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Does IV Magnesium Make Kids with Asthma Worse?

February 15, 2022

Written by Clay Smith

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IV magnesium (IV-Mg) was associated with worsening asthma score in children, greater odds of hospitalization, and no acceleration of exacerbation resolution in hospitalized patients.

Why does this matter?
NHLBI guidelines recommend considering IV-Mg in moderate to severe asthma exacerbations in pediatric patients with an incomplete response to steroids and albuterol. A Cochrane review of several small RCTs raised concern that the quality of evidence was poor. Does IV-Mg improve an objective asthma score and other important outcomes, like hospitalization rate?

Is this asthma “treatment” actually making kids worse?
This was a prospective study of 301 pediatric patients with moderate to severe asthma exacerbations. They used propensity score matching to mitigate confounding by indication – namely that physicians likely to use IV-Mg may be more likely to admit. They found that 2-hour AAIRS score actually worsened after IV-Mg (ß-coefficient of 0.98, 95%CI 0.20-1.77). What this means is that the 17-point AAIRS score worsened by about 1 point when IV-Mg was used. For reference, a 2-point decrease in AAIRS is a clinically meaningful improvement. So, this is at least a clear indication that these children are not getting better with IV-Mg and are statistically significantly worse. Children receiving IV-Mg had 5.8 – 6.8 fold greater odds of hospitalization in propensity score based multivariable regression models.  Hospitalized children did not have decreased time to Q4-hour albuterol, an accepted metric of exacerbation resolution, after propensity score adjustment.

Thanks to Don Arnold (lead author) for making me aware of this game-changing study and for your edits to this summary!

Prospective Observational Study of Clinical Outcomes After Intravenous Magnesium for Moderate and Severe Acute Asthma Exacerbations in Children. J Allergy Clin Immunol Pract. 2021 Dec 13:S2213-2198(21)01366-0. doi: 10.1016/j.jaip.2021.11.028. Epub ahead of print.

Peer reviewed by Don Arnold

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