Nebulized Magnesium Sulfate as an Add-On Therapy in Acute Exacerbations of COPD and Bronchial Asthma: Effects on Early Recovery and Reduced ICU Admission

Background: Acute exacerbations of Bronchial Asthma and Chronic Obstructive Pulmonary Disease (COPD) are common causes of hospital admission and respiratory distress. Nebulized Magnesium Sulfate has bronchodilatory and anti-inflammatory effects and may improve early clinical recovery when used as an adjunct therapy. Methods: This prospective comparative cross-sectional observational study was conducted in the Department of Medicine at Monno Medical College & Hospital, Manikganj, Bangladesh from October 2025 to March 2026. A total of 200 patients with acute exacerbations were enrolled, including 100 asthma and 100 COPD patients. Baseline demographic and clinical parameters were recorded and early clinical recovery within 24 hours after nebulized magnesium sulfate therapy was evaluated. Outcomes included improvement in respiratory parameters, requirement of ICU admission, mechanical ventilation and duration of hospital stay. Results: Among asthma patients (n = 100), the majority were aged 18–30 years (28%), whereas most COPD patients were in the >60 years age group (32%), showing a significant age difference between the groups (p < 0.001). Asthma patients were generally younger, while COPD patients were older and more commonly smokers. Improvement in respiratory rate (81% vs 69%), SpO₂ (84% vs 73%) and PEFR >20% (76% vs 63%) was significantly higher in asthma patients (p<0.05). ICU admission was lower in asthma patients (9%) compared to COPD patients (23%) and the mean hospital stay was shorter (3.7±1.5 vs 4.9±2.1 days). Adverse effects were minimal. Conclusion: Nebulized magnesium sulfate appears to be a safe and effective adjunct therapy that improves early recovery and reduces ICU admission, particularly among asthma patients.