One in every nine U.S. adults has asthma, accounting for an estimated 1 million hospital visits and 1.6 million ED visits each year, with treatment costs totaling more than $30 billion, according to Rozina Virani, MSN, RN, FNP-C, of North Park University School of Nursing in Chicago, Illinois.
“Despite clinical research and advancements in pharmacological treatment, the morbidity and mortality keeps rising every year,” she said during a poster session at the American Association of Nurse Practitioners 2015 meeting.
Magnesium may offer a simple solution. Despite it’s known health benefits, half of the U.S. population does not consume the recommended dietary allowance of daily magnesium from their food, data from the National Health and Nutrition Examination Survey indicate.
Magnesium is known to relax smooth muscle cells by reducing intracellular calcium and to exhibit an anti-inflammatory effect by balancing T-cells and suppressing mast cells. It also inhibits acetylcholine release and nitric acid and prostacyclin synthesis to decrease muscle fiber excitability.
So Virani performed a systemic literature review to assess magnesium supplementation as a nonpharmacological treatment for asthma management in both oral and intravenous formulations.
Oral magnesium supplementation was associated with the following positive outcomes, findings from three studies indicated:
- Improved pulmonary function on the FEVI and FVC
- Decreased airway reactivity and wheezing
- Less frequent asthma flare ups
- Fewer outpatient visits
- Less use of inhaled corticosteroids
- Decreased skin response to allergens
Adverse events were rare and most commonly included abdominal cramps and diarrhea.
In the four studies that assessed IV magnesium administration for acute asthma exacerbations, adult doses ranging from more than 30 to 40 mg per day and child doses ranging from 10 to 30 grams per day for those aged older than 2 years provided immediate relief for severe bronchospasm and airway inflammation, Virani found.
Long-term benefits included improvements in peak flow, FVC, and FEV1. The IV magnesium treatment was used as an add-on to abuterol and inhaled and systemic steroids.
Consider administering IV magnesium formulations in acute settings when lung sounds are diminished with inspiratory and expiratory wheezes, Virani suggested. Patients who responded well are those who failed continuous inhaled beta-agonist bronchodilator treatment, she said noted.
Adverse reactions for IV formulations included burning and flushing at the injection site with higher doses, and changes in heart rhythm and mental status.
“Family nurse practitioners need to consider checking magnesium blood levels in asthmatic patients and recommending daily use of magnesium supplements and use of a magnesium-rich diet as a prophylactic nonpharmacological treatment for asthmatic patients,” Virani said.
Current dietary guidelines recommend adult men consume 400-420 mg per day, adult women 300-320 mg per day, and children aged 9 to 12 years 200-300 mg per day. A normal serum value is 1.7 to 2.2 mg/dL.
Oral magnesium supplement doses should be 300-400 mg per day for adults, and 200-300 mg per day for children, according to Virani.
She also suggested providing patients with a list of magnesium-rich foods including avocado, banana, dark leafy vegetables, dried fruits, lentils, soybeans, nuts, whole grains, fish, yogurt and dark chocolate.
“Further clinical research on magnesium use and establishment of protocols and guidelines while using nebulize and intravenous magnesium will play a key role to make magnesium part of the Asthma Action plan,” Virani stated.