The Role of Magnesium Sulphate in the Management of Acute Asthma

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THE ROLE OF MAGNESIUM SULPHATE IN THE ROLE OF MAGNESIUM SULPHATE IN THE MANAGEMENT OF ACUTE ASTHMATHE MANAGEMENT OF ACUTE ASTHMA

ByBy

DR. COLONEL (R) AZMAT ALI DR. COLONEL (R) AZMAT ALI M.B.B.S, MSc. (Medical Administration) M.B.B.S, MSc. (Medical Administration)

DEPARTMENT OF PHARMACOLOGY DEPARTMENT OF PHARMACOLOGY

ISRA UNIVERSITY ISRA UNIVERSITY

HYDERABAD, SINDH HYDERABAD, SINDH



1

. INTRODUCTION 1

. INTRODUCTION

Mg Sulphate, an additive in the management of acute

asthma It may be effective through a variety of mechanisms

It is a common mineral in geological strata

Its other uses are

Magnesium may play a role in the pathogenesis of

asthma.

Intravenous magnesium may be helpful when

conventional therapy fails



2. AIMS AND OBJECTIVES 2. AIMS AND OBJECTIVES

To determine the substantial evidence regarding theTo determine the substantial evidence regarding the

role of MgSO4 in acute asthma.role of MgSO4 in acute asthma.

To determine whether this may be supportive therapyTo determine whether this may be supportive therapy

for patients presenting to the emergency departmentfor patients presenting to the emergency department

with acute asthma.with acute asthma.



extremelyextremely distressed,distressed, using using accessoryaccessorymusclesmuscles ofof respiration,respiration, areare

hyperinflatedhyperinflated andand tachypnoeic,tachypnoeic,ultimatelyultimately exhaustedexhausted andand requirerequireventrilatoryventrilatory supportsupport..ThereforeTherefore aimaim ofof studystudy isis toto preventprevent

suchsuch aa gravegrave situationsituation toto developdevelop bybytimelytimely administrationadministration ofof intravenousintravenous ororinhalationinhalation ofof magnesiummagnesium sulphatesulphate..



4. MATERIALS AND METHODS: 4. MATERIALS AND METHODS:

4.1. 4.1. Study design:Study design: Descriptive comparative Descriptive comparative

4. 2

. 4

. 2

. Setting:Setting: Department of Medicine, Isra University Department of Medicine, Isra University Hospital, Hospital, Hyderabad, Liaquat University Hyderabad, Liaquat University Hospital, Jamshoro and Institute of Chest Hospital, Jamshoro and Institute of Chest Diseases, Kotri Diseases, Kotri

4.3. 4.3. Duration of study: Duration of study:Six months from January 2010 to June 2010Six months from January 2010 to June 2010



4.4. Sample size:

73 patients of acute asthma were enrolled in this study.

Group I:

Patients were administered oxygen, intravenoushydrocortisone

and nebulization with ventoline solution

Group II:

Patients were administered intravenous magnesium sulfate besides

oxygen administration, parenteral Hydrocortisone and nebulization

by ventoline solution



4.5. 4.5. Sampling technique:Sampling technique: Non Probability Sampling Non Probability Sampling

4.6. 4.6. Sample Selection:Sample Selection: 4.6.1. 4.6.1. Inclusion criteria: Inclusion criteria:1.1. Hospitalized patients with acute asthma between Hospitalized patients with acute asthma between

the ages of 10 to 40 years.the ages of 10 to 40 years. 2. 2. Patients having Peak Expiratory Flow Rate is > Patients having Peak Expiratory Flow Rate is >

50 %.50 %.

3.3. Those who give informed consent Those who give informed consent

4.6. 2. 4.6. 2. Exclusion criteria: Exclusion criteria:1.1. Congestive cardiac failureCongestive cardiac failure 2. 2. Coronary artery diseaseCoronary artery disease3.3. Diabetes mellitus Diabetes mellitus 4. 4. Renal insufficiency Renal insufficiency5.5. Hypertension Hypertension6.6. Pnemonaemias Pnemonaemias7.7. Pregnancy Pregnancy8.8. Patients with temperature > 39.8OC Patients with temperature > 39.8OC9.9. Patients who are unable to use expiratory flow meter. Patients who are unable to use expiratory flow meter.



4.7.1. Sample collection (investigations)

Patient·s samples were collected:

Blood by Venepuncture into EDTA tube (2 ml for Blood CP)2. 2 ml blood for sugar in fluoride bottle3. 2 ml of blood in plain bottle for serum magnesium4. 2 ml of blood in heprinized syringe for ABGs

5. Urine DR and for pregnancy test in case of females

4.7. 2. Sample preparation

The samples were analyzed within 4 hours of collection

Parameters: PulseBlood pressure

Respiratory rate Peak Expiratory Flow Rate

Oxygen saturation



4.8.4.8. Treatment protocol:Treatment protocol:After carrying out initial assessment, selected patientsAfter carrying out initial assessment, selected patients

were divided into the following groupswere divided into the following groups::

4.8.1.4.8.1. Group A:Group A:Patients received conventional treatment of 0.5 ml ofPatients received conventional treatment of 0.5 ml ofSalbutamol (2.5 mg) by neublizer and oxygen therapy,Salbutamol (2.5 mg) by neublizer and oxygen therapy,followed by 100 mg of Hydrocortisone intravenously.followed by 100 mg of Hydrocortisone intravenously.

