Value of Adding Nebulized Magnesium Sulphate to Rescue Medications in Acute Exacerbation of Chronic Obstructive Pulmonary Disease in Patients Admitted to Emergency Room
Authors: Safwat Tarek Mohamad , Sayed Mohamad Ali El , Shehata Ahmad Mohamad Farag 
Published: August 2023

Abstract

Introduction
Chronic Obstructive Pulmonary Disease (COPD) is a common, preventable and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases, Nebulized magnesium is attractive as a therapeutic option because it is easily administered, relatively cheap and has minimal side effects. In light of some evidence for an effect when nebulized in severe exacerbations of asthma, the similarities between asthma and chronic obstructive pulmonary disease (COPD) (especially with regard to bronchodilator therapy) and the practical advantages of administration via nebuliser, we sought to focus on the nebulized route of delivery in acute exacerbations of chronic obstructive pulmonary disease (AECOPD).

Objective
The aim of this work was to evaluate the effect of administration of nebulized magnesium sulphate in the management of acute exacerbations of chronic obstructive pulmonary disease.

Patient and methods
The study was conducted upon 100 patients with acute exacerbation of COPD randomly divided into two groups, 50 patients for each group who admitted to emergency room with acute exacerbation of Chronic Obstructive Pulmonary Disease in Mansoura chest diseases hospital From January 2019 to June 2019, All patients randomly divided into two groups, Patients of group A: included 50 patients received 2.5 mg salbutamol (2.5 ml), mixed with 500 mg isotonic magnesium sulphate(5 ml), Patients of group B: included 50 patients received 2.5 mg salbutamol mixed with 2.5 ml isotonic saline. Treatment for all patients were given via nebulizer.

Results
There were no significant differences between group I who received nebulized magnesium sulphate + salbutamol and group II who received nebulized salbutamol regarding pulmonary functions (FEV1, FVC and FEV1/FVC), before and after treatment. After treatment there is a significant increase in O2 saturation, PO2 and Serum Mg(more in group I who received nebulized magnesium sulphate + salbutamol than group II who received nebulized salbutamol) and no significant difference between the two groups as regard PH, PCO2, HCO3, and CRP. There is significant change in pulmonary functions ( FEV1, FVC and FEV1/FVC), PO2, and O2 Saturation after treatment and no significant change in PH, PCO2, HCO3, serum Mg and CRP, in patients received salbutamol nebulizer. There is significant change in pulmonary functions ( FEV1, FVC and FEV1/FVC), PO2, O2 Saturation and serum Mg after treatment and no significant change in PH, PCO2, HCO3, and CRP in patients received Magnesium sulphate + salbutamol nebulizer.

Conclusion
Adding nebulized magnesium sulphate as an adjuvant to salbutamol treatment in the setting of AECOPD has no effect on FEV1, FVC&FEV1/FVC. Nebulized magnesium sulphate+ salbutamol provides nearly equal response to nebulized salbutamol in the treatment of Acute Exacerbation of Chronic Obstructive Pulmonary Disease in adults. So we do not recommend routine using of nebulizeld magnesium sulphate as an adjuvant to salbutamol treatment in the setting of AECOPD.