We would like to clarify some issues raised by the letter of Dr Kufs. Regarding the dose of the β-agonist used to treat the patients, this was not an arbitrary choice but rather part of an experimental protocol in which all patients were treated in a uniform manner to minimize variables in the study. Metaproterenol and albuterol were used, and all patients received two aerosolized treatments within the first 90 minutes prior to entry into the protocol. Only the patients with initial peak expiratory flow rates less than 200 L/min who failed to double this value by 90 minutes were entered into the study. The design of our study evaluated the bronchodilator activity of magnesium sulfate in a subgroup of asthmatic patients who were severely obstructed and for whom "adjunct" therapy would be a welcome addition to our therapeutic armamentarium. It would have been possible to adjust the
Spivey WH, Greenspon L, McNamara R, Skobeloff E. Intravenous Magnesium Sulfate in Acute Asthma-Reply. JAMA. 1990;263(4):517. doi:10.1001/jama.1990.03440040055023
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