RESUMO
Asthma in children constitutes a well-known respiratory condition with significant mortality. In poorly controlled asthma, multiple adjunct therapies including magnesium sulphate (MgSO4), are recommended to decrease the likelihood of intubation; however, limited evidence exists to support their routine usage in day-to-day situations. Aim of this study is to determine the outcomes of pediatric patients treated with magnesium sulphate during exacerbations of asthma admitted at a tertiary care unit. A retrospective study was conducted at The Aga Khan University Hospital, Karachi, Pakistan from January 2019 to December 2021. Patients aged 6 years to 15 years presented with acute asthma through Emergency Room (ER) having clinical respiratory score (CRS) more than five, admitted in high-dependency unit (HDU) were included in the study. Patients who were started on magnesium sulfate within 24 hours of admission were categorized in magnesium sulfate (MS) group. Patients receiving all standard acute asthma treatment but were not started on magnesium therapy within 24 hours of admission were categorized in the non-magnesium sulfate (non-MS) group. Different outcome variables were compared between the groups. A total of 110 patients with asthma were enrolled. Fifty-four patients were categorized into MS group while 56 were included in non-MS group. Fewer patients were transferred from HDU to pediatric intensive care unit (PICU) (24.07%) in MS group compared to non-MS group (42.85%), (p=0.02). In MS group, the mean number of days spent on oxygen in HDU were 2.38±0.81, while non-MS group spent more days (3.10±0.84 (p<0.01). This study demonstrates that for pediatric patients with severe asthma exacerbations, administration of IV MgSO4 (within 24 hours) is beneficial and results in fewer admissions to PICU and reduces the mean number of days spent on oxygen therapy.
RESUMO
The Global Initiative for Asthma (GINA) 2021 guidelines for asthma have been set forth with some alterations in Step 3, for children from 6-11-year-old age group. The low dose LABA-ICS, very low dose formoterol-ICS, medium dose ICS and ICS-LTRA combination were recommended in the guideline. We organized this study to draw an effective comparison between these three combinations of controller therapies in pediatric population. A retrospective study was conducted at the Aga Khan University Hospital, Karachi, Pakistan which enrolled 114 children aged 6-11 years old, from July 2021 to December 2022. These children were admitted with asthma exacerbations and were discharged on controller medications as per GINA guidelines on step 3 for control of asthma for 3 months. They were then followed for re-admission within 30 days of discharge, number of ER visits with asthma exacerbations for 1 year, number of admissions with asthma including HDU and PICU admissions, length of stay per admission for all admissions in subsequent one year. The pulmonary function test was done at 1 week follow-up in clinic after discharge and at 3 months visit post discharge. A total of 114 pediatric patients from age 6-11-year-old, were enrolled in the study period out of which 36 (31.57%), 33(28.9%) and 34 (29.82%) patients were categorized into ICS-LABA, ICS and ICS-LTRA groups respectively. ER visits were significantly low in ICS-LABA group followed by ICS-LRTA group and then ICS group (1.75±0.96 vs 2.93±1.412 vs 3.11±1.21, p<0.001). Similar statistically significant results were observed on average number of admissions per year (1.52±1.02 vs 1.96±0.84 vs 2.06±1.07, p=0.047) and number of patients needing PICU (13.88% vs 26.47% vs 39.39%, p=0.034) in these groups respectively. ICS- LABA group patients had the best values of FEV1 and FEV1/FVC ratio after pulmonary function tests at 3 months follow-up followed by ICS-LTRA and ICS group. Amongst the three options regimens for children managed at step 3 on GINA 2021 guidelines, ICS-LABA therapy helps attain optimal patient outcomes and lung functions in children with asthma followed by ICS-LTRA and ICS group respectively.