Serum Magnesium Level in Children with Bronchial Asthma in Duhok city

2. • Introduction
• Aims of the study
• Patients and Methods
• Results & Discussion
• Conclusions & Recommendations.

3. Bronchial Asthma
• Asthma is a common chronic disease, causing
considerable morbidity.
• It is caused by chronic inflammation of lung airways
with increased airway responsiveness and airflow
obstruction.
• In 2007, 9.6 million children (13.1%) had been
diagnosed with asthma in their lifetimes.
• Boys (14% vs 10%) girls
• Children in poor families (16% vs 10% not poor) are
more likely to have asthma.
• Approximately 80% of all asthmatic patients report
disease onset prior to 6 yr of age.

4. Bronchial Asthma
• The rise in asthma and allergic disease among
children is a matter of worldwide concern.
• Many authors have argued that the changes in
diet may have been an important determinant
of increased susceptibility to asthma.

5. Magnesium
• Magnesium (Mg) is the fourth most abundant ion
in the human body; of which 50% is stored in the
• bones, 49% in cells and the remaining 1% in the
serum.
• Mg is involved in the structure of many enzymes
in the body and plays a role in intracellular
reactions.
• Mg is crucial for normal neuromuscular activities.
• Magnesium deficiency is associated with
increased contractility of smooth muscle cells
including bronchiolar resulting in bronchospasm.

6. To determine prevalence of
hypomagnesemia among asthmatic children
Comparison between mean Serum
Magnesium levels in Asthmatic and
control group
To determine
association between
mean Serum
Magnesium and BMI
of Asthmatic patients
Comparison between mean Serum
Magnesium levels & duration of
Asthma
.
Aims of the study
To determine association
between mean Serum
Magnesium levels & use of
medications (controller) in
Asthmatics.
To determine
association between
mean Serum
Magnesium levels &
severity of Asthma.

7. • study location
• Heevi Pediatric Teaching Hospital /
Duhok/Kurdistan/Iraq.
• Study Design
• A case – control study
• Duration of Data collection.
• January1st 2014 and January1st 2015

8. • Selection of the study participants:
• 200 participants from both genders ; their
ages range between 1 to 15 years.
• Patient group: 100 asthmatic patients
• Control group: 100 healthy children.
Patients and Methods

9. • Inclusion Criteria:
• Diagnosis of asthma and severity of disease
were identified based on the Global Initiative
for Asthma (GINA) guideline criteria.
• Exclusion Criteria:
• Any patient with localized wheezing,
dehydration, fever, pneumonia, renal, hepatic
or cardiac dysfunction.
Patients and Methods

10. Data collection
• A pre designed questionnaire was filled and
all data were kept confidential.
• For each participant the weight, height and
BMI (body mass index) were measured.

11. Estimation of serum Magnesium
• A blood sample was collected from patients
and controls for the measurement of serum
Magnesium by using atomic absorption
spectrophotometer.
• Normal Serum Mg: (1.5-2.3 mg/dL)
• Magnesium (Mg): level of < 1.5 mg/dl was
considered hypomagnesemia

12. Data Analysis
• SPSS (statistical package for the social
sciences) for windows version 19.
• A P-value of less than 0.05 was considered to
be statistically significant.
Patients and Methods

14. The distribution of Age & Gender for both
Asthmatic and controls
Age (years)
Asthmatic patients Control Group
No.(%) Male Female No. Male Female
1 - <3 years 40(40%) 27(27%) 13(13%) 25(25%) 18(18%) 7(7%)
3 - <5 years 22(22%) 16(16%) 6(6%) 14(14%) 9(9%) 5(5%)
5 - <10 years 29(29%) 19(19%) 10(10%) 36(36%) 19(19%) 17(17%)
10-15 years 9(9%) 6(6%) 3(3%) 25(25%) 15(15%) 10(10%)
Total 100(100%) 68(68%) 32(32%) 100(100%) 61(61%) 39(39%)

15. The mean Serum Mg levels in Asthmatic and
control group
Groups
No.
(%)
Serum Mg
level(mg/dl) P-value
Mean(±SD.)
Asthmatic patient 100 1.91± 0.33
0.01
Controls 100 2.03± 0.33

