The prevalence of asthma has been increasing worldwide despite aggressive efforts to treat and prevent it.22 Asthma is a chronic disease affecting millions around the world. In the United States alone there are approximately 15 million patients with asthma. The airways of a person with asthma are hyper-responsive to a variety of allergic and nonallergic triggers. Alone or in various combinations,23 these triggers can initiate inflammatory cascades activating resident cells (i.e. mast cells and airway epithelium) and recruiting a variety of immune cells including eosinophils and neutrophils. Histamines, leukotrienes, prostaglandins, quinines and cytokines are among a myriad of activated substances released by these cells leading to epithelial damage, increased mucus production, mucosal edema, smooth muscle contraction and bronchial hyper-responsiveness.24 The outcomes are narrowed airways, airflow obstruction and elevated airways resistance.
Use of magnesium therapy in asthma was first described in 1936 by two Uruguayan physicians.25 Despite this, it is not a standard recommendation of the National Heart, Lung and Blood Institute (NHLBI) guidelines26 for diagnosis and management of asthma because of conflicting reports regarding its efficacy.
The mechanism by which magnesium works in asthma is still unclear but it is likely that it is related to relaxation of bronchial smooth muscle cells.27,28 It has been demonstrated that when magnesium is administered to animals, relaxation of bronchial smooth muscle cells ensues.29 Magnesium seems to inhibit the release of histamine from mast cells which recruits inflammatory mediators.30 Adverse events associated with magnesium administration include facial flushing, tachycardia (i.e. a high frequency of ventricular contraction per minute, at least 90/min), muscle weakness, nausea and vomiting.31 Most literature suggests that magnesium provides no benefit in the treatment of asthma in adults.32,33 Rowe et al. performed a meta-analysis (i.e. a statistical procedure in which a number of human-based studies comparing the effects of a new drug treatment with a conventional therapy are pooled together to increase the statistical power of the findings) identifying seven randomized, controlled trials which evaluated intravenous magnesium sulphate in acute asthma for a total of 668 patients.33 Overall, the outcome measures were not significantly different when compared to standard care.34 Data in paediatric patients tend to be slightly more favourable.35,36
In general, the drug is well tolerated and inexpensive at the usual clinical dose of 1.2-2.0 g administered intravenously over 20 min. In spite of this the overall data present in the literature do not support routine use of magnesium in patients with acute asthma. Furthermore, inhaled preparations of magnesium sulphate have been reported to provide no additional benefit in addition to therapy with albuterol, which is a drug with ^-adrenergic properties, i.e. acting as a ^-adrenergic agonist, in adult patients with mild or moderate asthma exacerbations.37
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