Nebulized Magnesium Sulfate as an Adjunct to Standard Therapy in Asthma Exacerbation

NCT ID: NCT02584738

Last Updated: 2015-12-02

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

PHASE4

Total Enrollment

152 participants

Study Classification

INTERVENTIONAL

Study Start Date

2015-09-30

Study Completion Date

2018-01-31

Brief Summary

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The purpose of this study is to investigate the effectiveness of nebulized magnesium sulfate in patient with moderate to severe asthma exacerbation in pediatric emergency

Detailed Description

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The inclusion period of the patients in this research will be on September 2015 to November 2015. Patients are going to be selected by the medical staff on duty in the emergency paediatric service, according to the criteria previously established inclusion and exclusion. Immediately a baseline degree of respiratory distress using PRAM scale and heart rate, respiratory rate, blood pressure and oxygen saturation. While informed consent in which the objective and characteristics of the study will be obtained will be explained.

Patients will be randomly assigned one of the two treatments in the Research: standard treatment for moderate to severe asthma attack, according to GINA or standard treatment plus nebulised magnesium sulphate, according to the table of random allocation of treatment.

Evaluations were performed after administration of each spray, that is, at 20, 40, 60, 120, 180 and 240 minutes after beginning treatment. The parameters' to evaluate are going to be heart rate, respiratory rate, oxygen saturation, blood pressure and assessment of severity of acute asthma with PRAM scale.

The application of nebulized drugs are made in the emergency department of pediatrics by inhalation therapy staff who are also responsible for the preparation of medicines. It is clear that this staff not participate in the evaluation of patients, which will be performed by the research staff or by medical staff on duty in the pediatric emergency department.

Patients and evaluating physician will not pick out between the two solutions for nebulization not only colour but also smell or other special feature, because the solutions were arranged in two identical syringes. Administered alone at the end of the study treatment is known.

Later the entry or exit of the patient decide, who can be egress to show clinical improvement with decreased severity index PRAM, patients will be graduates of an outpatient treatment according to international guidelines on the management of acute asthma. All initial and outcome data will be recorded in a format of data collection All decisions will be made by patients pediatricians emergency department which will follow patients throughout the study and will have the power to release the study patients to use other interventions that they consider clinically necessary

Conditions

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Asthma

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

TRIPLE

Participants Caregivers Investigators

Study Groups

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Nebulized Magnesium Sulfate

Nebulized salbutamol and ipratropium bromide mixed with 2.5 ml of isotonic MgSO4.

Intravenous methylprednisolone or oral prednisolone

Group Type EXPERIMENTAL

Nebulized Magnesium Sulfate

Intervention Type DRUG

Nebulized salbutamol and ipratropium bromide mixed with 2.5 ml of isotonic MgSO4 (150 mg) per dose every 20 minutes during the first hour.

will be continued with nebulized standard treatment every hour for 4 hours.

Nebulized Salbutamol

Intervention Type DRUG

Nebulized salbutamol 2.5mg (2-5 years) or 5 mg (≥6 years)

Ipratropium bromide

Intervention Type DRUG

Nebulized ipratropium bromide 250 mcg

Methylprednisolone or Prednisolone

Intervention Type DRUG

Begin with intravenous methylprednisolone or oral prednisolone 2 mg/kg/day for each treatment

Nebulized isotonic saline

Nebulized salbutamol and ipratropium bromide with 2.5 ml of isotonic saline. Intravenous methylprednisolone or oral prednisolone

Group Type PLACEBO_COMPARATOR

Nebulized isotonic saline

Intervention Type DRUG

Nebulized salbutamol and ipratropium bromide mixed with 2.5 ml of isotonic saline per dose every 20 minutes during the first hour.

will be continued with nebulized standard treatment every hour for 4 hours.

Nebulized Salbutamol

Intervention Type DRUG

Nebulized salbutamol 2.5mg (2-5 years) or 5 mg (≥6 years)

Ipratropium bromide

Intervention Type DRUG

Nebulized ipratropium bromide 250 mcg

Methylprednisolone or Prednisolone

Intervention Type DRUG

Begin with intravenous methylprednisolone or oral prednisolone 2 mg/kg/day for each treatment

Interventions

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Nebulized Magnesium Sulfate

Nebulized salbutamol and ipratropium bromide mixed with 2.5 ml of isotonic MgSO4 (150 mg) per dose every 20 minutes during the first hour.

will be continued with nebulized standard treatment every hour for 4 hours.

