Background BTS/SIGN guidance introduced the consideration of using nebulised magnesium sulphate (MgSO4) as an adjunct therapy for acute severe wheeze into its asthma guideline in 2014 (and subsequently 2016). The MAGNETIC trial (2013) supported its use for acute severe wheeze improving asthma severity scores at 60 minutes. Having witnessed differing clinical practices and opinions on its use I wanted to clarify what current practice is and use this to help promote discussion.
Objectives Discover the extent use of nebulised MgSO4 for acute childhood wheeze in the South West of England and in Children’s hospitals across the UK. Gauge opinion as to why or why it was not being used.
Methods Using an online survey tool information was obtained from Paediatricians in the South West of England and Children’s hospitals. If there was no response contact was made with the emergency department of that hospital to determine current practice. Data was collected on current use, previous use or plans for future use of nebulised MgSO4.
Results 16 hospitals in the South West of England were surveyed 12.5%(2) regularly used nebulised MgSO4 and a 12.5%(2) did so intermittently. Where nebulised MgSO4 was not in use, 50% of hospitals were considering its addition.
24 Children’s hospitals were surveyed with 21%(5) using nebulised MgSO4 regularly with another 4%(1) using it intermittently. 7 departments are considering introducing it.
Opinions varied from “insufficient evidence for benefit in large RCT” to “evidence it works in acute exacerbation” and “We always try nebulise medication rather than give it IV”. Some hospitals were not aware that it was in use, others followed their local specialist hospital’s guideline.
Conclusion Nebulised MgSO4 is not currently widely used in the UK for acute wheeze in children. despite it being part of a national guideline, safe and there being evidence of its benefit. Reasons include lack of awareness of its use and interpretation of the current evidence. Larger departments are exploring its use and it will be interesting to see if this in turn raises awareness elsewhere.
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