Does anybody know whether taking magnesium supplements have any benefit to asthmatics? Every time I present to A&E (about 1-2 times a month) I am given IV magnesium. I know this is protocol but I wondered whether, if I took a supplement everyday, it would prevent the attacks in the first place?
Any suggestions greatfully received!
Sarah
Hi Sarah,
I'm afraid I haven't the energy right now to make a meaningful comment on this, I will try to come up with something later, but you might find these abstracts of interest:
Thorax 1999;54:115-118 ( February )
Dietary antioxidants and magnesium in type 1 brittle asthma: a case control study
J C Baker, W S Tunnicliffe, R C Duncanson, J G Ayres
Brittle Asthma Unit, Birmingham Heartlands Hospital
BACKGROUND Type 1 brittle asthma is a rare form of asthma. Atopy, psychosocial factors and diet may contribute to this condition. As increased dietary magnesium has a beneficial effect on lung function and selenium, vitamins A, C and E have antioxidant properties, a study was undertaken to test the hypothesis that patients with brittle asthma have diets deficient in these nutrients compared with subjects with non-brittle asthma and healthy adults.
METHODS A case control study of the dietary intakes of 20 subjects with brittle asthma, 20 with non-brittle asthma, and 20 healthy adults was performed using five day weighed dietary records. Intake of magnesium was the primary outcome measure with selenium and vitamins A, C and E as secondary outcomes. Serum levels were measured at the same time as the dietary assessment.
RESULTS Sixty subjects (27 men) of mean age 49.5 years were recruited and completed the study. Subjects with brittle asthma had statistically lower median dietary intakes of vitamins A and E than the other groups (vitamin A: brittle asthma 522.5 µg/day, non-brittle asthma 869.5 µg/day, healthy adults 806.5 µg/day; vitamin E: brittle asthma 4.3 mg/day, non-brittle asthma 4.6 mg/day, healthy adults 4.5 mg/day). Median dietary intakes for the other nutrients were not significantly different between groups. Serum levels were within normal ranges for each nutrient in all subjects. Intakes less than the reference nutrient intake (RNI) for magnesium and vitamins A and C, and less than the safe intake (SI) for vitamin E were more likely in patients with brittle asthma than in those with non-brittle asthma.
CONCLUSION Nutrient deficiency and reduced antioxidant activity may contribute to disease activity in type 1 brittle asthma, although a prospective study of replacement therapy will be needed to confirm this hypothesis.
Eur Respir J 1997; 10: 2225-2229
Investigation of the effect of short-term change in dietary magnesium intake in asthma
J Hill, A Micklewright, S Lewis, and J Britton
Epidemiological evidence suggests that a low dietary intake of magnesium is associated with impaired lung function, bronchial hyperreactivity and wheezing. This study was designed to investigate whether short-term alterations of dietary magnesium intake have an effect on the clinical control of asthma. In a randomized, double-blind, placebo-controlled, cross-over study, 17 asthmatic subjects adhered to a low magnesium diet for two periods of 3 weeks, preceded and separated by a 1 week run-in/wash-out, in which they took either placebo or magnesium (400 mg x day(-1)) tablet supplementation. Forced expiratory volume in one second (FEV1) and the provocative dose of methacholine required to cause a 20% fall in FEV1 from baseline (PD20,FEV1) were measured at the beginning and end of each treatment period, and variation in peak expiratory flow (PEF) rate, bronchodilator use and symptom scores recorded throughout. Asthma symptom scores were significantly lower during the magnesium treatment period, the median (95% confidence interval) difference from placebo being 3.8 (0.5-7.0) symptom points per 7 days (p=0.02). However, there was no significant improvement in FEV1, PD20,FEV1, log amplitude percentage mean PEF variation or bronchodilator use during magnesium supplementation. A high magnesium intake was associated with improvement in symptom scores, though not in objective measures of airflow or airway reactivity, in these stable asthmatic subjects.
I will try to make a meaningful comment on these and the other evidence in the literature about magnesium supplementation when my brain is working! However, I think the general consensus is that although severe asthmatics are more likely to have a diet deficient in magnesium, selenium and key vitamins, supplementation with these does not actually significantly improve the patient's condition.
Hope this helps
Em H
I tried Magnesium tablets once - from a health food shop - didn't notice any difference.
Dear Emily,
I am a little bit confused by your answer. After reading the results of the Baker, Tunnicliffe etc. study in Thorax 1999, I would have thought you would have recommended that brittle asthmatics should try vitamin A and E supplementation. Let's face it, it worked for me!
Hi Marian,
I am delighted if vitamin supplementation has worked for you to improve your symptoms - everyone is different, asthma is a vastly heterogeneous condition and, especially with brittle asthma where the numbers involved in the study are of necessity small, a strictly evidence based approach is not necessarily possible or appropriate.
