Asthma
Conditions
Keywords
Magnesium sulfate, Childhood asthma, Emergency department
Brief summary
The purpose of this study is to evaluate the effectiveness of nebulized magnesium sulfate as a vehicle for albuterol in children with moderate to severe asthma exacerbation.
Detailed description
Patients presenting to the Emergency Department for acute asthma exacerbation will receive standard care of up to three doses of albuterol and ipratropium bromide plus oral steroid medication. Those seven years of age and older who require further treatment will be screened for eligibility. Eligibility screening will comprise measurement of forced expiratory volume in one second (FEV1) with a bedside spirometer by a respiratory therapist. Children under the age of seven are generally unable to complete spirometry maneuvers and will thus be excluded. The Pediatric Asthma Severity Score (PASS) will also be noted by a respiratory therapist. Patients able to complete spirometry testing and with an FEV1 less than 70% of predicted (the definition of moderate asthma exacerbation) will be enrolled. Enrolled patients will be randomized to receive either Children's Medical Center standard care of 15 mg albuterol diluted in 22 ml of normal saline or the study intervention of 15 mg of albuterol diluted in 22 ml of magnesium sulfate solution. This solution will be prepared at the time of use by a pharmacist in the Emergency Department and will consist of 22 ml of a commercially available 40 mg/ml magnesium sulfate solution (880 mg). The nebulizer treatment will be given over approximately one hour via a large volume nebulizer at 25 ml/hr. Physicians, nurses, and respiratory therapists will be blinded to the diluent used. Vital signs will be noted at baseline. Heart rate, heart rhythm, respiratory rate, and pulse oximetry will be monitored continuously while blood pressure will be measured at baseline and every 15 minutes during study medication administration. The study physician, treating physician, and/or bedside nurse will monitor these values for any clinically significant changes. At the end of the 15 mg albuterol treatment FEV1 and PASS will again be noted. Any further treatments needed, as determined by the treating physician, will be given following Children's Medical Center standard of care. At the discretion of the treating physician intravenous magnesium sulfate may be used post study intervention. The dose used for study participants will be the Children's Medical Center standard dose of 75 mg/kg (max 3 g) minus 880 mg to avoid the risk of magnesium sulfate overdose. Further treatments and patient disposition will be observed by study personnel and noted. Bounce-back rates will be collected by review of enrolled patients' medical record.
Interventions
15 mg albuterol in 22 ml of magnesium sulfate solution (880 mg) via nebulizer over one hour Versus 15 mg albuterol in 22 ml of normal saline via nebulizer over one hour
Sponsors
University of Texas Southwestern Medical Center
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Caregiver, Investigator)
Eligibility
Sex/Gender
ALL
Age
7 Years to 18 Years
Healthy volunteers
No
Inclusion criteria
* Patients age ≥ seven years * Previous diagnosis of asthma or previous episode of wheezing treated with beta-agonist medication * Able to complete bedside spirometry * FEV1 \< 70% predicted
Exclusion criteria
* Known allergy to magnesium sulfate * Known contra-indication to albuterol * Respiratory distress occurring as a result of bedside spirometry * History of neuromuscular disease, cardiac disease, renal disease, or underlying chronic lung disease * Pregnancy * Use of oral steroid medication within 72 hours of presentation * Radiographic evidence of pneumonia at presentation * Intubation during the current encounter prior to study enrollment * Administration of intravenous magnesium sulfate prior to study enrollment * Prior participation in this study
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Forced Expiratory Volume in One Second (FEV1) % | Baseline and one hour after treatment | Change in forced expiratory volume in one second (FEV1) as measured by bedside spirometry before and after study intervention. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Magnesium Sulfate Group 15 mg albuterol in 22 ml of magnesium sulfate solution (880 mg) via nebulizer over one hour
Nebulized magnesium sulfate: 15 mg albuterol in 22 ml of magnesium sulfate solution (880 mg) via nebulizer over one hour
Versus
15 mg albuterol in 22 ml of normal saline via nebulizer over one hour | 22 |
| Normal Saline Group 15 mg albuterol in 22 ml of normal saline solution via nebulizer over one hour
Nebulized magnesium sulfate: 15 mg albuterol in 22 ml of magnesium sulfate solution (880 mg) via nebulizer over one hour
Versus
15 mg albuterol in 22 ml of normal saline via nebulizer over one hour | 21 |
| Total | 43 |
Baseline characteristics
| Characteristic | Normal Saline Group | Magnesium Sulfate Group | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 21 Participants | 22 Participants | 43 Participants |
| Age, Categorical >=65 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Between 18 and 65 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Continuous | 10.8 years | 10.8 years | 10.8 years |
| Region of Enrollment United States | 21 participants | 22 participants | 43 participants |
| Sex: Female, Male Female | 5 Participants | 7 Participants | 12 Participants |
| Sex: Female, Male Male | 16 Participants | 15 Participants | 31 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 25 | 0 / 25 |
| other Total, other adverse events | 4 / 25 | 0 / 25 |
| serious Total, serious adverse events | 0 / 25 | 0 / 25 |
Outcome results
Primary
Change in Forced Expiratory Volume in One Second (FEV1) %
Change in forced expiratory volume in one second (FEV1) as measured by bedside spirometry before and after study intervention.
Time frame: Baseline and one hour after treatment
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Magnesium Sulfate Group | Change in Forced Expiratory Volume in One Second (FEV1) % | 3.6 Percentage of FEV1 |
| Normal Saline Group | Change in Forced Expiratory Volume in One Second (FEV1) % | 5 Percentage of FEV1 |