Clinical question: Can magnesium sulfate be used as an efficacious adjunct therapy in the treatment of chronic obstructive pulmonary disease (COPD) exacerbations?
Background: Low serum magnesium has been shown to be a predictor of the frequency of acute COPD exacerbations and hospital readmissions. While guidelines recommend a single dose of intravenous magnesium in patients with inadequate response to bronchodilator therapy in acute asthma exacerbations, standard guidelines do not recommend the routine use of magnesium in acute COPD exacerbations.
Study design: Systematic review and meta-analysis of randomized controlled trials (RCTs)
Setting: Eight single-center trials (four in Iran, one each in New Zealand, Nepal, Turkey, and the United Kingdom) and three two-center trials (New Zealand, Tunisia, and the United States)
Synopsis: The systematic review included 11 RCTs with a total of 762 participants with mean ages between 62 and 76 years. Seven studies assessed intravenous magnesium sulfate infusion + standard of care versus placebo + standard of care. Low-certainty evidence from three of the trials indicated a reduced rate of hospital admissions with intravenous magnesium therapy (NNT = 7). Otherwise, there was no significant difference seen in the need for non-invasive ventilation, all-cause mortality, or lung function measured as a change in FEV1 post-intervention or improvement in oxygen saturation. There was similarly no significant difference seen in the use of nebulized magnesium sulfate versus placebo in any of the measured outcomes.
The study has several limitations, including the fact that all the studies included in the analysis were single- or two-center studies with small numbers of participants. Additionally, there was a low level of heterogeneity and a small number of trials, making it difficult to make a confident pooled-effects estimate.
Bottom line: There is limited evidence supporting the use of intravenous or nebulized magnesium in the treatment of acute COPD exacerbations.
Citation: Ni H, et al. Magnesium sulfate for acute exacerbations of chronic obstructive pulmonary disease. Cochrane Database of Systematic Rev. 2022;5(5):CD013506. doi:10.1002/14651858.
Dr. Sundararaghavan is an assistant professor of medicine at the University of Virginia School of Medicine, Charlottesville, Va.