Nashville, Tenn: A recent study has reported that IV magnesium is related to an increased exacerbation severity, increased hospitalization risk, and no acceleration in resolution among hospitalized children with moderate-to-severe asthma exacerbations. The study appears in The Journal of Allergy and Clinical Immunology: In Practice.
National Heart, Lung, and Blood Institute expert guidelines recommend IV magnesium (IV-Mg) for children having moderate-to-severe asthma exacerbations who are not completely responsive to systemic corticosteroid (CCS) and inhaled albuterol. However, there is not much knowledge regarding whether IV-Mg improves outcomes in children with acute asthma exacerbations.
Considering the above, Donald H. Arnold, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tenn, and colleagues aimed to examine whether IV-Mg improves outcomes in children with moderate and severe exacerbations.
For this purpose, using data from a prospective observational cohort of children aged 5 to 17 years having moderate to severe exacerbations, the researchers performed a secondary analysis. Standardized treatment included systemic corticosteroid and inhaled albuterol, with consideration of IV-Mg (75 mg/kg) for patients with insufficient response after 20 minutes. Associations of IV-Mg treatment with change in the validated Acute Asthma Intensity Research Score, hospitalization rate, and time to spacing of inhaled albuterol of 4 hours or more among hospitalized participants were examined using propensity score (PS).
Among 301 children, median age was 8.1 years.
Key findings include:
· In a PS covariate-adjusted multivariable linear regression model, IV-Mg treatment was associated with a 2-hour increase in the Acute Asthma Intensity Research Score (β-coefficient = 0.98), indicating increased exacerbation severity.
· Three additional PS-based models yielded similar results.
· Participants receiving IV-Mg had 5.8-fold and 6.8-fold greater odds of hospitalization in PS-based multivariable regression models.
· Among hospitalized participants, there was no difference in time to albuterol of every 4 hours or more in a PS covariate-adjusted Cox proportional hazards model (hazard ratio = 1.2).
The authors conclude, "Among children with moderate and severe exacerbations, IV-Mg is associated with increased risk for hospitalization, increased exacerbation severity, and no acceleration in exacerbation resolution among hospitalized participants.
Reference:
The study titled, "Prospective Observational Study of Clinical Outcomes After Intravenous Magnesium for Moderate and Severe Acute Asthma Exacerbations in Children," was published in the Journal of Allergy and Clinical Immunology: In Practice.
DOI: https://doi.org/10.1016/j.jaip.2021.11.028