I have always liked the idea of parenteral administration of natural medicines. I think choosing the method of delivery adds a level of sophistication to prescribing. So often we administer pills orally and simply expect (or hope) that the active constituents will reach their target. There are, of course, numerous complications and consideration associated with this approach but it seems to be the most convenient method for most people.
 
Magnesium is an extremely useful therapeutic nutrient. It provides benefits for a wide variety of conditions and is a remarkably powerful nutritional agent. Numerous well designed trials have shown magnesium to be effective in the treatment of fatigue related syndromes, cardiovascular diseases, osteoporosis, kidneys stones, spasmic genitourinary conditions, and constrictive respiratory diseases.
 
One mechanism by which magnesium is effective in these conditions is by exerting a relaxing or antispasmodic effect on smooth muscles. Magnesium antagonizes calcium channels to maintain appropriate concentrations of calcium inside muscle cells.  High intracellular calcium levels can lead to spasms. In asthma, the airways become constricted due to excessive spasm of the smooth muscle that lines bronchioles. Both oral and intravenous magnesium have been shown to be effective in the treatment of asthma, however each these methods of administration have their drawbacks. IV magnesium is very effective but it must be done in-office and requires a nurse or trained therapist to do so. As such, regular administration is costly, time consuming, and can be mildly painful. Oral magnesium is less effective and in therapeutic doses can often lead to loose stools, diarrhea and decreased transit time. This is because the antispasmodic action is occurring in the digestive tract that is similarly lined with smooth muscle.
 
Clearly the preferred approach is to deliver the magnesium to site of desired action directly. This is what nebulised magnesium sulphate does. A pressurized stream of air is used to vaporize the magnesium into tiny droplets that can then be inhaled delivering the magnesium directly to the desired site of action. Several studies have been conducted to assess the efficacy and safety of this treatment.
 
One study concluded that nebulised magnesium sulphate had a clinically significant bronchodilatory effect, which was not significantly different from that of salbutamol (the standard pharmaceutical treatment), in acute asthma. The authors also noted that “no side-effects were noted, probably owing to a greater therapeutic ratio through the inhalation route.” In another study, magnesium sulphate was used as the solvent for nebulising salbutamol. In this trial the authors concluded that compared with saline, the use of magnesium sulphate as an adjuvant to nebulised salbutamol may be a beneficial therapy for improving airway function in a severe asthma exacerbation.
 
After trying the treatment on myself, I have begun to administer this treatment to my patients. The great advantage is that many asthmatic patients are used to nebulizers and may have one already at home. This allows them to easily administer the treatment at home. As for the cost of the magnesium sulphate, the amount needed per treatment is less than 50 cents. I am very excited about this treatment and eager to see if regular use will help to reduce the use of conventional bronchodilators in my patients.