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What is the most appropriate second-line intravenous bronchodilator treatment when a child with a severe asthma attack is not responsive to initial inhaled therapy? The second-line treatment options for acute asthma include parenteral β 2 -agonists, methylxanthine and magnesium sulphate (MgSO 4 ). There is a poor evidence-base to inform this decision. This review argues that intravenous MgSO 4  is the obvious treatment of choice for this situation as the initial treatment based on current knowledge.  We describe the mode of action, scope and limitations of MgSO 4 , safety profile, economic impact, comparisons of the alternatives, and finally, what the guidelines say.  This review explores the suitability of intravenous MgSO 4  as a pragmatic and safe initial second-line therapy for children unresponsive to initial asthma management.

breathe

Stating the obvious: intravenous magnesium sulphate should be the first parenteral bronchodilator in paediatric asthma exacerbations unresponsive to first-line therapy