Different Doses of Nebulized Magnesium Sulphate in Status Asthmaticus
Primary Purpose
Status Asthmaticus
Status
Completed
Phase
Phase 1
Locations
Pakistan
Study Type
Interventional
Intervention
Magnesium Sulfate 500 mg/ml+ ventolin
Ventolin
Sponsored by
About this trial
This is an interventional treatment trial for Status Asthmaticus focused on measuring asthma, nebulized, magnesium sulphate
Eligibility Criteria
Inclusion Criteria:
- Children between 2 to 12 years of age.
- Children with the diagnosis of asthma having a pram score of more than 4.
- Children with reactive airways
Exclusion Criteria:
- Critically ill children who require intubation or mechanical ventilation.
- Having hypersensitivity or allergy to MgSO4.
- with history of chronic lung impairment.
- Whose parents are not giving informed consent for participation in research.
Sites / Locations
- Rabia Asif
Arms of the Study
Arm 1
Arm 2
Arm Type
Active Comparator
Experimental
Arm Label
Nebulized Ventolin
Nebulized Magnesium Sulphate + Ventolin
Arm Description
Nebulized Ventolin will given to 1st group after every 20 min for 1 hour
Dose of Nebulized Magnesium sulphate will vary in 3 subgroups.
Outcomes
Primary Outcome Measures
Change in Pediatric Respiratory Assessment Measure (PRAM) score from the baseline
The outcome measure was the response to treatment in terms of change in Pediatric Respiratory Assessment Measure (PRAM) score from the baseline, i.e; suprasternal indrawing, scalene retractions, wheezing, air entry, oxygen saturation on room air. Change in PRAM score means decrease in score i.e; mild (0-4), moderate (5-8), severe(9-12), impending respiratory failure (12+).
Change from baseline Suprasternal indrawing
Absent (0) , Present (2)
Change from baseline Scalene retractions
Absent (0) , Present (2)
Change from baseline Wheezing
Absent (0), Expiratory only (1), Inspiratory and expiratory (2) Audible without (3) stethoscope/silent chest with minimal air entry
Change from baseline Air entry
Normal (0), Decreased at bases (1), Widespread decrease (2), Absent/minimal (3)
Change from baseline Oxygen saturation on room air
>93% (0), 90%-93% (1) or <90% (2)
Secondary Outcome Measures
Hospital stay
curtailment in the length of hospital stay
Hospital stay
curtailment in the length of hospital stay
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT04929626
Brief Title
Different Doses of Nebulized Magnesium Sulphate in Status Asthmaticus
Official Title
Comparison of Doses of Nebulized Magnesium Sulphate as an Adjuvant Treatment With Salbutamol in Children With Status Asthmaticus
Study Type
Interventional
2. Study Status
Record Verification Date
April 2023
Overall Recruitment Status
Completed
Study Start Date
January 1, 2022 (Actual)
Primary Completion Date
November 12, 2022 (Actual)
Study Completion Date
November 12, 2022 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Ziauddin University
4. Oversight
Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No
5. Study Description
Brief Summary
In this study investigators will use magnesium sulphate in the nebulized form in children between 2 and 12 years of age as an acute reliever for acute severe asthma. Aim of this study is to determine that whether adding low (250mg), intermediate (500mg), and high doses (750mg) of magnesium sulphate in the 1st hour of treatment has any difference in the improvement of clinical condition of the patient and length of hospital stay. There will be total 108 patients having 2 groups. 1st group will receive only Ventolin while 2nd group will be given Ventolin and Magnesium sulphate.
Detailed Description
This randomized clinical trial will include 126 patients after taking informed consent who will meet the eligibility criteria. Patients will be randomly distributed in 2 groups on alternate basis as computerized generated number. Improvement will be assessed in terms of clinical condition i.e., Heart Rate, Respiratory Rate, blood pressure, pattern of breathing oxygen saturation and Pediatric Respiratory Assessment Measure (PRAM) score at start of treatment and then afterwards at 20 min interval up to 1 hour and then at 2nd hour and then after every 6 hours for 24 hours.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Status Asthmaticus
Keywords
asthma, nebulized, magnesium sulphate
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Parallel Assignment
Model Description
Eligible patients were divided in two groups. In group A, patients received 3 back-to-back nebulization with Ventolin solution only using nebulizer machine and face mask after every 20 minutes for 60 minutes. In group B, patients were divided into 3 subgroups and each subgroup received both Ventolin and MgSO4 with three different doses after every 20 minutes for 60 minutes
Masking
ParticipantCare Provider
Masking Description
The principal investigator was aware of the intervention being provided. Others were masked including the participant and care provider.
