COPD: magnesium sulphate added to albuterol had no clear effect.

Clinical bottom line (level 1b-)

  1. Patients with exacerbations of COPD who were given magnesium sulphate after albuterol, and had no clear difference in hospital admissions than those given placebo.
  2. Patients given magnesium sulphate after albuterol had no clear difference in peak expiratory flow at 45 minutes, than those given placebo.
Skorodin et al: Archives of Internal Medicine 1995; 155: 496-500
Expires November 2003

The study

Double-blinded ?concealed randomised trial with intention-to-treat
Setting: 2 Veterans Affairs emergency departments, USA

72 patients (aged mean 65 years, 97% male) acute exacerbations of chronic obstructive pulmonary disease, provided they met the diagnostic criteria for chronic bronchitis and/or emphysema as defined by the American Thoracic Society.

Excluded if
  • <35 years old
  • temperature >37.9 ° C
  • systolic blood pressure <100 mmHg
  • history of kidney disease
  • clinical evidence of pneumonia
  • initial peak expiratory flow >250 L/min or if it had doubled 20 minutes after albuterol treatment


    • Control Group: (n = 36, 36 analysed): placebo- 2.4 mL of saline in 150 mL of normal saline, administered during a 20 minute period
    Experimental Group: (n = 36, 36 analysed): 1.2 g magnesium sulphate in 150 ml of normal saline, administered over a 20 minute period.
    Patients were initially given nebulised albuterol, 2.5 mg in mL of normal saline.
    100% followed for ?

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    admission to hospital unknown 13
    (41.94%)    		 9
    (28.13%)    		 33.0%
    (-34.0% to 66.0%)    		 13.8%
    (-9.52% to 37.1%)    		 7
    (NNT = 3 to infinity;
    NNH = 11 to infinity)

    Outcome Control Group
    (SD)    		 Experimental Group
    (SD)    		 Mean Difference
    (95% CI)
    mean difference in peak expiratory flow, L/min 143
    (70.5)     		161
    (78.7)     		18.0
    (-17.4 to 53.4)

  • There were 31 patients in the placebo group and 32 in the magnesium group analysed for hospital admission.
  • There were no observed adverse effects from magnesium sulphate.

    • Comments

    1. The study is too small to show any clear difference in hospital admissions or mean peak expiratory flow between the two groups.

    Citation

    1. Skorodin MS, Tenholder MF, Yetter B, et al: Magnesium sulphate in exacerbations of chronic obstructive pulmonary disease. Archives of Internal Medicine 1995; 155: 496-500
    Search Terms: COPD, chronic obstructive pulmonary disease and therapy in Medline and Cochrane
    Contributor: Clare Wotton and Musab Hayatli, November 1999
    Reviewer: Mitsuhiro Kamei

    Clinical Question.
    Patient acute exacerbations of COPD
    Intervention or Exposure magnesium sulphate
    Comparison placebo
    Outcome hospitalisation and peak flow