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Abstract

Objective: This study aimed to evaluate whether nebulized magnesium sulphate (MgSO₄) offers any clinical advantage over nebulized salbutamol in children presenting with acute asthma exacerbations. Methods: We carried out a six-month randomized controlled trial from September 2024 to March 2025 in the Paediatrics Department at Shaikh Zayed Hospital, Lahore. A total of 100 children between 2 and 12 years of age, all with moderate to severe exacerbations (Paediatric Asthma Severity Score [PASS] > 8), were recruited. Using a double-blind design, they were randomly assigned to receive either nebulized MgSO₄ (Group A, n=50) or nebulized salbutamol (Group B, n=50). Each child was given three nebulizations 20 minutes apart. The primary outcome was defined as a fall of at least 4 points in PASS after 6 hours. Results: The two groups were well matched at baseline, with mean ages of 7.1 ± 2.6 years in the MgSO₄ group and 7.4 ± 2.8 years in the salbutamol group, and a slight male predominance in both (60% and 58%, respectively). After six hours, children receiving MgSO₄ demonstrated a greater improvement: mean PASS dropped by 5.3 ± 1.4 points compared with 4.1 ± 1.6 points in the salbutamol group (p=0.002). A clinically meaningful response (≥4-point reduction) was achieved in 86% of children on MgSO₄ versus 68% on salbutamol (p=0.04). Oxygen saturation also rose more sharply in the MgSO₄ group, from 89.3% ± 3.4 to 96.8% ± 2.1, compared with an increase from 89.6% ± 3.6 to 95.2% ± 2.8 in the salbutamol group (p=0.03). No serious adverse effects were observed, apart from minor throat irritation in a few cases. Conclusion: Nebulized magnesium sulphate proved more effective than salbutamol alone in improving clinical outcomes for children with acute asthma exacerbations. Its ease of administration, safety profile, and low cost support its potential role as an adjunct therapy in routine pediatric emergency care.