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Master of Public Health

Prospective observational study of clinical outcomes after intravenous magnesium for moderate and severe acute asthma exacerbations in children

AUTHORS

Arnold DH , Gong W , Antoon JW , Bacharier LB , Stewart TG , Johnson DP , Akers WS , Hartert TV , . The journal of allergy and clinical immunology. In practice. 2021 12 13; ().

ABSTRACT

BACKGROUND: There is limited knowledge whether intravenous magnesium (IV-Mg) improves outcomes in children with acute asthma exacerbations.

OBJECTIVE: Examine whether IV-Mg improve outcomes in children with moderate and severe exacerbations.

METHODS: We performed a secondary analysis using data from a prospective observational cohort of children aged 5-17 years with moderate and severe exacerbations. Standardized treatment included systemic corticosteroid and inhaled albuterol, with consideration of IV-Mg (75mg/kg) for patients with insufficient response after 20 minutes. Propensity score (PS) models were used to examine associations of IV-Mg treatment with change of the validated Acute Asthma Intensity Research Score (AAAIRS), hospitalization rate, and time to spacing of inhaled albuterol 4 hours or greater (Q4hr) among hospitalized participants.

RESULTS: Among 301 children, median [IQR] age was 8.1 [6.4, 10.2] years, 170 (57%) Black race, 201 (67%) male sex, and 84 (28%) received IV-Mg. In a PS covariate adjusted multivariable linear regression model, IV-Mg treatment was associated with a 2-hour increase in the AAIRS (β-coefficient 0.98; 95% CI 0.20, 1.77), indicating increased exacerbation severity. Three additional PS-based models yielded similar results. Participants receiving IV-Mg had 5.8-fold (95% CI 2.8, 11.9) and 6.8-fold (95% CI 3.6, 12.9) greater odds of hospitalization in PS-based multivariable regression models. Among hospitalized participants there was no difference in time to Q4hr albuterol in a PS covariate-adjusted Cox proportional hazards model (HR 1.2; 95% CI 0.8, 1.8).

CONCLUSION: Among children with moderate and severe exacerbations, IV-Mg is associated with increased exacerbation severity, increased risk of hospitalization, and no acceleration in exacerbation resolution among hospitalized participants.

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