Comparison of Efficacy of Nebulized Magnesium Sulphate with Intravenous Magnesium Sulphate in Children with Acute Asthma

Background: Acute asthma is a frequent cause of pediatric emergency admissions, requiring prompt management to relieve airway obstruction and prevent respiratory failure. Magnesium sulphate, administered either intravenously or via nebulization, has been used as an adjunct to standard bronchodilator therapy due to its bronchodilatory and anti-inflammatory effects. Objective: This study aimed to compare the efficacy and safety of nebulized magnesium sulphate with intravenous magnesium sulphate in children presenting with acute moderate-to-severe asthma. Methodology: A total of 148 children aged 1–12 years with acute asthma were enrolled and randomly assigned into two equal groups. One group received intravenous (IV) magnesium sulphate and the other nebulized magnesium sulphate, in addition to standard asthma therapy. The Pulmonary Asthma Score (PAS) was recorded at baseline, and at 30, 60, 120, 240, and 360 minutes. The duration of Pediatric Intensive Care Unit (PICU) stay, total hospital stay, treatment efficacy, and adverse effects were compared between groups. Results: Baseline demographic and clinical characteristics were comparable between groups (p > 0.05). Both treatments significantly improved PAS over time, with a faster initial reduction at 30 minutes in the nebulized group (9.53 ± 2.44 vs. 10.32 ± 2.13; p = 0.036). The mean PICU stay was shorter in the nebulized group (3.32 ± 4.23 vs. 5.94 ± 9.78 hours; p = 0.036), as was total hospital stay (28.76 ± 19.21 vs. 47.08 ± 42.71 hours; p = 0.001). Treatment efficacy was similar between groups (p = 0.069). Adverse effects occurred in 29.7% of IV-treated patients but in none of the nebulized group (p < 0.001). Conclusion: Nebulized magnesium sulphate provides comparable therapeutic efficacy to intravenous administration while offering faster initial improvement, shorter recovery, and a superior safety profile. It represents a safe, effective, and practical alternative for managing acute asthma in children.