4.8.2.4.8.2. Group B:Group B:Besides conventional treatment as in group A received after 30Besides conventional treatment as in group A received after 30minutes, a dose of Intravenousminutes, a dose of Intravenous magnesium sulfate 25 mg per Kg magnesium sulfate 25 mg per Kg bodybody weight or maximum 2 g diluted in 100 ml of normalweight or maximum 2 g diluted in 100 ml of normal

saline in 20saline in 20minutes.minutes.Administration of drugs in the both the groups were monitoredAdministration of drugs in the both the groups were monitoredby pulse oxymetry. After a period of 60 and 120 minutes vitalby pulse oxymetry. After a period of 60 and 120 minutes vitalsigns, pulse oxymetry and Peak Expiratory Flow Rate (PEFR)signs, pulse oxymetry and Peak Expiratory Flow Rate (PEFR)were again recorded for the patients in both the groups.were again recorded for the patients in both the groups.



5. Statistical analysis:

The data were evaluated in statistical program SPSS

versions 16.0. Categorical parameters such as Gender,

Age groups etc. were presented as n(%). Numerical

variables like Age in years, Duration of asthma, PulseRate, Respiratory Rate, Systolic and Diastolic Blood

Pressure, Oxygen Saturation, Peak Expiratory Flow

Rate etc. were presented as Mean + Standard

Deviation and Student t test (2 tailed) was applied to

compare the means among the Conventional andMagnesium). All the data were calculated on 95%

confidence interval. A P value < 0.05 was considered

as statistically significant level for all the comparisons.



RESULTSTABLE NO. 7

COMPARISON OF RESPIRATORY RATE (BREATHS / MINUTES)BASELINE, AFTER 60 & 120 MINUTES OF TREATMENT

(n = 73)

Respiratory rate(breaths /minutes)

Conventional(n = 36)

Magnesium(n = 37)

P value

Before

After 60 minutes

After 120 minutes

32.6 + 4.84

28.7 + 6.03

21.1 + 2.95

33.7 + 5.41

26.5 + 3.89

17.9 + 2.02

0.36

0.06

< 0.001*

Results are expressed as Mean + Standard deviation calculated by studentt test

* P value is statistically significant

Table No. 1



COMPARISON OF RESPIRATORY RATE (BREATHS / MINUTES)

BASELINE, AFTER 60 & 120 MINUTES OFTREATMENT

(n = 73)

RESULTSGraph No. 1

P = 0.36

P = 0.06

P = <0.0001



RESULTS

Comparision of Respiration Rate Base line after 60

& 120 min of treatment

12

17

22

27

32

37

42

30 60 120

(Time Minutes)

R e s p i r a t i o n

R a t e

Conventional

Magnesium

GRAPH NO. 7

COMPARISON OF RESPIRATORY RATE (BREATHS / MINUTES)BASELINE, AFTER 60 & 120 MINUTES OF TREATMENT

(n = 73)

Graph No. 2



COMPARISON OF OXYGEN SATURATION


RESULTSGraph No. 3

P = 0.004

P = 0.85

P = 0.23



RESULTSGRAPH NO. 4

COMPARISON OF O Y EN SATURATION

BASELINE, AFTER 60 & 120 MINUTES OF TREATMENT

(n = 73)C n O n S n B L n ,

60 & 120 n n

85

87

89

91

93

95

97

99

30 60 120

(T M n )

O

n S

n

Conv ntional

Magnesium

(n = 73)



COMPARISON OF PEAK EXPIRATORY FLOW RATE (L/MINUTE)


(n = 73)

RESULTSGraph No. 5

P = 0.001

P = 0.008

P = 0.23



RESULTS

Comparision of Peak E piratory Base Line, after

60 & 120 min of treatment

150

170

190

210

230

250

30 60 120

(Time Minutes)

P e a k E

p i r a t o r y

Conventional

Magnesium

GRAPH NO. 11

COMPARISON OF PEA E PIRATORY FLO RATE (L/MINUTE)

BASELINE, AFTER 60 & 120 MINUTES OF TREATMENT

(n = 73)

Graph No. 6



RESULTSTABLE NO. 10

COMPARISON OF PULSE (HEART RATE/MINUTE)BASELINE, AFTER 60 & 120 MINUTES OF TREATMENT

(n = 73)