Allocation
Randomized
Enrollment
126 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Nebulized Ventolin
Arm Type
Active Comparator
Arm Description
Nebulized Ventolin will given to 1st group after every 20 min for 1 hour
Arm Title
Nebulized Magnesium Sulphate + Ventolin
Arm Type
Experimental
Arm Description
Dose of Nebulized Magnesium sulphate will vary in 3 subgroups.
Intervention Type
Drug
Intervention Name(s)
Magnesium Sulfate 500 mg/ml+ ventolin
Other Intervention Name(s)
MgSO4
Intervention Description
3 doses of magnesium sulphate i.e; 250mg(0.5ml), 500mg(1ml), 750mg(1.5ml) will be used in nebulized form
Intervention Type
Drug
Intervention Name(s)
Ventolin
Other Intervention Name(s)
Salbutamol
Intervention Description
it will be given to control group in nebulized form after every 20 min in 1st hour
Primary Outcome Measure Information:
Title
Change in Pediatric Respiratory Assessment Measure (PRAM) score from the baseline
Description
The outcome measure was the response to treatment in terms of change in Pediatric Respiratory Assessment Measure (PRAM) score from the baseline, i.e; suprasternal indrawing, scalene retractions, wheezing, air entry, oxygen saturation on room air. Change in PRAM score means decrease in score i.e; mild (0-4), moderate (5-8), severe(9-12), impending respiratory failure (12+).
Time Frame
20, 40, 60, 120, 360, 720, 1080, 1440 minutes after commencement of treatment
Title
Change from baseline Suprasternal indrawing
Description
Absent (0) , Present (2)
Time Frame
20, 40, 60, 120, 360, 720, 1080, 1440 minutes after commencement of treatment
Title
Change from baseline Scalene retractions
Description
Absent (0) , Present (2)
Time Frame
20, 40, 60, 120, 360, 720, 1080, 1440 minutes after commencement of treatment
Title
Change from baseline Wheezing
Description
Absent (0), Expiratory only (1), Inspiratory and expiratory (2) Audible without (3) stethoscope/silent chest with minimal air entry
Time Frame
20, 40, 60, 120, 360, 720, 1080, 1440 minutes after commencement of treatment
Title
Change from baseline Air entry
Description
Normal (0), Decreased at bases (1), Widespread decrease (2), Absent/minimal (3)
Time Frame
20, 40, 60, 120, 360, 720, 1080, 1440 minutes after commencement of treatment
Title
Change from baseline Oxygen saturation on room air
Description
>93% (0), 90%-93% (1) or <90% (2)
Time Frame
20, 40, 60, 120, 360, 720, 1080, 1440 minutes after commencement of treatment
Secondary Outcome Measure Information:
Title
Hospital stay
Description
curtailment in the length of hospital stay
Time Frame
24 hours
Title
Hospital stay
Description
curtailment in the length of hospital stay
Time Frame
48 hours
10. Eligibility
Sex
All
Minimum Age & Unit of Time
2 Years
Maximum Age & Unit of Time
12 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Children between 2 to 12 years of age.
Children with the diagnosis of asthma having a pram score of more than 4.
Children with reactive airways
Exclusion Criteria:
Critically ill children who require intubation or mechanical ventilation.
Having hypersensitivity or allergy to MgSO4.
with history of chronic lung impairment.
Whose parents are not giving informed consent for participation in research.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Rabia Asif, MBBS, PGT
Organizational Affiliation
Ziauddin Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
Rabia Asif
City
Karachi
State/Province
Sindh
ZIP/Postal Code
75530
Country
Pakistan
12. IPD Sharing Statement
Plan to Share IPD
No
Citations:
PubMed Identifier
25652104
Citation
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.
Results Reference
background
Citation
Mustafa J, Iqbal SMJ, Azhar IA, Sultan MA. Nebulized magnesium sulphate as an adjunct therapy in the management of children presenting with acute exacerbation of asthma. Pakistan J Med Heal Sci. 2018;12(2):554-5.
Results Reference
background
PubMed Identifier
27996280
Citation
Daengsuwan T, Watanatham S. A comparative pilot study of the efficacy and safety of nebulized magnesium sulfate and intravenous magnesium sulfate in children with severe acute asthma. Asian Pac J Allergy Immunol. 2017 Jun;35(2):108-112. doi: 10.12932/AP0780.
Results Reference
background
PubMed Identifier
28153353
Citation
Turker S, Dogru M, Yildiz F, Yilmaz SB. The effect of nebulised magnesium sulphate in the management of childhood moderate asthma exacerbations as adjuvant treatment. Allergol Immunopathol (Madr). 2017 Mar-Apr;45(2):115-120. doi: 10.1016/j.aller.2016.10.003. Epub 2017 Jan 31.