16. Comparison between Mg levels in Asthmatic
and control group
Serum Magnesium
Asthmatic
patients
Control
group
Total
Low S.Mg(<1.5 µg/dl) 9(9%) 1(1%) 10(5%)
Normal S.Mg (1.5-2.3 mg/dL) 91(91%) 99(99%) 190(95%)
Total 100(100%) 100(100%) 200(100%)
X2=8.36 df=2 P=0.01

17. Comparison between mean Serum Serum
Magnesium levels & severity of Asthma.
Severity of
Asthma
No. (%)
Serum Mg level(
mg/dl) P-value
Mean(±SD.)
Intermittent 67(67%) 1.96±0.33
0.05
Mild persistent 20 (20%) 1.85±0.26
Moderate
persistent
10 (10%) 1.79±0.42
Severe persistent 3(3%) 1.50±0.10
Total 100 (100%) 1.91±0.33

18. Comparison between mean Magnesium levels &
duration of Asthma.
Duration of Asthma No.(%)
Serum Mg level(
mg/dl) P-value
Mean(±SD.)
< 1 year 28 (28%) 1.97±0.27
0.1
1 - <3 years 48 (48%) 1.91±0.33
3- <5 years 11 (11%) 1.87±0.36
>5 years 13 (13%) 1.72±0.44
Total 100 (100%) 1.91±0.33

19. The relation between mean Serum
Magnesium and BMI of Asthmatic patients
BMI No.
Serum D3
level(µg/dl)
P-
value
Mean(±SD.)
Under weight
<5%
21(21%) 1.97±0.25
0.3
Normal
5% to 85%
57 (57%) 1.90±0.36
Overweight
85% to 95%
13 (13%) 1.78±0.30
Obese
>95%
9 (9%) 2.00±0.32
Total 100 (100%) 1.91±0.33

20. The Comparison between mean Serum Magnesium
levels & use of medications (controller) in
Asthmatics.
Drugs No.(%)
Serum Mg level ( mg/dl)
P-value
Mean(±SD.)
Steroid as controller medications
Used steroid 20 (20%) 1.92±0.37
0.7
Not used steroid 80 (80%) 1.90±0.30
Bronchodilators as controller medications
Use 31 (31%) 1.91±0.34
0.9
Not used 59 (59%) 1.90±0.31
Total 100(100%) 1.91±0.33

22. Prevalence of Low Mg Level in
Asthmatic patients
Serum Magnesium level was found to be significantly lower
in asthmatic children as compared to the control group
Ukraine
Egypt
Turkey
No significant differences between patients and controls
Spain
Iran

23. Possible Explanation of Magnesium
Deficiency in Asthmatics
• Magnesium is the cofactor of more than 300 enzymes and is
involved in many physiological functions including protein synthesis,
intracellular signal distribution and enzyme catalysis.
• Since it is the natural antagonist of calcium, it provides smooth
muscle relaxation
• In addition, magnesium suppresses the excitability of muscle
fibers by reduction of acetylcholine secretion from motor nerve
terminals.
• Moreover, it inhibits production of inflammatory mediators by
helping stabilization of T-cells and inhibiting mast cell
degranulation.
• Again, it reduces the severity of inflammation in asthma by
stimulating nitric oxide and prostacyclin syntheses.

24. Possible Explanation of Magnesium
Deficiency in Asthmatics
• Although the cause of hypomagnesemia in
patients with bronchial asthma was unknown,
• It may be related to either low magnesium
intake in asthmatics or increased urinary loss
of magnesium, as a side effect of therapy with
b2- agonist, corticosteroid, and theophylline.

25. CONCLUSION AND
RECOMMENDATIONS

26. Conclusions
• Asthmatic Patients have significantly lower
mean Serum Mg levels compared with healthy
controls.
• There is significant difference between mean
Serum Mg levels AND severity of asthma.
• Serum Mg level inversely correlates with the
duration of asthma but not significantly.
• But no statistically significant association were
observed between Serum Mg and BMI.
• No significant change in serum Mg develops with
the use of steroids and bronchodilators in
treatment.

27. Recommendations
• Magnesium supplementation might be
considered a useful additional intervention for
improving outcome in patients with Asthma.
• A large follow up study is recommended to
look on the effect of Magnesium
supplementation in Asthmatic patients.
• Further extended cohort study is indicated to
look on the relations between the Asthmatic
patients and serum Magnesium level.

28. THANKS FOR YOUR
ATTENTION