Pulse Rate (beats /minutes): Conventional

(n = 36)Magnesium

(n = 37) P value

Before

After 60 minutes

After 120 minutes

108.7 + 19.83

123.2 + 16.86

91.9 + 8.46

109.9 + 17.48

104.8 + 15.40

88.3 + 5.11

0.91

< 0.001

0.04

Results are expressed as Mean + Standard deviation calculated by student ttest* P value is statistically significant

Table No. 5



RESULTSGRAPH

¡

.¢ 2

I ( / I )I , I

(

Graph No. 7

P = 0.04

P = < 0.0001

P = 0.91



RESULTS

Comparision of Pulse Rate b/w Conventional &

Magnesium roup @ 0, 60 & 120 min

70

90

110

130

150

170

190

30 60 120

(Time Minutes)

P u l s

e R a t e

Conventional

Magnesium

GRAPH . 3

I ( / I ) I ,I

( )

Graph No. 8



DISCUSSION

In the present study, the mean age was similar tothe study of Silverman RA et al.(Silverman RA,

Osborn H et al.2002) The duration of asthma in this study was also

similar to the study of Aggarwal P et al.(AggarwalP, Sharad S et al.2006)

Mean serum magnesium level in this study iscomparable with the study of Silverman RA etal.(Silverman RA, Osborn H et al.2002).



The heart rate in the baseline and after 60 minutesof treatment in this study was insignificant in both

the groups and Aggarwal P, Sharad S et al.2006 aswell found same observation in their study. In thepresent study, the heart rate after 120 minutes wassignificantly slowed down to 88.3 + 5.11 (beats

/minutes) in the magnesium group (n = 37) and it

remained 91.9 + 8.46 (beat / minutes) in theconventional group (n = 36). These results aresimilar to the study of Aggarwal P, Sharad S etal.2006.

DISCUSSION



Respiratory rate was significantly reduced in the magnesiumgroup after final treatment. Mean respiratory rate + SD inbaseline was 32.6+4.84 breaths / minute in the conventional

group and 33.7 + 5.41breaths / minute in magnesium group.After final treatment, mean respiratory rate + SD were 21.1+ 2.95 breath / minute (n = 36) and 17.9 + 2.02 breaths /minute (n = 37) of conventional and magnesium groupsrespectively. This finding was comparable with study of BijaniK et al. 2002, in whose study the average of respiratory rate

in baseline was 34 breaths / minute in the magnesium groupand 35 breaths / minute in the saline group. After finaltreatment the respiratory rate declined to 24 breaths/minutein the magnesium group and 30 in the saline group.

DISCUSSION



In this study, the baseline average of PEFR were174.0 and 164 L/minute in the magnesium (n =

37) and conventional groups respectively. After 60minutes of treatment, the mean + SD inconventional (nebulization) and intravenousmagnesium plus nebulization conventional were183.1 + 34.25(n = 36) and 206.2 + 37.81(n =

37) respectively. Nannini et al. (Nannini LJ Jr,Pendino JC et al.2000) showed that compared witha single dose of sabutamol, there was a greatincrease in peak flow rate when a single dose of magnesium sulfate was added to nebulised

patient with salbutamol.

DISCUSSION



CONCLUSION

The serious health problem posed by asthma cannot beoveremphasized. Unfortunately it is inadequately diagnosed

and is poorly managed, resulting in a vicious cycle of morbidity and mortality. Even worse is the fact that a lot of misconceptions about the illness which are widely prevalenteven among health professionals.

A single dose of intravenous magnesium sulfate and

conventional therapy (by oxygen inhalation, ventolinenebulization, and intravenous hydrocortisone) administeredto patients with severe acute asthma has been observed tobe effective in relieving the symptoms as compared toconventional therapy alone.



RECOMMENDATIONS Education of patient is important as regards current asthma

management

Patients should understand their disease process, use of

medications, ability to react to their change disease symptoms, oractual measured peak flow

Peak flow meter must be available in all the clinics and emergencydepartments and all patients be provided their instruments onsubsidized rates.

Doctor or nurses should be encouraged to use peak flow meter.

In for flung areas of countries, physicians, should be encouraged

to use ½ MgSO4 besides conventional treatment Mechanical verifications be made available at least at Taluka and

RHC level.

Patients of asthma be registered and drug companies be instructedto provide medication on reduced rates for poor patients

Asthma society Hyderabad Chapter may be activated.



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PROFORMADemographic details:S. No: Name of Institution / Hospital:

Name: Age: Sex: 1. Male 2. Female

Occupation:

Address:

Marital status: Religion:

Date of admission: Ward:

Reg: No. Bed No:

Brief history:



Weight (Kg):

Height:

Duration of Asthma (in years):Number of previous hospitalizations:

Time of arrival:

Hospital stay:

The Role of Magnesium Sulphate in the Management of Acute Asthma

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