TY - JOUR T1 - Stating the obvious: intravenous magnesium sulphate should be the first parenteral bronchodilator in paediatric asthma exacerbations unresponsive to first-line therapy JF - Breathe JO - Breathe DO - 10.1183/20734735.0113-2021 VL - 17 IS - 4 SP - 210113 AU - Gokul Erumbala AU - Sabu Anzar AU - Amjad Tonbari AU - Ramadan Salem AU - Colin Powell Y1 - 2021/12/01 UR - http://breathe.ersjournals.com/content/17/4/210113.abstract N2 - What is the most appropriate second-line intravenous bronchodilator treatment when a child with a severe asthma attack is not responsive to initial inhaled therapy? The second-line treatment options for acute asthma include parenteral β2-agonists, methylxanthine and magnesium sulphate (MgSO4). There is a poor evidence-base to inform this decision. This review argues that intravenous MgSO4 is the obvious treatment of choice for this situation as the initial treatment based on current knowledge.  We describe the mode of action, scope and limitations of MgSO4, safety profile, economic impact, comparisons of the alternatives, and finally, what the guidelines say.  This review explores the suitability of intravenous MgSO4 as a pragmatic and safe initial second-line therapy for children unresponsive to initial asthma management.In acute asthma in children, when they are not responsive to maximal inhaled therapy, intravenous magnesium sulphate should be the first choice second-line intravenous treatment. https://bit.ly/3lvmH08 ER -