PMID- 24429155
OWN - NLM
STAT- MEDLINE
DCOM- 20140220
LR  - 20140815
IS  - 2213-2600 (Print)
IS  - 2213-2600 (Linking)
VI  - 1
IP  - 4
DP  - 2013 Jun
TI  - Magnesium sulphate in acute severe asthma in children (MAGNETIC): a randomised, 
      placebo-controlled trial.
PG  - 301-8
LID - S2213-2600(13)70037-7 [pii]
LID - 10.1016/S2213-2600(13)70037-7 [doi]
AB  - BACKGROUND: Little evidence is available for the effect of nebulised magnesium 
      sulphate (MgSO(4)) in acute asthma in children. We assessed the effect of MgSO(4) 
      treatment in children with severe acute asthma. METHODS: In this randomised 
      placebo-controlled, multi-centre, parallel trial, we enrolled children (aged 2-16 
      years) with severe acute asthma who did not respond to standard inhaled treatment 
      from 30 hospitals in the UK. Children were randomly allocated (1:1) to receive 
      nebulised salbutamol and ipratropium bromide with either 2.5 mL of isotonic 
      MgSO(4) (250 mmol/L; 151 mg per dose; MgSO(4) group) or 2.5 mL of isotonic saline 
      (placebo group) on three occasions at 20-min intervals. Randomisation was done 
      with a computer-generated randomisation sequence, with random block sizes of two 
      to four. Both patients and researchers were masked to treatment allocation. The 
      primary outcome measure was the Yung Asthma Severity Score (ASS) at 60 min 
      post-randomisation. We used a statistical significance level of p<0.05 for a 
      between-group difference, but regarded a between-group difference in ASS of 0.5 
      as the minimal clinically significant treatment effect. Analysis was done by 
      intention to treat. This trial is registered with controlled-trials.com, number 
      ISRCTN81456894. FINDINGS: Between Jan 3, 2009, and March 20, 2011, we recruited 
      and randomly assigned 508 children to treatment: 252 to MgSO(4) and 256 to 
      placebo. Mean ASS at 60 min was lower in the MgSO(4) group (4.72 [SD 1.37]) than 
      it was in the placebo group (4.95 [SD 1.40]; adjusted difference -0.25, 95% CI 
      -0.48 to -0.02; p=0.03). This difference, however, was not clinically 
      significant. The clinical effect was larger in children with more severe asthma 
      exacerbation (p=0.03) and those with symptoms present for less than 6 h 
      (p=0.049). We detected no difference in the occurrence of adverse events between 
      groups. INTERPRETATION: Overall, nebulised isotonic MgSO(4), given as an adjuvant 
      to standard treatment, did not show a clinically significant improvement in mean 
      ASS in children with acute severe asthma. However, the greatest clinical response 
      was seen in children with more severe attacks (SaO(2)<92%) at presentation and 
      those with preceding symptoms lasting less than 6 h. FUNDING: National Institute 
      for Health Research Health Technology Assessment Programme.
CI  - Copyright (c) 2013 Elsevier Ltd. All rights reserved.
FAU - Powell, Colin
AU  - Powell C
AD  - School of Medicine, Cardiff University, Cardiff, UK. Electronic address: 
      powellc7@cardiff.ac.uk.
FAU - Kolamunnage-Dona, Ruwanthi
AU  - Kolamunnage-Dona R
AD  - Department of Biostatistics, University of Liverpool, Liverpool, UK.
FAU - Lowe, John
AU  - Lowe J
AD  - School of Medicine, Cardiff University, Cardiff, UK; Department of Biostatistics, 
      University of Liverpool, Liverpool, UK.
FAU - Boland, Angela
AU  - Boland A
AD  - Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, 
      UK.
FAU - Petrou, Stavros
AU  - Petrou S
AD  - Department of Public Health, University of Warwick, Coventry, UK.
FAU - Doull, Iolo
AU  - Doull I
AD  - Department of Respiratory Paediatrics, Children's Hospital for Wales, Cardiff, 
      UK.
FAU - Hood, Kerenza
AU  - Hood K
AD  - School of Medicine, Cardiff University, Cardiff, UK.
FAU - Williamson, Paula
AU  - Williamson P
AD  - Department of Biostatistics, University of Liverpool, Liverpool, UK.
CN  - MAGNETIC study group
LA  - eng
SI  - ISRCTN/ISRCTN81456894
PT  - Comparative Study
PT  - Journal Article
PT  - Multicenter Study
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20130422
PL  - England
TA  - Lancet Respir Med
JT  - The Lancet. Respiratory medicine
JID - 101605555
RN  - 0 (Anticonvulsants)
RN  - 0 (Bronchodilator Agents)
RN  - 7487-88-9 (Magnesium Sulfate)
RN  - GR88G0I6UL (Ipratropium)
RN  - QF8SVZ843E (Albuterol)
SB  - IM
EIN - Lancet Respir Med. 2013 Jun;1(4):285
MH  - Acute Disease
MH  - Administration, Inhalation
MH  - Adolescent
MH  - Albuterol/administration & dosage
MH  - Anticonvulsants/administration & dosage
MH  - Asthma/diagnosis/*drug therapy/physiopathology
MH  - Bronchodilator Agents/administration & dosage
MH  - Child
MH  - Child, Preschool
MH  - Drug Therapy, Combination
MH  - Female
MH  - Follow-Up Studies
MH  - Forced Expiratory Volume/drug effects/*physiology
MH  - Humans
MH  - Injections, Intravenous
MH  - Ipratropium/administration & dosage
MH  - Magnesium Sulfate/*administration & dosage
MH  - Male
MH  - Respiratory Muscles/drug effects/*physiopathology
MH  - Retrospective Studies
MH  - Severity of Illness Index
MH  - Treatment Outcome
EDAT- 2014/01/17 06:00
MHDA- 2014/02/22 06:00
CRDT- 2014/01/17 06:00
PHST- 2014/01/17 06:00 [entrez]
PHST- 2014/01/17 06:00 [pubmed]
PHST- 2014/02/22 06:00 [medline]
AID - S2213-2600(13)70037-7 [pii]
AID - 10.1016/S2213-2600(13)70037-7 [doi]
PST - ppublish
SO  - Lancet Respir Med. 2013 Jun;1(4):301-8. doi: 10.1016/S2213-2600(13)70037-7. Epub 
      2013 Apr 22.