Nebulized Magnesium Sulfate For Bronchial Asthma?-1
Bronchial asthma is a chronic airway inflammatory disease that is divided into acute exacerbation and remission periods. There are about 300 million asthma patients in the world, and there is a trend of increasing year by year, and the mortality rate has also increased in recent years. National guidelines for asthma management mostly follow a step-by-step, tiered approach.
Most asthma guidelines recommend standard treatment based on fast-acting beta2-agonists, short-acting anticholinergics, and glucocorticoids when an asthma exacerbation occurs. However, approximately 5% of patients with acute asthma exacerbations do not respond well to standard therapy. Magnesium sulfate, as a second-line drug for the treatment of acute asthma exacerbations, has been used for the first time in asthma since 1936, and has a history of 80 years. However, so far, various asthma guidelines have discussed the use of magnesium sulfate in acute asthma exacerbations in adults and children. There are still differences in the use of the drug, especially in terms of route of use and dosage.
Magnesium sulfate is familiar to most clinicians, mainly from its application in hypertension, eclampsia, epilepsy, etc., but its role in asthma is little known outside of specialists. A ten-year comparison between 2003 and 2013 found that the use of intravenous magnesium sulfate increased significantly in children with severe asthma exacerbations (2013: 68.2%, 2003: 0.0%). This shows that doctors' understanding of magnesium sulfate in asthma is deepening. Although there has been a major breakthrough in the application of magnesium sulfate in asthma, the mechanism of action of magnesium sulfate in asthma has not been fully elucidated.
Magnesium sulfate is a bronchial smooth muscle relaxant that relaxes the bronchi. Magnesium ion, as a calcium ion channel antagonist, reduces intracellular calcium ion concentration in various ways, thereby relaxing bronchial smooth muscle: inhibiting the release of calcium ions in the cytoplasmic endoplasmic reticulum, activating sodium-calcium pumps; inhibiting calcium ions and myospheres Protein interaction; and magnesium ions can appropriately increase the affinity of β2 receptor agonists with the corresponding receptors, so it can increase the bronchodilatory effect of the drug. The role of magnesium sulfate in asthma is largely explained. In addition to the ability to relax bronchial smooth muscle, the following mechanisms have been reported: 1. Reducing the release of acetylcholine from motor nerve terminals to counteract bronchial smooth muscle contraction; 2. Inhibiting neutrophil respiratory burst and inhibiting inflammation; 3. Inhibiting Degranulation of mast cells, thereby reducing the release of histamine; 4. Stimulates the synthesis of nitric oxide and prostacyclin, which may reduce the severity of asthma.
In conclusion, the pharmacological mechanism of magnesium sulfate in the field of asthma treatment is complex, and its precise mechanism needs further research to clarify.
Regarding the use of magnesium sulfate in acute asthma exacerbations, whether in adults or children, intravenous drip and nebulized inhalation are still controversial.