Results Reference
background
PubMed Identifier
27354766
Citation
Sarhan HA, El-Garhy OH, Ali MA, Youssef NA. The efficacy of nebulized magnesium sulfate alone and in combination with salbutamol in acute asthma. Drug Des Devel Ther. 2016 Jun 9;10:1927-33. doi: 10.2147/DDDT.S103147. eCollection 2016.
Results Reference
background
PubMed Identifier
27220675
Citation
Schuh S, Sweeney J, Freedman SB, Coates AL, Johnson DW, Thompson G, Gravel J, Ducharme FM, Zemek R, Plint AC, Beer D, Klassen T, Curtis S, Black K, Nicksy D, Willan AR; Pediatric Emergency Research Canada Group. Magnesium nebulization utilization in management of pediatric asthma (MagNUM PA) trial: study protocol for a randomized controlled trial. Trials. 2016 May 24;17(1):261. doi: 10.1186/s13063-015-1151-x.
Results Reference
background
PubMed Identifier
24865567
Citation
Kew KM, Kirtchuk L, Michell CI. Intravenous magnesium sulfate for treating adults with acute asthma in the emergency department. Cochrane Database Syst Rev. 2014 May 28;(5):CD010909. doi: 10.1002/14651858.CD010909.pub2.
Results Reference
background
Citation
Akter T, Islam N, Hoque MA, Khanam S, Saha BK. Original Article Nebulization by Isotonic Magnesium Sulphate Solution with Salbutamol Provide Early and Better Response as Compared to Conventional Approach ( Salbutamol Plus Normal Saline ) in Acute Exacerbation of Asthma in Children . 2014;9(2):61-7.
Results Reference
background
PubMed Identifier
24144222
Citation
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.
Results Reference
background
PubMed Identifier
26955277
Citation
Hendaus MA, Jomha FA, Alhammadi AH. Is ketamine a lifesaving agent in childhood acute severe asthma? Ther Clin Risk Manag. 2016 Feb 22;12:273-9. doi: 10.2147/TCRM.S100389. eCollection 2016.
Results Reference
background
PubMed Identifier
23218449
Citation
Dexheimer JW, Abramo TJ, Arnold DH, Johnson KB, Shyr Y, Ye F, Fan KH, Patel N, Aronsky D. An asthma management system in a pediatric emergency department. Int J Med Inform. 2013 Apr;82(4):230-8. doi: 10.1016/j.ijmedinf.2012.11.006. Epub 2012 Dec 4.
Results Reference
background
Citation
Kumar A. Effectiveness of Nebulized Magnesium Sulphate as an Adjuvant Therapy (With Salbutamol) in the Management of Acute Asthma. Pakistan J Med Dent. 2020;9(02):39-44.
Results Reference
background
PubMed Identifier
26206872
Citation
Reddel HK, Bateman ED, Becker A, Boulet LP, Cruz AA, Drazen JM, Haahtela T, Hurd SS, Inoue H, de Jongste JC, Lemanske RF Jr, Levy ML, O'Byrne PM, Paggiaro P, Pedersen SE, Pizzichini E, Soto-Quiroz M, Szefler SJ, Wong GW, FitzGerald JM. A summary of the new GINA strategy: a roadmap to asthma control. Eur Respir J. 2015 Sep;46(3):622-39. doi: 10.1183/13993003.00853-2015. Epub 2015 Jul 23.
Results Reference
background
PubMed Identifier
31388549
Citation
Al-Shamrani A, Al-Harbi AS, Bagais K, Alenazi A, Alqwaiee M. Management of asthma exacerbation in the emergency departments. Int J Pediatr Adolesc Med. 2019 Jun;6(2):61-67. doi: 10.1016/j.ijpam.2019.02.001. Epub 2019 Mar 15. No abstract available. Erratum In: Int J Pediatr Adolesc Med. 2020 Dec;7(4):212.
Results Reference
background
PubMed Identifier
28546381
Citation
Rehder KJ. Adjunct Therapies for Refractory Status Asthmaticus in Children. Respir Care. 2017 Jun;62(6):849-865. doi: 10.4187/respcare.05174.
Results Reference
background
PubMed Identifier
29625590
Citation
Indinnimeo L, Chiappini E, Miraglia Del Giudice M; Italian Panel for the management of acute asthma attack in children Roberto Bernardini. Guideline on management of the acute asthma attack in children by Italian Society of Pediatrics. Ital J Pediatr. 2018 Apr 6;44(1):46. doi: 10.1186/s13052-018-0481-1.
Results Reference
background
PubMed Identifier
21175517
Citation
Schuh S, Macias C, Freedman SB, Plint AC, Zorc JJ, Bajaj L, Black KJ, Johnson DW, Boutis K. North American practice patterns of intravenous magnesium therapy in severe acute asthma in children. Acad Emerg Med. 2010 Nov;17(11):1189-96. doi: 10.1111/j.1553-2712.2010.00913.x.
Results Reference
background
PubMed Identifier
24429154
Citation
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.