All I was saying was that, on the basis of the studies I quoted and others I have read, although brittle asthmatics do seem to be more likely to have diets that are deficient in some vitamins and minerals (which could be for many reasons and due to many confounding factors) there appears to be no convincing evidence that supplementation actually improves objective measures of disease.
In addition, therapies that improve symptoms but do not improve objective measures such as PEFR and FEV1 always make me slightly nervous, as one has to wonder whether the effect that they are actually having is to reduce one's awareness of one's symptoms, which obviously could be potentially dangerous.
Having said that, vitamin and mineral supplementation would appear, on the face of it, to be a fairly safe and well tolerated intervention for most people, and I would certainly not wish to discourage anyone from trying it, with appropriate discussion with their healthcare team. I very pleased for anyone who has found it to be effective. I don't think the evidence supports its widescale use, but as I have said, evidence isn't everything when you are treating something as comparatively rare and individual as brittle asthma.
Hope this makes it a little clearer.
Em H
Hi there,
I am treated by one of the folk who wrote that article, and he certainly doesn't think it is worth supplementing diet in brittle asthma, so I guess it depends how you read it - not that I have, I may add.
Hi Owl,
Yes, when I was treated by him (Prof Ayres) before he moved from Heartlands to Aberdeen, I asked him about dietary supplementation and his feeling was that if you have a good balanced diet with plenty of variety there is no extra benefit from supplementation. I think he does recommend it in a few people who have a very restricted diet (eg because of multiple food allergies etc) but most people even with a few allergies should be able to get all the nutrients they need from their diet.
I also asked at the Brompton about dietary supplementation and was told the same thing. If my own local consultant, as well as Prof Ayres and the Brompton all say that it is of no value in most people with brittle asthma that is good enough for me.
I know there are some people who swear by it, and I don't intend to cause an argument - as I say, asthma is a vastly heterogeneous condition, what works for one person may not work for another, and taking dietary supplements would seem to be a relatively low risk strategy. Given the relative lack of evidence, though, and the opinions of the clinicians I trust, I would rather not burden myself with extra tablets - I take enough of the darn things already!
Em H
HI, I am new to this forum, but this one caught my eye. I too was treated by prof Ayres at Heartlands before he left (now Mansur) and I too am a Brittle Asthmatic. In january I had one of the worst attacks I have had in ages and after leaving a 2 week hospital stay i deteriorated again. In the end my GP spoke with heartlands and they gave me Magnesium Sulphate to Nebulise.
It is currently in trial i think and i had to mix the solutions myself with MGS04 and water for injection and then neb with ventolin - but it was great - really improved the situation far better than Atrovent and Ventolin.
Anyone else tried this as a 'Home based' solution and how do they find it?
Lisa
Gloomyeeyore, I asked my cons this very question several years ago and he too said that dietary suppliments of magnesium seem to be of little or no use in brittle asthma. I guess there'd be no harm in trying it if you wanted to, though as EmH has already said, if you eat a balanced diet then you should already be getting adequate amounts of all the vitamins and minerals you need.
Becky.
Thankyou for all of your responses - I really didn't want to have to take yet another tablet but thought I'd ask in case doing so meant I stayed out of A&E for longer than a week! I am quite interested in nebs that may help though - anyone else on them??
MGSO4 nebs
In response to some questions I have recieved - I am actually not using MGSO4 nebs as part of the trial...My GP prescribed it all as my brittle asthma was so out of control!. I am just aware that it is being trialed at the minute, but my results are not part of that.
the trial is
Salbutamol (2.5 mg in 2.5 ml) diluted in isotonic magnesium (2.5 ml of 0.25 mmol/ml [61.75 mg/ml] magnesium) to make up a 5 ml solution for nebulisation.
This has to be perfectly accurate as the MGSO4 needs to be isotonic! get it wrong and I believe it can be fatal!
So i use 1 Vial of magnesium Sulphate 50% - 2ml vials which is 1g in 2ml
and mix this with 14.66ml Water for injection (or near as poss). This has to be done with syringes and stuff and I often get someone else to check it. It can then be stored in the fridge.
When needed I then draw 2.5ml of the solution and add it into the neb with a Salbutamol 2.5 mg in 2.5 ml. THIS HAS TO BE DONE THIS WAY, it cannot be nebed alone (so I am told).
I do find sometimes on nebing that i get a wierd feeling at a bit of a stabbing head pain after the frist one of the day but it is mild and wears off quickly.
The benefit to the asthma is well worth it. Maybe the trial will come up with some issues but hopefully once completed they will bring out ready made vials of the solution as I must say it scares me stiff when I am mixing them.
Hope this helps some people and if others are using a different dosage then please let me know - i am certainly not the mind of all knowledge on this one!
Lisa x
Thank you Lisa this is deffo one to ask the bods at RBH about next time I have an appt. Speaking of which had better book one 
Bex
was informed it would make no difference in taking a suppliment to my treatment
Very interesting about the MgSO4 nebs although drawing it up does sound scary! Will be asking my consultant about this one as well.
Thanks
Em H
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