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Chronic obstructive pulmonary disease and magnesium for acute exacerbations

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Peeyush Ghalot
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(Image Courtesy: - McKesson Medical-Surgical)

A thorough search in MEDLINE and SCOPUS with no date restrictions, as well as a manual evaluation of journals, were used to determine the effectiveness of magnesium sulphate in treating chronic obstructive pulmonary disease (COPD). The route(s) by which magnesium sulphate and other drugs were delivered affected the outcome measures. Evidence quality was graded and bias risk was assessed. Included were four (4) randomised studies. All trials exhibited a moderate risk of bias and were of medium methodological quality. Intravenously administered magnesium sulphate did not appear to have an immediate bronchodilator impact, but it does seem to enhance the bronchodilator effects of inhaled beta-2 agonists. Although the mean percentage change in PEFR was only 24%, those who received magnesium sulphate exhibited a greater increase in PEFR at 30 and 45 min compared to those who received a placebo (P = 0.03). There were no significant differences between the groups in terms of dyspnoea scores, hospital admission rates, or emergency department readmission rates. Forced expiratory volume in 1 second (FEV1) evaluated at 90 minutes after adjusting for baseline FEV1 did not differ significantly between nebulized magnesium sulphate with salbutamol and nebulized salbutamol with saline placebo (P = 0.34), nor did the necessity for hospital admission. In terms of hospital admission, intubation, and death, nebulized ipratropium bromide and combined inhalational and intravenous magnesium sulphate were comparable to each other, but the ipratropium bromide group demonstrated superior bronchodilator effects and improvements in arterial blood gas parameters. Overall, there is insufficient trial evidence to support the use of magnesium sulphate in the treatment of acute COPD exacerbations.

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