Results Reference
background
Citation
Ibrahim Z, Modawi FS, Almehaid AM, Alshenaifi NA, Albahouth ZI. REVIEW OF THE RECENT UPDATES REGARDING ACUTE ASTHMA EXACERBATION MANAGEMENT IN CHILDREN : A SIMPLE LITERATURE REVIEW Corresponding author : 2019;06(01):850-5
Results Reference
background
PubMed Identifier
25394502
Citation
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.
Results Reference
background
PubMed Identifier
27305039
Citation
Shein SL, Speicher RH, Filho JO, Gaston B, Rotta AT. Contemporary treatment of children with critical and near-fatal asthma. Rev Bras Ter Intensiva. 2016 Jun;28(2):167-78. doi: 10.5935/0103-507X.20160020.
Results Reference
background
Links:
URL
https://pubmed.ncbi.nlm.nih.gov/21175517/
Description
North American practice patterns of intravenous magnesium therapy in severe acute asthma in children
URL
https://pubmed.ncbi.nlm.nih.gov/25652104/
Description
Nebulized magnesium for moderate and severe pediatric asthma: A randomized trial
URL
https://pubmed.ncbi.nlm.nih.gov/27996280/
Description
A comparative pilot study of the efficacy and safety of nebulized magnesium sulfate and intravenous magnesium sulfate in children with severe acute asthma
URL
https://pubmed.ncbi.nlm.nih.gov/28153353/
Description
The effect of nebulised magnesium sulphate in the management of childhood moderate asthma exacerbations as adjuvant treatment
URL
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4907636/
Description
The efficacy of nebulized magnesium sulfate alone and in combination with salbutamol in acute asthma
URL
https://pubmed.ncbi.nlm.nih.gov/27220675/
Description
Magnesium nebulization utilization in management of pediatric asthma (MagNUM PA) trial: study protocol for a randomized controlled trial
URL
https://pubmed.ncbi.nlm.nih.gov/24865567/
Description
Intravenous magnesium sulfate for treating adults with acute asthma in the emergency department
URL
https://www.banglajol.info/index.php/FMCJ/article/view/25675
Description
Nebulization by Isotonic Magnesium Sulphate Solution with Salbutamol Provide Early and Better Response as Compared to Conventional Approach (Salbutamol Plus Normal Saline) in Acute Exacerbation of Asthma in Children
URL
https://pubmed.ncbi.nlm.nih.gov/24144222/
Description
MAGNEsium Trial In Children (MAGNETIC): a randomised, placebo-controlled trial and economic evaluation of nebulised magnesium sulphate in acute severe asthma in children
URL
https://pubmed.ncbi.nlm.nih.gov/26955277/
Description
Is ketamine a lifesaving agent in childhood acute severe asthma?
URL
https://pubmed.ncbi.nlm.nih.gov/23218449/
Description
An asthma management system in a pediatric emergency department
URL
https://pjmd.zu.edu.pk/volume-9-issue-2/effectiveness-of-nebulized-magnesium-sulphate-as-an-adjuvant-therapy-with-salbutamol-in-the-management-of-acute-asthma/
Description
Effectiveness of Nebulized Magnesium Sulphate as an Adjuvant Therapy (With Salbutamol) in the Management of Acute Asthma
URL
https://pubmed.ncbi.nlm.nih.gov/26206872/
Description
A summary of the new Global Initiative for Asthma (GINA) strategy: a roadmap to asthma control
URL
https://pubmed.ncbi.nlm.nih.gov/31388549/
Description
Management of asthma exacerbation in the emergency departments
URL
https://pubmed.ncbi.nlm.nih.gov/28546381/
Description
Adjunct Therapies for Refractory Status Asthmaticus in Children
URL
https://pubmed.ncbi.nlm.nih.gov/29625590/
Description
Guideline on management of the acute asthma attack in children by Italian Society of Pediatrics
URL
https://pubmed.ncbi.nlm.nih.gov/24429154/
Description
Intravenous or nebulised magnesium sulphate versus standard therapy for severe acute asthma (3Mg trial): a double-blind, randomised controlled trial
URL
https://zenodo.org/record/2537623#.YJXVubUzZPY
Description
REVIEW OF THE RECENT UPDATES REGARDING ACUTE ASTHMA EXACERBATION MANAGEMENT IN CHILDREN: A SIMPLE LITERATURE REVIEW
URL
https://pubmed.ncbi.nlm.nih.gov/25394502/
Description
Economic evaluation of nebulized magnesium sulphate in acute severe asthma in children
URL
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4943055/
Description
Contemporary treatment of children with critical and near-fatal asthma
Learn more about this trial
Different Doses of Nebulized Magnesium Sulphate in Status Asthmaticus
We'll reach out to this number within 24 hrs