COMPARISON OF INTRAVENOUS VERSUS NEBULIZED MAGNESIUM SULFATE AS ADJUNCT TREATMENT IN ACUTE ASTHMA IN ADULTS IN THE EMERGENCY DEPARTMENT OF A TERTIARY CARE HOSPITAL

Abstract

Background: Magnesium sulfate (MgSO₄) is an established adjunct treatment for acute severe asthma, available via intravenous (IV) or nebulized routes. Limited evidence exists comparing these administration methods in adults, with most research focusing on pediatric populations.

Objective: To compare the efficacy of IV versus nebulized MgSO₄ as adjunct treatment in acute asthma among adults presenting to the emergency department, specifically examining dyspnea improvement and clinical outcomes.

Methods: A randomized controlled trial was conducted at Dr. Ziauddin Hospital Kemari Campus Emergency Department involving 126 adults with acute asthma exacerbations. Patients were randomized to receive either IV MgSO₄ (2g in 100ml normal saline over 20 minutes) or nebulized MgSO₄ (three 500mg doses at 20-minute intervals). All patients received standard therapy including oxygen, hydrocortisone, salbutamol, and ipratropium. The primary outcome was Visual Analogue Scale (VAS) score improvement at 120 minutes. Secondary outcomes included ICU admission rates, readmissions, mortality, and adverse events.

Results: Both groups showed significant improvement in VAS scores. The IV group demonstrated superior outcomes with 37.27% improvement in VAS scores compared to 31.01% in the nebulized group. ICU admission rates were substantially lower in the IV group (4.76%) versus nebulized group (12.70%). Respiratory rates decreased more rapidly in the IV group (21.6% vs 19.1% reduction). No readmissions, mortality, or adverse events were reported in either group.

Conclusion: While both administration routes effectively improved acute asthma symptoms, IV MgSO₄ demonstrated superior outcomes in symptom relief and prevention of clinical deterioration requiring intensive care compared to nebulized administration.