Many studies have investigated the efficacy and safety of Intravenous magnesium sulfate and inhaled steroids in addition to the standard treatment for patients with severe asthma attacks. In this 2x2 factorial design blinded randomized study, no interaction of hypothesized treatments is expected.Investigators hypothesize that two doses of intravenous magnesium sulfate,a high dose followed by a (lower) standard dose, will shorten the time to medical readiness for discharge compared to a single standard dose followed by placebo.The second hypothesis is that nebulized inhaled budesonide will be superior to placebo.

Brief Title

Two Doses of the Intravenous Magnesium Sulfate Versus the Standard Single Dose ,With/ Without the Nebulized Budesonide For the Management of the Severe Asthma Exacerbation in the Emergency Room; A Randomized Controlled Trial.

Official Title

Two Doses of the Intravenous Magnesium Sulfate Versus the Standard Single Dose With/Without Nebulized Budesonide for the Emergency Management of the Severe Asthma. A Randomized Controlled Trial.

Brief Summary

Many studies have investigated the efficacy and safety of Intravenous magnesium sulfate and <br /> inhaled steroids in addition to the standard treatment for patients with severe asthma <br /> attacks. <br /> <br /> In this 2x2 factorial design blinded randomized study, no interaction of hypothesized <br /> treatments is expected.Investigators hypothesize that two doses of intravenous magnesium <br /> sulfate,a high dose followed by a (lower) standard dose, will shorten the time to medical <br /> readiness for discharge compared to a single standard dose followed by placebo.The second <br /> hypothesis is that nebulized inhaled budesonide will be superior to placebo.

Detailed Description

Patient with a severe asthma attack will be admitted to the observation area in the Pediatric
Emergency Center and assessed for eligibility for the study by the attending physician, based
upon our study inclusion/exclusion criteria.

Eligible patients will be enrolled after obtaining written consent from the parents. Patients
will receive routine treatment for a severe asthma attack, such as inhaled bronchodilators,
plus intravenous steroids and supplementary oxygen if needed. Standard blood work and chest
X-Ray will be obtained and bronchial asthma severity score will be measured at baseline
before starting treatment,and then at 4,8,12,24,36,48 hr and thereafter. The medical team as
well as parents and patient will be blinded to the medications delivered. The patient will be
randomized into one of the four study groups and adverse effects of the medications in each
group will be monitored and documented carefully.

Outcome Measures

Outcome measures are the tests that investigators perform to prove whether or not a treatment being tested in a clinical trial is having any effect.