Asthma is a prevalent disease that affects as many as334 million individuals worldwide,
and is a major source of disability and premature death in children(1).
Asthma affects 7.1 million children in the United States (2). and is the most common
pediatric chronic disease(3).Globally, the prevalence of pediatric asthma varies from 10%
to 30%. Its symptoms range from chronic cough to life-threatening
bronchospasm.(4,5,6).The most common triggers of asthma exacerbations in both younger and
older children are viral respiratory tract infections, exposure to allergens, tobacco
smoke, air pollutants, cold or dry air, and poorly controlled asthma(4,7).Current
management strategies for acute asthma recommend a stepwise approach, with first-line
standard therapy followed by additional therapeutic options(8).Firstline therapy consists
of inhaled rapid-acting selective b2-agonists, inhaled ipratropium bromide, and oral or
intravenous corticosteroids. Response to standard acute asthma therapy is variable,
influenced by factors that cannot be assessed or accounted for urgently such as genetic
polymorphisms(9-12).For patients who do not respond adequately to first-line therapy,
further improvement can be seen with additional therapy such as inhaled magnesium sulfate
(MgSO4) or intravenous aminophylline, terbutaline, or magnesium sulfate. Though all
available second-line therapeutic agents produce bronchodilatory effects, magnesium
sulfate produces fewer side effects, is more widely available, and costs less than other
second-line therapies(13). This combination of efficacy, few side effects, wide
availability, and low cost suggest that magnesium sulphate is a promising therapeutic
agent that deserves further consideration for use in children with acute asthma. Acute
bronchiolitis (AB) is an infection of the lower respiratory tract that is caused by viral
agents, especially respiratory syncytial virus, most prevalent in children aged less than
24months(14). It is the most common reason for hospital admissions in the first year of
life, representing a significant health burden worldwide. Bronchiolitis usually
demonstrates a benign course, most patients are treated as outpatients but progression to
severe illness may occur rapidly and respiratory support and admission to pediatric
intensive care unit (PICU) may be required promptly in some cases(14). It is
characterized by damage of epithelial cells leading to ciliary destruction, airway
inflammation, edema, and increased mucus production. Mucus plugs and cellular debris
obstruct bronchiolar lumens and result in various degrees of respiratory distress(15).
Current recommendations for treatment of AB focus on supportive care, including
respiratory support, oxygen supplementation if needed, and adequate hydration. Other
treatment agents, such as bronchodilators, hypertonic saline, corticosteroids, and
antiviral/antibacterial agents, showed no clearly defined benefit. Only highflow nasal
cannula (HFNC) oxygen therapy has been elucidated as a new and promising tool for
respiratory support for these patients(16-23).
- Magnesium sulfate was also investigated as a treatment option for bronchiolitis in
few studies