Therapeutic Impact of Add-On Intravenous Magnesium Sulphate During Acute Exacerbations of COPD: A Prospective Comparative Study from a Bangladeshi Tertiary Hospital

Abstract

Background: Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) contributes substantially to respiratory morbidity and healthcare burden in Bangladesh. Intravenous magnesium sulfate (IV MgSO₄), with bronchodilatory and anti-inflammatory properties, has been proposed as adjunctive treatment, but evidence remains mixed and is largely derived from emergency-department trials in high-income settings.

Objective: To assess the adjunctive effect of IV MgSO₄ on pulmonary function, dyspnea severity and hospital stay among hospitalised patients with AECOPD at Dhaka Medical College Hospital.

Methods: An observational, prospective, hospital-based comparative study was conducted in the Department of Respiratory Medicine. Ninety patients with AECOPD were enrolled by purposive consecutive sampling and assigned according to the attending consultant’s clinical decision: Group A received standard therapy alone (n = 51), and Group B received standard therapy plus IV MgSO₄ (2 g in 50 mL 0.9% saline infused over 20 minutes once daily for three days; n = 39). No placebo, randomisation or blinding was used. Peak expiratory flow rate (PEFR) and Dyspnea Severity Score (DSS) were recorded at baseline, 45 minutes, and day 3; hospital stay was recorded in days. Paired t-tests assessed within-group changes and the Mann–Whitney U test assessed between-group differences; p < 0.05 was significant.

Results: Baseline PEFR and DSS were comparable (p = 0.61 and p = 0.54). Both groups improved significantly. PEFR increased more in Group B (+50.57 ± 9.14 vs. +34.87 ± 8.25 L/min, p < 0.001), while DSS reduction was greater (−3.40 ± 0.61 vs. −2.93 ± 0.55, p = 0.002). Mean hospital stay was shorter in Group B (4.36 ± 1.62 vs. 5.12 ± 1.84 days, p = 0.031). No adverse reactions or haemodynamic instability were observed.

Conclusion: Adjunctive IV MgSO₄ was associated with greater improvement in airflow and dyspnea and a shorter hospital stay, without observed adverse effects. As treatment was allocated by clinical judgement rather than randomisation, confounding by indication cannot be excluded; findings are hypothesis-generating and require confirmation in randomised trials.