Mehmet ASLAN, Hilal KARABAĞ ÇITLAK, Erdem TOPAL, Harika GÖZÜKARA BAĞ, Fatih KAPLAN

Nebulize magnezyum sülfatın çocuklarda astım atakları üzerine etkisi

Amaç: Bu çalışmanın amacı orta ila şiddetli akut astım atakları olan çocuklarda standart tedaviye nebülize magnezyum sülfat eklenmesinin etkisini belirlemektir. Yöntem: Acil servise orta ve şiddetli astım atağı ile başvuran pediatrik hastalar çalışmaya dâhil edildi. Hastalar iki gruba ayrıldı. Grup S standart tedavi alırken, Grup M standart tedaviye ek olarak nebulize magnezyum sülfat aldı. Bulgular: Çalışmaya toplam 129 hasta dâhil edildi, 86’sı (%66,7) erkekti ve ortanca yaş (minimum-maksimum) 4(2-8) idi. Gruplar karşılaştırıldığında magnezyum sülfat verilen grupta 1. saat oksijen satürasyonu daha yüksek (p=0,024), 4. saat PRAM skoru (PRAM: Okul öncesi solunum değerlendirme ölçüsü) daha düşüktü (p=0,008). Diğer parametrelerde gruplar arasında 1. ve 4. saatte fark yoktu (p>0,05). Sonuç: Astım atağı olan çocuklarda standart tedaviye nebülize magnezyum sülfat eklenmesi oksijen satürasyonunu daha hızlı iyileştirmekte ve 4. saatteki PRAM skorunu olumlu yönde etkilemektedir.

Anahtar Kelimeler:

Adrenerjk beta-2 agonistler, astım, astım krizi, çocuk, inhalerler, magnezyum sülfat

The effect of nebulized magnesium sulfate on asthma attacks in the children

Aim: This study aimed to determine the effect of adding nebulized magnesium sulfate to standard treatment in children with moderate to severe acute asthma attacks. Methods: Pediatric patients admitted to the emergency department with moderate to severe asthma attacks were included in the study. The patients were divided into two groups. Group S received standard treatment, while Group M received nebulized magnesium sulfate in addition to standard therapy. Results: A total of 129 patients were included in the study, 86 (66.7%) were male, and the median (minimum-maximum) age was 4 (2-8) years. When groups were compared, oxygen saturation at hour 1 was higher (p=0.024), and the PRAM (preschool respiratory assessment measure) scores at the 4th hour were lower (p=0.008) in the group that received magnesium sulfate. The groups had no differences regarding any of the other parameters at the 1st and 4th hours (p>0.05). Conclusion: Adding nebulized magnesium sulfate to standard treatment in children with asthma attacks improves oxygen saturation faster and positively affects PRAM score at hour 4.

Keywords:

Adrenergic beta-2 agonists, asthma, asthmatic crisis, child, inhalers, magnesium sulfate,

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Daengsuwan T, Watanatham S. A comparative pilot study of the efficacy and safety of nebulized magnesium sulfate and intravenous magnesium sulfate in children with severe acute asthma. Asian Pac J Allergy Immunol. 2017;35(2):108-12.
Mohammed S, Goodacre S. Intravenous and nebulised magnesium sulphate for acute asthma: systematic review and meta-analysis. Emerg Med J. 2007;24(12):823-30.
Knightly R, Milan SJ, Hughes R, et al. Inhaled magnesium sulfate in the treatment of acute asthma. Cochrane Database Syst Rev. 2017;11(11):CD003898.
GIF Asthma. Global strategy for asthma management and prevention. Global Initiative for Asthma; 2015. Access date: 08.10.2022. Available from: https://ginasthma.org/wp-content/uploads/2016/01/GINA_Report_2015_Aug11-1.pdf.
Goodacre S, Cohen J, Bradburn M, et al. Intravenous or nebulised magnesium sulphate versus standard therapy for severe acute asthma (3Mg trial): a double-blind, randomised controlled trial. Lancet Respir Med. 2013;1(4):293-300.
Singh AK, Gaur S, Kumar R. A randomized controlled trial of intravenous magnesium sulphate as an adjunct to standard therapy in acute severe asthma. Iran J. Allergy. Asthma Immunol. 2008;7(4):221-9.
Kew KM, Kirtchuk L, Michell CI. Intravenous magnesium sulfate for treating adults with acute asthma in the emergency department. Cochrane Database Syst Rev. 2014;(5):CD010909.
Schulz KF, Altman DG, Moher D; CONSORT Group. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. Int J Surg 2011;9:672–7.
Chalut DS, Ducharme FM, Davis GM. The Preschool Respiratory Assessment Measure (PRAM): a responsive index of acute asthma severity. J Pediatr. 2000;137(6):762-8.
Classen H; Jacob R; Schimatschek H. Interactions of Magnesium with Direct and Indirect Acting Sympathomimetic Amines. Magnesium. 1987;9:80-7.
Middleton E Jr. Antiasthmatic drug therapy and calcium ions: review of pathogenesis and role of calcium. J Pharm Sci. 1980;69(2):243-51.
Hill J, Britton J. Dose-response relationship and time-course of the effect of inhaled magnesium sulphate on airflow in normal and asthmatic subjects. Br J Clin Pharmacol. 1995;40(6):539-44.
Iseri LT, French JH. Magnesium: nature’s physiologic calcium blocker. Am Heart J. 1984;108(1):188-93.
Nannini LJ Jr, Pendino JC, Corna RA, Mannarino S, Quispe R. Magnesium sulfate as a vehicle for nebulized salbutamol in acute asthma. Am J Med. 2000;108(3):193-7.
Mahajan P, Haritos D, Rosenberg N, Thomas R. Comparison of nebulized magnesium sulfate plus albuterol to nebulized albuterol plus saline in children with acute exacerbations of mild to moderate asthma. J Emerg Med. 2004;27(1):21-5.
Aggarwal P, Sharad S, Handa R, Dwiwedi SN, Irshad M. Comparison of nebulised magnesium sulphate and salbutamol combined with salbutamol alone in the treatment of acute bronchial asthma: a randomised study. Emerg Med J. 2006;23(5):358-62.
National Institutes of Health. Global strategy for asthma management and prevention [updated 2005]. Access date: 25.10. 2022. Available from: www.ginasthma.org.
Ducharme FM, Davis GM. Measurement of respiratory resistance in the emergency department: feasibility in young children with acute asthma. Chest. 1997;111(6):1519-25.
Gorelick MH, Stevens MW, Schultz TR, Scribano PV. Performance of a novel clinical score, the Pediatric Asthma Severity Score (PASS), in the evaluation of acute asthma. Acad Emerg Med. 2004;11(1):10-8.
Canny GJ, Reisman J, Healy R, et al. Acute asthma: observations regarding the management of a pediatric emergency room. Pediatrics. 1989;83(4):507-12.
Birken CS, Parkin PC, Macarthur C. Asthma severity scores for preschoolers displayed weaknesses in reliability, validity, and responsiveness. J Clin Epidemiol. 2004;57(11):1177-81.