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Vol. 42. Issue 8.
Pages 384-387 (August 2006)
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Vol. 42. Issue 8.
Pages 384-387 (August 2006)
Original Articles
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Effect of Intravenous Magnesium Sulfate on Chronic Obstructive Pulmonary Disease Exacerbations Requiring Hospitalization: a Randomized Placebo-Controlled Trial
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Juan Abreu Gonzáleza,
Corresponding author
juan_abre@hotmail.com

Correspondence: Dr. J. Abreu González. Servicio de Neumología. Hospital Universitario de Canarias. Ofra, s/n. 38320 La Laguna. Santa Cruz de Tenerife. España
, Concepción Hernández García, Pedro Abreu Gonzálezb, Candelaria Martín Garcíaa, Alejandro Jiménezc
a Servicio de Neumología, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain
b Departamento de Fistología Humana, Facultad de Medicina, Universidad de La Laguna, La Laguna, Santa Cruz de Tenerife, Spain
c Unidad de Investigación, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain
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Objective

Magnesium sulfate has been shown to have a bronchodilating effect in asthma, but this effect has not been clearly established in the context of chronic obstructive pulmonary disease (COPD). For this reason we investigated the possible bronchodilating effect of magnesium sulfate in COPD exacerbations.

Patients and methods

We studied 24 patients with exacerbated COPD who required admission to our hospital's pneumology department. All patients underwent baseline spirometry and were subsequently randomized to groups in a double-blind crossover design. Patients received 1.5 g of magnesium sulfate or placebo in an intravenous solution for 20 minutes. Those who received magnesium sulfate the first day were given placebo the second day, and vice versa. Spirometry was performed 15, 30, and 45 minutes after administration of magnesium sulfate or placebo. Finally, 400 μg of salbutamol were administered using a spacer and a final spirometry was performed 15 minutes later. All patients also received treatment with corticosteroids, intravenous antibiotics, oxygen, and regularly-scheduled bronchodilator therapy (salbutamol and ipratropium bromide every 6 hours).

Results

When we compared absolute increase in liters and percentage increase in forced expiratory volume in 1 second (FEV1) obtained with magnesium sulfate application to the increases obtained with placebo after 15, 30, and 45 minutes, no significant differences were found. When we compared absolute and percentage increases in FEV1 after administering salbutamol, we found significantly greater increases after magnesium sulfate administration. The mean (SD) absolute increase in FEV1 was 0.185 (0.42) L after magnesium sulfate administration and 0.081 (0.01) L after placebo (P=.004). The percentage increase in FEV1 was 17.11% (3.7%) after magnesium sulfate and 7.06% (1.8%) after placebo (P=.008).

Conclusions

Intravenous administration of magnesium sulfate has no bronchodilating effect in patients with COPD exacerbations. It does, however, enhance the bronchodilating effect of inhaled β2-agonists.

Key words:
Chronic obstructive pulmonary disease, COPD
Magnesium sulfate
Bronchodilator agents
Objetivo

El sulfato de magnesio (SM) ha demostrado tener en el asma bronquial un efecto broncodilatador, que resulta dudoso en el caso de la enfermedad pulmonar obstructiva crónica (EPOC). Por ello hemos llevado a cabo un estudio con el objetivo de investigar el posible efecto broncodilatador del SM intravenoso en la EPOC agudizada.

Pacientes y métodos

Se estudió a 24 pacientes diagnosticados de EPOC agudizada que requirieron ingreso en la Unidad de Hospitalizaciön de Neumología. A cada uno se le realizó una espirometría basal. Posteriormente, se efectuó una aleatorización a doble ciego y cruzada de los pacientes para recibir 1,5 g de SM o placebo en solución intravenosa (20 min). A quienes el primer día recibieron SM se les administró placebo el segundo día, y al revés. Se realizaron espirometrías a los 15, 30 y 45 min de la administración de SM o placebo. Por último, se administraron 400 μg de salbutamol inhalados mediante cámara espaciadora y a los 15 min se realizó una última espirometría. Todos los enfermos recibieron además tratamiento con esteroides, antibióticos intravenosos, oxígeno y broncodilatadores pautados (salbutamol y bromuro de ipratropio cada 6 h).

Resultados

Cuando se compararon los incrementos absolutes (en ml) y porcentuales del volumen espiratorio forzado en el primer segundo (FEV1) obtenidos con SM y placebo a los 15, 30 y 45 min, no se encontraron diferencias significativas. Al comparar los incrementos absolutos y porcentuales del FEV1 tras la administración de salbutamol se observaron incrementos significativos con el SM (incrementos absolutos FEV1 SM/placebo: 0,185 ± 0,42 frente a 0,081 ± 0,01 l; p = 0,004. Incrementos porcentuales FEV1 SM/placebo: 17,11 ± 3,7% frente al 7,06 ± 1,8%; p = 0,008).

Conclusiones

La administración de SM intravenoso carece de efecto broncodilatador en pacientes con EPOC agudizada; sin embargo, sí potencia dicho efecto de los betamiméticos inhalados.

Palabras clave:
Enfermedad pulmonar obstructiva crónica (EPOC)
Sulfato de magnesio
Broncodilatadores
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