean Serum Mg levels AND severity of asthma.

• Serum Mg level inversely correlates with the duration of asthma but not significantly.

• But no statistically significant association were observed between Serum Mg and BMI.

• No significant change in serum Mg develops with the use of steroids and bronchodilators in treatment.

Recommendations

• Magnesium supplementation might be considered a useful additional intervention for improving outcome in patients with Asthma.

• A large follow up study is recommended to look on the effect of Magnesium supplementation in Asthmatic patients.

• Further extended cohort study is indicated to look on the relations between the Asthmatic patients and serum Magnesium level.

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