Pediatrics · Medical Literature
Randomised controlled trial of intravenous magnesium sulfate versus terbutaline for children in the management of acute exacerbation of asthma.
Abstract
To compare the effectiveness and safety of intravenous magnesium sulfate versus terbutaline in children with acute asthma exacerbations. This randomised controlled trial was conducted at the Paediatric Department of The Children's Hospital and Institute of Child Health, Multan, Pakistan, from January to August 2024, and comprised children of either gender aged 5-12 years who had a history of asthma for a minimum of six months, and presented with acute exacerbation of asthma requiring emergency treatment. The patients were randomly allocated to group A receiving intravenous magnesium sulfate and group B receiving intravenous terbutaline. After four hours of treatment, the response to treatment was measured on the basis of peak expiratory flow rate, oxygen saturation, heart rate and respiratory rate. Data was analysed using SPSS 26. Of the 120 children, 62(51.7%) were girls. The overall mean age was 8.40±2.41 years. Post-treatment peak expiratory flow rate, oxygen saturation, heart rate, tachycardia and need for hospitalisation values were significantly better in group A compared to group B (p<0.05). Intravenous magnesium sulfate was more effective and safer than terbutaline in the management of acute asthma exacerbations in children. NCT06626620.
Clinical relevance
In children aged 5–12 years presenting with acute asthma exacerbations, is intravenous magnesium sulfate more effective and safer than intravenous terbutaline, as measured by post-treatment peak expiratory flow rate, oxygen saturation, heart rate, and need for hospitalization? __SNAPSHOT__ {"studyDesign":"Randomized controlled trial (two-arm, parallel-group)","setting":"Paediatric Department, The Children's Hospital and Institute of Child Health, Multan, Pakistan; single tertiary-care center; January–August 2024","sampleSize":"n=120 (Group A [IV magnesium sulfate]: not reported per arm; Group B [IV terbutaline]: not reported per arm); 62 (51.7%) female","population":"Children of either gender, aged 5–12 years (mean age 8.40 ± 2.41 years), with a documented history of asthma for ≥6 months presenting to the emergency department with an acute asthma exacerbation requiring emergency treatment","intervention":"Group A: Intravenous magnesium sulfate (dose and infusion duration not reported in abstract)","comparator":"Group B: Intravenous terbutaline (dose and infusion duration not reported in abstract)","primaryOutcome":"Response to treatment at 4 hours post-initiation, assessed by: peak expiratory flow rate (PEFR), oxygen saturation (SpO₂), heart rate, tachycardia incidence, and need for hospitalization","followUp":"4 hours post-treatment (in-hospital observation); longer-term follow-up not reported","fundingSource":"Not reported"}
Key findings
Among 120 children randomized to IV magnesium sulfate (Group A) or IV terbutaline (Group B), post-treatment PEFR, oxygen saturation, heart rate, tachycardia incidence, and need for hospitalization were all reported as statistically significantly better in Group A versus Group B (p<0.05 for all comparisons). Specific absolute values, mean differences, confidence intervals, effect sizes, and relative risk reductions for individual outcomes were not reported in the available abstract. The NNT for hospitalization avoidance cannot be calculated from the abstract data. No detailed breakdown of adverse event rates was reported beyond the statement that tachycardia was significantly less frequent in the magnesium sulfate arm (p<0.05). Per-arm sample sizes were not reported, precluding independent calculation of effect measures. The abstract concludes that IV magnesium sulfate was both more effective and safer than IV terbutaline, but the magnitude of clinical benefit for each individual outcome remains unreported.
Practice implications
This single-center Pakistani RCT found statistically significant advantages favoring IV magnesium sulfate over IV terbutaline across all measured outcomes at 4 hours in school-aged children with acute asthma. The finding regarding reduced tachycardia is mechanistically plausible given terbutaline's known β1-adrenergic cardiovascular effects versus magnesium's calcium-antagonist bronchodilatory mechanism. However, the study does not establish the magnitude of clinical benefit, as no absolute values, confidence intervals, or effect sizes are provided in the abstract. The 4-hour follow-up window is insufficient to assess outcomes such as relapse, 24-hour re-presentation, or length of stay beyond the observation period. Results apply to children aged 5–12 years in a single resource-limited tertiary center; generalizability to other healthcare settings, age groups (particularly under 5), and exacerbation severity categories (mild vs. moderate vs. severe, per GINA or NAEPP criteria) is not established. Patients with very severe or life-threatening exacerbations, or those with comorbidities, are not characterized. Importantly, this summary is based on abstract-only data; the full publication (JPMA Vol. 76, No. 07, pp. 1006–1010, 2026) should be consulted for complete outcome tables, dosing protocols, randomization methodology, and safety data before drawing practice-level conclusions. __LIMITATIONS__ Abstract-only data available at time of analysis; complete outcome tables, dosing regimens, randomization and allocation concealment details, and blinding methodology are not assessable.,Per-arm sample sizes not reported; adequacy of statistical power and balance of baseline characteristics between groups cannot be verified.,No absolute values, confidence intervals, or effect sizes provided for any individual outcome; only directional p<0.05 reported.,Short 4-hour follow-up window precludes assessment of relapse, re-presentation, length of stay, or sustained bronchodilation beyond the observation period.,Single-center design at a tertiary pediatric hospital in Pakistan limits generalizability to other healthcare settings, patient populations, and resource contexts.,Severity of asthma exacerbations not stratified (mild vs. moderate vs. severe) using validated tools (e.g., PRAM, PASS, or percent-predicted PEFR), limiting applicability by severity subgroup.,Blinding status (open-label vs. blinded) not reported in abstract, introducing potential for performance and assessment bias.,Dosing protocols for both agents not reported, precluding replication or comparison with prior literature dosing standards.,Funding source not reported; potential conflicts of interest cannot be assessed.,Comparator (terbutaline) is not the first-line IV agent in all international guidelines (e.g., IV salbutamol/albuterol is preferred in several Western guidelines), limiting cross-setting applicability. __BOTTOM_LINE_CATEGORY__ potentially_practice_informing __BOTTOM_LINE__ This single-center Pakistani RCT of 120 children suggests IV magnesium sulfate may offer statistically significant advantages over IV terbutaline in post-treatment PEFR, oxygen saturation, heart rate, tachycardia incidence, and hospitalization rates at 4 hours; however, the abstract provides no absolute values or effect sizes, and full methodological details are unavailable. These findings are broadly consistent with prior comparative data favoring IV magnesium sulfate in pediatric acute severe asthma, but cannot independently drive a practice change. Clinicians should consult the full publication and contextualize findings within existing systematic review evidence and local formulary availability before preferentially selecting IV magnesium sulfate over standard beta-agonist-based IV rescue therapy.