الفهرس 
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Abstract
SUMMARY
Chronic Obstructive Pulmonary Disease (COPD) is a common, preventable and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases.
COPD exacerbations play a central role in the natural history of the disease, affecting its overall severity, decreasing pulmonary function, worsening underlying co-morbidities, impairing quality of life and leading to severe morbidity and mortality. Besides COPD severity, the history of exacerbations is also a good predictor of future exacerbations. Furthermore, there is a strong correlation with symptoms of depression and recurrent exacerbations
Several studies have identified clinical and conventional laboratory parameters associated with higher rates of readmission following an AECOPD. These variables include age, sex, physical capacity, levels of partial arterial oxygen pressure and partial arterial carbon dioxide pressure, global and respiratory muscle weakness, socioeconomic status, health-related quality of life and anxiety or depression, cured meat consumption and adherence to inhaled therapy and follow-up.
In the airways, magnesium is a bronchodilator through various mechanisms including an inhibitory effect on bronchial smooth muscle contraction mediated by calcium and an inhibitory effect on acetylcholine release from cholinergic nerve terminals and histamine from mast cells.
Fewer studies have addressed the effects of magnesium in chronic obstructive pulmonary disease even though asthma and COPD share some pathophysiological characteristics as well as numerous therapies, particularly bronchodilator treatments.
In light of some evidence for an effect when nebulized in severe exacerbations of asthma, the similarities between asthma and chronic obstructive pulmonary disease and the practical advantages of administration via nebulizer, we sought to focus on the nebulized route of delivery in acute exacerbations of chronic obstructive pulmonary disease.
This work aims to evaluate the effect of administration of nebulized magnesium sulphate in the management of acute exacerbations of chronic obstructive pulmonary disease.
The current study was conducted upon 100 patients with acute exacerbation of COPD randomly divided into two groups, 50 patients for each group who admitted to emergency room with acute exacerbation of chronic Obstructive Pulmonary Disease in Mansoura chest diseases hospital from January 2019 to June 2019.
All patients randomly divided into two groups, 50 patients for each group as patients of group A: included 50 patients received 2.5 mg (2.5 ml) salbutamol mixed with 500mg (4 ml) isotonic magnesium sulphate and Patients of group B: included 50 patients received 2.5mg salbutamol mixed with 2.5 ml isotonic saline. Treatment for all patients were given via nebulizer.
The primary outcome measures
• FEV1, FVC, ABG, CRP and serum magnesium after finishing nebulization after 30 minutes.
Results can be summarized as follow:
• After treatment there is a significant increase in O2 Saturation, PO2 and Serum Mg (P<0.05) more in patients received Magnesium sulphate + salbutamol nebulizer than patients received salbutamol nebulizer only and no significant difference as regard PH,PCO2,HCO3 and CRP (P>0.05).
• Subjective improvement in Cough and Dyspnea after treatment more in patients received Magnesium sulphate + salbutamol nebulizer than patients received salbutamol nebulizer only.
• There was no significant difference between groups regarding Pulmonary function (FEV1, FVC&FEV1/FVC) before and after treatment (P >0.05).
• There was significant change in pulmonary functions (FEV1,FVC&FEV1/FVC), PO2, O2 Saturation and serum Mg after treatment while, no significant change in PH, PCO2, HCO3, and CRP in patients received Magnesium sulphate + salbutamol nebulizer.
• There is significant change in pulmonary functions (FEV1, FVC&FEV1/FVC), PO2 and O2 Saturation after treatment and no significant change in PH, HCO3, PCO2, serum Mg and CRP in patients received salbutamol nebulizer.
• Respiratory rate were significantly higher improvement more in patients received Magnesium sulphate + salbutamol nebulizer than patients received salbutamol nebulizer only (p<0.05).
CONCLUSIONS
from the results of our study, we concluded that:
• Nebulized magnesium as an adjuvant to salbutamol treatment in the setting of AECOPD has no effect on FEV1, FVC and FEV1/FVC
• Nebulized magnesium sulphate+salbutamol provides nearly equal response to salbutamol in the treatment of Acute Exacerbation of chronic Obstructive Pulmonary Disease in adults.
• The routine use of magnesium sulphate for the treatment of acute exacerbation of COPD cannot be recommended. However, trials are relatively small and for today the accumulated data is not enough to make precise decisions.
• .The efficiency and mechanisms of action of Nebulized magnesium Sulphate in exacerbations of COPD remain to be elucidated in future well designed controlled clinical trials.
RECOMMENDATIONS
from this study we recommended that
• Larger studies are needed to evaluate the effect of administration of nebulized magnesium sulphate in the management of acute exacerbations of chronic obstructive pulmonary disease.
• Our findings, together with previous studies, suggest that the priority for further investigation of magnesium in AECOPD should be with the intravenous route of administration.