Use of nebulised magnesium sulphate as an adjuvant in the treatment of acute exacerbations of COPD in adults: a randomised double-blind placebo-controlled trial.

BACKGROUND: Intravenous magnesium has been shown to cause bronchodilation in acute severe asthma and in small trials in acute exacerbations of chronic obstructive pulmonary disease (AECOPD). There is also some evidence of benefit from nebulised magnesium in acute severe asthma. Our hypothesis was that adjuvant magnesium treatment administered via repeated nebulisation was effective in the management of AECOPD. METHODS: In this randomised double-blind placebo-controlled trial, we approached 161 patients with AECOPD presenting to the emergency departments at two New Zealand hospitals with a forced expiratory volume in 1 s (FEV1) <50% predicted 20 min after initial administration of salbutamol 2.5 mg and ipratropium 500 µg via nebulisation. Patients received 2.5 mg salbutamol mixed with either 2.5 ml isotonic magnesium sulphate (151 mg per dose) or 2.5 ml isotonic saline (placebo) on three occasions at 30 min intervals via nebuliser. The primary outcome measure was FEV1 at 90 min. RESULTS: 116 patients were randomised, 52 of whom were randomly allocated to the magnesium adjuvant group. At 90 min the mean (SD) FEV1 in the magnesium group (N=47) was 0.78 (0.33) l compared with 0.81 (0.30) l in the saline group (N=61) (difference -0.026 l (95% CI -0.15 to 0.095, p=0.67). No patients required non-invasive ventilation. There were 43/48 admissions to hospital in the magnesium group and 56/61 in the saline group (RR 0.98, 95% CI 0.86 to 1.10, p=0.69). CONCLUSIONS: Nebulised magnesium as an adjuvant to salbutamol treatment in the setting of AECOPD has no effect on FEV1. Australian New Zealand Clinical Trials Registry ACTRN12608000167369.

What risks do women face when seeking advice during pregnancy from pharmacies and natural health retailers?

AIM: Potential risks to mother and foetus exist with the incorrect use of complementary and alternative medicine (CAM) products during pregnancy. This study aimed to identify the risks that a woman may face when seeking advice during pregnancy from pharmacies and health food stores (HFS) in Greater Wellington (New Zealand). METHODS: 21 HFS and 21 geographically-matched pharmacies were visited by a researcher who sought advice regarding vitamin supplementation and nausea in early pregnancy using a standardised scenario. Any advice given, including details of recommended products, was documented immediately upon leaving the premises. Proportions were obtained and paired contingency table analysis was used to examine the agreement between the matched pairs. RESULTS: A minority of pharmacies (5/21, 23.8%) and HFS (1/21, 4.8%) made primary recommendations for nausea which were supported by Ministry of Health (MOH) guidelines, and both pharmacies (14/21, 66.7%) and HFS (7/21, 33.3%) recommended products contrary to these guidelines. A greater proportion of pharmacies gave advice consistent with MOH recommended dosage of folic acid supplementation than HFS (20/21, 95.2% vs 10/21, 47.6%). 2/21 (9.5%) of pharmacies and 4/21 (19%) of HFS gave advice with a potential risk of vitamin A overdose. CONCLUSIONS: Pharmacies and HFS in Greater Wellington provided potentially hazardous advice, recommending products, often branded for pregnancy, which contradicted NZ MOH guidelines. Regulatory reform of CAM products and those who sell them is called for in New Zealand.

What risk do consumers face when seeking medical advice from health food stores?

AIM: There is currently no specific legislation to regulate either complementary and alternative medicine (CAM) products or the majority of those promoting them. This study sought to highlight the general risk a consumer may face when they seek help/advice from a pharmacy or health food store (HFS). METHODS: 21 HFS, matched with pharmacies, were visited by a researcher complaining of tiredness, who stated he had been taking warfarin over the previous 2 months. The name, manufacturer and retail price of any products recommended were recorded immediately after leaving the premises. Paired contingency table analysis was used. RESULTS: A pharmacy was significantly more likely to advise the consumer to consult a doctor (13/21) than a HFS (3/21) with a difference in marginal proportions of 47.6% (95% CI 22.5-72.7), p=0.006. A HFS was more likely to recommend more products, and only about one-quarter gave appropriate advice regarding possible interactions with warfarin and management of anticoagulation compared with two-thirds of pharmacies. CONCLUSION: To provide safe and quality advice to consumers, those promoting CAM products need to obtain relevant history and give accurate information regarding possible dug interactions and be prepared to refer back to mainstream medical services. Better regulation of CAM products and those promoting them is called for.

High blood pressure advice given by natural health food stores.

AIM: Complimentary and alternative medicines are widely used but are not registered medicines. The aim of the study was to compare advice given by health food stores and pharmacists for hypertension. METHODS: Twenty-six health food stores and 26 pharmacies were visited by an individual for advise on a hypothetical problem of hypertension. RESULTS: Staff in 25 out of 26 health food stores did not refer the researcher to a medical practitioner; instead they recommended and sold a wide variety of compounds of unproven efficacy. CONCLUSIONS: We recommend the implementation of a formal training programme for health food stores staff and that complimentary and alternative medicines-use in New Zealand is regulated.