Intervention Type DRUG

Nebulized isotonic saline

Nebulized salbutamol and ipratropium bromide mixed with 2.5 ml of isotonic saline per dose every 20 minutes during the first hour.

will be continued with nebulized standard treatment every hour for 4 hours.

Intervention Type DRUG

Nebulized Salbutamol

Nebulized salbutamol 2.5mg (2-5 years) or 5 mg (≥6 years)

Intervention Type DRUG

Ipratropium bromide

Nebulized ipratropium bromide 250 mcg

Intervention Type DRUG

Methylprednisolone or Prednisolone

Begin with intravenous methylprednisolone or oral prednisolone 2 mg/kg/day for each treatment

Intervention Type DRUG

Other Intervention Names

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MgSO4 Standard treatment Corticosteroid therapy

Eligibility Criteria

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Inclusion Criteria

* Clinical diagnosis of moderate or severe asthma exacerbations
* 2 to 15 years old.
* Served in the pediatric emergency department of naval high specialty General Hospital from September to December 2015.
* Signing the consent by the parents.

Exclusion Criteria

* Coexistence of lung disease.
* Severe kidney disease.
* Severe liver disease.
* Pregnancy.
* Known previous reaction to magnesium.
* Parents who have not signed the agreement.
* Patients without a clinical history of asthma.
* Clinical diagnosis of mild asthma attack.
* Previously included in the study.
* Presence of comorbidities that endanger the patient's life.
* The patient has clinical or gasometric criteria for advanced airway management.
* Life-threatening symptoms.
Minimum Eligible Age

2 Years

Maximum Eligible Age

15 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Hospital General Naval de Alta Especialidad - Escuela Medico Naval

OTHER_GOV

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Jesús Abisai Uicab Saucedo, Pediatrician

Role: PRINCIPAL_INVESTIGATOR

Secretaria de Marina

Locations

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Hospital General Naval de Alta Especialidad

Mexico City, Mexico City, Mexico

Site Status RECRUITING

Countries

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Mexico

Central Contacts

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Jesús Abisai Uicab Saucedo, Pediatrician

Role: CONTACT

(52)5550371200 ext. 5423

Facility Contacts

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Jesús Abisai Uicab Saucedo, Pediatrician

Role: primary

(52)5550371200 ext. 5423

References

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Birken CS, Parkin PC, Macarthur C. Asthma severity scores for preschoolers displayed weaknesses in reliability, validity, and responsiveness. J Clin Epidemiol. 2004 Nov;57(11):1177-81. doi: 10.1016/j.jclinepi.2004.02.016.

Reference Type BACKGROUND
PMID: 15567635 (View on PubMed)

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 Jan;11(1):10-8. doi: 10.1197/j.aem.2003.07.015.

Reference Type BACKGROUND
PMID: 14709423 (View on PubMed)

Rodrigo GJ, Plaza Moral V, Forns SB, Castro-Rodriguez JA, de Diego Damia A, Cortes SL, Moreno CM, Nannini LJ, Neffen H, Salas J; SEPAR; ALAT. [ALERTA 2 guidelines. Latin America and Spain: recommendations for the prevention and treatment of asmatic exacerbations. Spanish Pulmonology and Thoracic Surgery Society (SEPAR). Asthma Department of the Latinamerican Thoracic Association (ALAT)]. Arch Bronconeumol. 2010 Oct;46 Suppl 7:2-20. doi: 10.1016/S0300-2896(10)70041-7. No abstract available. Spanish.

Reference Type BACKGROUND
PMID: 21320808 (View on PubMed)

Gourgoulianis KI, Chatziparasidis G, Chatziefthimiou A, Molyvdas PA. Magnesium as a relaxing factor of airway smooth muscles. J Aerosol Med. 2001 Fall;14(3):301-7. doi: 10.1089/089426801316970259.

Reference Type BACKGROUND
PMID: 11693841 (View on PubMed)

Dominguez LJ, Barbagallo M, Di Lorenzo G, Drago A, Scola S, Morici G, Caruso C. Bronchial reactivity and intracellular magnesium: a possible mechanism for the bronchodilating effects of magnesium in asthma. Clin Sci (Lond). 1998 Aug;95(2):137-42.

Reference Type BACKGROUND
PMID: 9680494 (View on PubMed)

Cairns CB, Kraft M. Magnesium attenuates the neutrophil respiratory burst in adult asthmatic patients. Acad Emerg Med. 1996 Dec;3(12):1093-7. doi: 10.1111/j.1553-2712.1996.tb03366.x.

