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Category: Volume 06 Issue 05 May 2018
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Title: Effectiveness of Inhaled MgSO4 as an Adjuvant to Initial Treatment of Acute Moderate Asthma in Children: An open Randomized Controlled Trial

Authors: Dr Kiran Raj H , Dr Suman Rath

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i5.162

Abstract

Abstract

Introduction: Asthma is the most common and best understood chronic disease in childhood, but the diagnosis and management of this disorder is a challenge for pediatricians and for the entire health-care system. Management of asthma depends upon the severity of attack and may include nebulized β2-agonists, anticholinergic agents, inhaled and systemic steroids, Intravenous magnesium sulphate and oxygen supplementation. Use of inhaled magnesium sulphate had been emerging as aninteresting topic for research. Many studies have come up with the conclusion that nebulized MgSO4 in patients with asthma exacerbation results in earlier improvement in clinical signs and symptoms, significant improvement in lung function and consequently a faster recovery. We undertook this study to analyze possibility of any added benefit when nebulized Mgso4 is used in the initial treatment along with the standard drugs in children with acute attack of asthma /wheeze.

Aims and Objectives 1. To know the effectiveness of combined inhaled salbutamol and ipratropium in magnesium sulphate over salbutamol and ipratropium in isotonic saline in acute moderate asthma in children. 2. To compare the efficacy of combined inhaled salbutamol and ipratropium in magnesium sulphateover salbutamol and ipratropium in isotonic saline in acute moderate asthma in children.

Materials and Methods: This was an open-labelled randomized controlled trial consisting of children in the age group of 2 to 14years attending pediatric OPD with wheeze according to GINA guidelines and PRAM scores. 100 children included in this study were divided into 2 groups. Children in Group A received standard treatment of Salbutamol along with Ipratropium and Normal saline while children in group Breceived Salbutamol along with Ipratropium and MgSo4 nebulization as treatment. The effectiveness and comparison of efficacy of treatment in these groups were studied. Student ’t’ test and chi square tests were used to find the significance of study parameters. P value less than 0.05 was considered as significant.

Results: Out of the 100 children who were included in this study there were 60 (60%) males and 40 (40%) females with a M:F ratio of 1.5:1. Mean age and weights were found to be comparable in both the groups. There was a statistically significant family history in Group A. PRAM scores at 0,20,40 and 60 minutes were statistically significantly higher in patients of Group A than in Group B. Heart rates at 0,20,40 and 60 minutes were comparable in both the groups and there was no statistically significant difference in both the groups. Respiratory rates were statistically significantly higher in Group A at 20,40 and 60 minutes. SpO2 levels were higher at 20 and 40 minutes. Peak expiratory flow rates were found to be comparable in both the groups. The analysis of patients on the basis of need to revisit the hospital showed that there was no statistically significant difference in hospitalrevisit rates in both the groups. There were no cases of treatment failure in any of the groups.

Conclusion: Inhaled Magnesium along with the standard treatment gives a significantly better clinical improvement in acute moderate asthma. Hence Inhaled magnesium along with standard treatment given as nebulization may be considered as initial treatment for use in moderate to severe acute asthma in children.

Keywords: Acute moderate asthma, inhaled MgSO4, PRAM Scores, Peak Expiratory Flow Rates

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Corresponding Author

Dr Kiran Raj H

Senior Resident, Department of Pediatrics,

Srinivas Institute of Medical Sciences and Research Centre, Mukka, Mangaluru, India

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