Severe (or even mild) asthma is one of the scariest conditions that someone can experience. Many parents of asthmatic children live terrified with the possibility of an attack, and many children that suffer from asthma have no idea as to the extent of their illness. Just imagine the stress of knowing that any second your lungs (or your child’s lungs) could stop functioning and that there is very little that you can do except for rush to the hospital or start cardiopulmonary resuscitation (CPR).
Although conventional medicine is an essential part of acute and some cases of chronic asthma management, most sufferers don’t realize that their are alternative treatments available, or even more importantly that their asthma may be related to their diet alone.
Asthma is part of a group of conditions known in medicine as atopic diseases, which include allergies, eczema, allergic rhinitis, eosinophilic esophagitis as well as Crohn’s disease is thought to also fall into this family. Regardless of the disease or classification, these conditions will often respond to food elimination. Food allergy elimination can often work for atopic conditions because these diseases are all related to inappropriate immune responses by our antibody (humoral) immune system. Even when symptoms are identified to be triggered by the environment, this is even more of a reason to suspect food allergies as a potential associated cause.
Antigens from our environment, including our microflora, but also foods and particles in the air can all trigger the immune system to react … leading to histamine release or resulting in damage to the proteins on the surface of our body that are meant to protect us from the environment. Cortical steroids control this reaction but steroids are not an ideal long term solution!
I am outlining the following trial in my discussion regarding childhood asthma because it is of very high quality and outlines my favourite mineral for the treatment of asthma. Although nobody (with or without asthma) wants to suck on nebulized magnesium sulphate every time they are having an asthma attack this trial outlines an effective more natural solution (without the risk of side effects from standard medication) for the treatment of acute asthma in children.
Powell C, Kolamunnage-Dona R, Lowe J, et al. 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):1-216. doi: 10.3310/hta17450. (Original) PMID: 24144222
BACKGROUND: There are few data on the role of nebulised magnesium sulphate (MgSO 4 ) in the management of acute asthma in children. Those studies that have been published are underpowered, and use different methods, interventions and comparisons. Thus, no firm conclusions can be drawn.
OBJECTIVES: Does the use of nebulised MgSO 4 , when given as an adjunct to standard therapy in acute severe asthma in children, result in a clinical improvement when compared with standard treatment alone?
DESIGN: Patients were randomised to receive three doses of MgSO 4 or placebo, each combined with salbutamol and ipratropium bromide, for 1 hour. The Yung Asthma Severity Score (ASS) was measured at baseline, randomisation, and at 20, 40, 60 (T60), 120, 180 and 240 minutes after randomisation.
SETTING: Emergency departments and children`s assessment units at 30 hospitals in the UK.
PARTICIPANTS: Children aged 2-15 years with acute severe asthma.
INTERVENTIONS: Patients were randomised to receive nebulised salbutamol 2.5 mg (ages 2-5 years) or 5 mg (ages >/= 6 years) and ipratropium bromide 0.25 mg mixed with either 2.5 ml of isotonic MgSO 4 (250 mmol/l, tonicity 289 mOsm; 151 mg per dose) or 2.5 ml of isotonic saline on three occasions at approximately 20-minute intervals. MAIN
OUTCOME MEASURES: The primary outcome measure was the ASS after 1 hour of treatment. Secondary measures included `stepping down` of treatment at 1 hour, number and frequency of additional salbutamol administrations, length of stay in hospital, requirement for intravenous bronchodilator treatment, and intubation and/or admission to a paediatric intensive care unit. Data on paediatric quality of life, time off school/nursery, health-care resource usage and time off work were collected 1 month after randomisation.
RESULTS: A total of 508 children were recruited into the study; 252 received MgSO 4 and 256 received placebo along with the standard treatment. There were no differences in baseline characteristics. There was a small, but statistically significant difference in ASS at T60 in those children who received nebulised MgSO 4 {0.25 [95% confidence interval (CI) 0.02 to 0.48]; p = 0.034} and this difference was sustained for up to 240 minutes [0.20 (95% CI 0.01 to 0.40), p = 0.042]. The clinical significance of this gain is uncertain. Assessing treatment-covariate interactions, there is evidence of a larger effect in those children with more severe asthma exacerbations ( p = 0.034) and those with a shorter duration of symptoms ( p = 0.049). There were no significant differences in the secondary outcomes measured. Adverse events (AEs) were reported in 19% of children in the magnesium group and 20% in the placebo group. There were no clinically significant serious AEs in either group. The results of the base-case economic analyses are accompanied by considerable uncertainty, but suggest that, from an NHS and Personal Social Services perspective, the addition of magnesium to standard treatment may be cost-effective compared with standard treatment only. The results of economic evaluation show that the probability of magnesium being cost-effective is over 60% at cost-effectiveness thresholds of pound1000 per unit decrement in ASS and pound20,000 per quality-adjusted life-year (QALY) gained, respectively; it is noted that for some parameter variations this probability is much lower, reflecting the labile nature of the cost-effectiveness ratio in light of the small differences in benefits and costs shown in the trial and the relation between the main outcome measure (ASS) and preference based measures of quality of life used in cost-utility analysis (European Quality of Life-5 Dimensions; EQ-5D).
CONCLUSIONS: This study supports the use of nebulised isotonic MgSO 4 at the dose of 151 mg given three times in the first hour of treatment as an adjuvant to standard treatment when a child presents with an acute episode of severe asthma. No harm is done by adding magnesium to salbutamol and ipratropium bromide, and in some individuals it may be clinically helpful. The response is likely to be more marked in those children with more severe attacks and with a shorter duration of exacerbation. Although the study was not powered to demonstrate this fully, the data certainly support the hypotheses that nebulised magnesium has a greater clinical effect in children who have more severe exacerbation with shorter duration of symptoms.
TRIAL REGISTRATION(S): Current Controlled Trials ISRCTN81456894.
FUNDING: The National Institute for Health Research Health Technology Assessment programme.