Reference Type BACKGROUND
PMID: 8959161 (View on PubMed)

Mohammed S, Goodacre S. Intravenous and nebulised magnesium sulphate for acute asthma: systematic review and meta-analysis. Emerg Med J. 2007 Dec;24(12):823-30. doi: 10.1136/emj.2007.052050.

Reference Type BACKGROUND
PMID: 18029512 (View on PubMed)

Shan Z, Rong Y, Yang W, Wang D, Yao P, Xie J, Liu L. Intravenous and nebulized magnesium sulfate for treating acute asthma in adults and children: a systematic review and meta-analysis. Respir Med. 2013 Mar;107(3):321-30. doi: 10.1016/j.rmed.2012.12.001. Epub 2013 Jan 3.

Reference Type BACKGROUND
PMID: 23290189 (View on PubMed)

Powell C, Dwan K, Milan SJ, Beasley R, Hughes R, Knopp-Sihota JA, Rowe BH. Inhaled magnesium sulfate in the treatment of acute asthma. Cochrane Database Syst Rev. 2012 Dec 12;12:CD003898. doi: 10.1002/14651858.CD003898.pub5.

Reference Type BACKGROUND
PMID: 23235599 (View on PubMed)

Goodacre S, Cohen J, Bradburn M, Gray A, Benger J, Coats T; 3Mg Research Team. Intravenous or nebulised magnesium sulphate versus standard therapy for severe acute asthma (3Mg trial): a double-blind, randomised controlled trial. Lancet Respir Med. 2013 Jun;1(4):293-300. doi: 10.1016/S2213-2600(13)70070-5. Epub 2013 May 17.

Reference Type BACKGROUND
PMID: 24429154 (View on PubMed)

Powell CV, Kolamunnage-Dona R, Lowe J, Boland A, Petrou S, Doull I, Hood K, Williamson PR; MAGNETIC study group. MAGNEsium Trial In Children (MAGNETIC): a randomised, placebo-controlled trial and economic evaluation of nebulised magnesium sulphate in acute severe asthma in children. Health Technol Assess. 2013 Oct;17(45):v-vi, 1-216. doi: 10.3310/hta17450.

Reference Type BACKGROUND
PMID: 24144222 (View on PubMed)

Alansari K, Ahmed W, Davidson BL, Alamri M, Zakaria I, Alrifaai M. Nebulized magnesium for moderate and severe pediatric asthma: A randomized trial. Pediatr Pulmonol. 2015 Dec;50(12):1191-9. doi: 10.1002/ppul.23158. Epub 2015 Feb 4.

Reference Type BACKGROUND
PMID: 25652104 (View on PubMed)

Rowe BH. Intravenous and inhaled MgSO4 for acute asthma. Lancet Respir Med. 2013 Jun;1(4):276-7. doi: 10.1016/S2213-2600(13)70097-3. Epub 2013 May 17. No abstract available.

Reference Type BACKGROUND
PMID: 24429139 (View on PubMed)

Petrou S, Boland A, Khan K, Powell C, Kolamunnage-Dona R, Lowe J, Doull I, Hood K, Williamson P. Economic evaluation of nebulized magnesium sulphate in acute severe asthma in children. Int J Technol Assess Health Care. 2014 Oct;30(4):354-60. doi: 10.1017/S0266462314000440. Epub 2014 Nov 14.

Reference Type BACKGROUND
PMID: 25394502 (View on PubMed)

Wang H, Xiong Y, Gong C, Yin L, Yan L, Yuan X, Liu S, Shi T, Dai J. Effect of inhaled magnesium sulfate on bronchial hyperresponsiveness. Indian J Pediatr. 2015 Apr;82(4):321-7. doi: 10.1007/s12098-014-1476-6. Epub 2014 Jun 12.

Reference Type BACKGROUND
PMID: 24916134 (View on PubMed)

Smith SR, Baty JD, Hodge D 3rd. Validation of the pulmonary score: an asthma severity score for children. Acad Emerg Med. 2002 Feb;9(2):99-104. doi: 10.1111/j.1553-2712.2002.tb00223.x.

Reference Type RESULT
PMID: 11825832 (View on PubMed)

Chalut DS, Ducharme FM, Davis GM. The Preschool Respiratory Assessment Measure (PRAM): a responsive index of acute asthma severity. J Pediatr. 2000 Dec;137(6):762-8. doi: 10.1067/mpd.2000.110121.

Reference Type RESULT
PMID: 11113831 (View on PubMed)

Related Links

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http://www.ginasthma.org

Global Initiative for Asthma (GINA). Global strategy for asthma management and prevention (Updated 2015).

Other Identifiers

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HGNAE-03

Identifier Type: -

Identifier Source: org_study_id