Hypomagnesaemia in Acute Exacerbation Chronic Obstructive Airway Disease; Association with Anthonisen’s Levels of Exacerbation

Keywords: COPD. Acute exacerbation. Serum Magnesium levels. Hypomagnesaemia


Background: COPD is major public health issue causing morbidity and mortality. Lower serum magnesium levels are seen in patients with acute exacerbations compared to stable COPD patients. This study aims at identifying hypomagnesemia as predictor of COPD exacerbations that may help reduce the burden of readmissions and mortality.

Material and Methods: The Descriptive cross-sectional study was conducted DHQ Hospital Rawalpindi from 16 July 2016 to 15 Jan 2017 after the ethical approval and informed consent. The indoor adult (> 18 years) diagnosed cases of COPD exacerbation were included by consecutive sampling. Patients with malignancy, pregnancy and receiving magnesium supplements were excluded.  Demographic details documented and after complete clinical evaluation, serum Magnesium levels of were assessed. Serum Magnesium < 1.80 mg/dl labeled hypomagnesaemia.  Data was analyzed by SPSS with significant p< 0.05.

Results: Amongst 176 patients; there were 93(52.8%) males and 83(47.2%) females. Mean age was 56+7 years. Mean duration of COPD was 6.56 + 5.24 years (2-10 years).  Mean height in the study was 181 +12 cm and mean weight was 56.06 + 7.08 kg. The mean serum magnesium level was 1.5 + .49mg/dl. Low serum magnesium (<1.8 mg/dl) observed in 103(58.5%), gender wasn’t associated with hypomagnesaemia (p=0.294). Hypomagnesaemia in accordance to types of Anthonisen’s criteria was observed in 19(44.2%) with Type I, 37(57.8%) with Type II and 47(68.1%) with Type III COPD exacerbation. Hypomagnesaemia had significant association with Anthinosen’s levels of exacerbation (p=0.043). The mean age in patients with hypomagnesaemia was 56.61+6.78 Vs.  55.30+7.47 in patients without hypomagnesaemia (p=0.228).

Conclusion: The study concludes mean serum magnesium levels are significantly lower in patients with acute exacerbation of COPD (58.5%), particularly in type II and III. Magnesium levels should be performed in all COPD exacerbations irrespective of gender and age. Replacement of magnesium may be helpful in alleviating symptoms and reducing frequency of exacerbations. 


S. P. Bhatt, P. Khandelwal, S. Nanda, J. C. Stoltzfus, and G. T. Fioravanti, “Serum magnesium is an independent predictor of frequent readmissions due to acute exacerbation of chronic obstructive pulmonary disease,” Respiratory Medicine, vol. 102, no. 7, pp. 999–1003, 2008

Yamada M, Ichinose M. Cutting edge of COPD therapy: current pharmacological therapy and future direction. COPD Research and Practice. 2015 Oct 2;1(1):5.

Pesce, Giancarlo. “Mortality Rates for Chronic Lower Respiratory Diseases in Italy from 1979 to 2010: An Age–period–cohort Analysis.” ERJ Open Research 2.1 (2016): 00093–2015. PMC. Web. 2 Apr. 2017.

Skrepnek GH, Skrepnek SV. An assessment of therapeutic regimens in the treatment of acute exacerbations in chronic obstructive pulmonary disease and asthma. Am J Manag Care. 2004 Jul 1;10(s5).

deBaaij JHF, Hoenderop JGJ, Bindels RJM. Magnesium in man: implications for health and disease. Physiol Rev 2015; 95: 1–46.

Lum G. Hypomagnesemia in acute and chronic care patient populations. American journal of clinical pathology. 1992 Jun 1;97(6):827-30

Kew KM, Kirtchuk L, Michell CI. Intravenous magnesium sulfate for treating adults with acute asthma in the emergency department. Cochrane Database of Systematic Reviews. 2014(5).

Shah BA, Naik MA, Rajab S, Muddasar S, Dhobi GN, Khan AA, Banday KA, Baba S. Serum Magnesium Levels in Exacerbation of COPD: A Single Centre Prospective Study from Kashmir, India. JMS SKIMS. 2010 Jun 21;13(1):15-9.

Donaldson GC, Law M, Kowlessar B, Singh R, Brill SE, Allinson JP, Wedzicha JA. Impact of prolonged exacerbation recovery in chronic obstructive pulmonary disease. American journal of respiratory and critical care medicine. 2015 Oct 15;192(8):943-50.

Robert A. Stone, Derek Lowe, Jonathan M. Potter, Rhona J. Buckingham, C. Michael Roberts, Nancy J. Pursey, Managing patients with COPD exacerbation: does age matter?, Age and Ageing, Volume 41, Issue 4, July 2012, Pages 461–468, https://doi.org/10.1093/ageing/afs039
Ntritsos G, Franek J, Belbasis L, et al. Gender-specific estimates of COPD prevalence: a systematic review and meta-analysis. Int J Chron Obstruct Pulmon Dis. 2018;13:1507-1514. Published 2018 May 10. doi:10.2147/COPD.S146390

Aryal S, Diaz-Guzman E, Mannino DM. Influence of sex on chronic obstructive pulmonary disease risk and treatment outcomes. Int J Chron Obstruct Pulmon Dis. 2014; 9():1145-54.

Buist AS, Vollmer WM, Sullivan SD, Weiss KB, Lee TA, et al. The Burden of Obstructive Lung Disease Initiative (BOLD): rationale and design. COPD. 2005 Jun; 2(2):277-83.

Ejiofor SI, Stolk J, Fernandez P, Stockley RA. Patterns and characterization of COPD exacerbations using real-time data collection. Int J Chron Obstruct Pulmon Dis. 2017;12:427-434.https://doi.org/10.2147/COPD.S126158

Selvan T, Rao R, Priyasamy. A Study of Serum Magnesium Levels in Acute Exacerbation of Chronic Pulmonary Disease on Admission and at the Time of Discharge. J Med Sci Clinical Reseacrh. 2020: 8(11); https://dx.doi.org/10.18535/jmscr/v8i11.64.

Kalagouda Mahishale V, Angadi N, Metgudmath V, Lolly M, Eti A, Khan S. The Prevalence of Chronic Obstructive Pulmonary Disease and the Determinants of Underdiagnosis in Women Exposed to Biomass Fuel in India-a Cross Section Study. Chonnam medical journal. 2016 ;52(2):117-22
How to Cite
Aziz J, Amir M, Akbar A, Aziz S, Shams N, Meraj L. Hypomagnesaemia in Acute Exacerbation Chronic Obstructive Airway Disease; Association with Anthonisen’s Levels of Exacerbation. JRMC [Internet]. 30Jun.2022 [cited 12Aug.2022];26(2):195-01. Available from: https://journalrmc.com/index.php/JRMC/article/view/1758

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