Role of serum magnesium in acute exacerbations of chronic obstructive pulmonary disease


  • Arunkumar Sreekumar Department of Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala, India
  • K. K. Velayudhan Department of Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala, India



Magnesium, COPD, Exacerbation, PEFR


Background: This prospective study was done to assess the association between serum magnesium deficiency and its effect on exacerbation of chronic pulmonary obstructive disease (COPD), and also to probably suggest a cut-off level which may be useful for predicting clinical outcomes and serving as a target value for therapeutic intervention. 

Methods: This study was conducted among 100 patients in a tertiary hospital, who were diagnosed with COPD, and their serum magnesium levels were measured when they presented to the hospital during routine check-up (stable) and during an exacerbation. Their PEFR and oxygen saturation were also measured to assess severity. 

Results: Out of 100 patients studied, 91 were males and 9 were females, of which 38 of them were aged 60 or below and 62 of them aged 61 and above.  The average serum magnesium levels of patients presenting during routine check-up was 2.08 mg/dl (below 60) and 2.06 mg/dl (above 61) as compared to values during an exacerbation which was 1.58 mg/dl (below 60) and 1.60 mg/dl (above 60) which was significant. Our study also determined a serum magnesium cut-off value averaging 1.65 mg/dl, which may be useful therapeutic target for intervention.

Conclusions: Serum low serum magnesium levels has a definite association with exacerbations of COPD. Earlier therapeutic interventions may help in decreasing the episodes of exacerbation. A significant reduction of magnesium levels may correlate with severity of airway obstruction.


Buist AS, McBurnie MA, Vollmer WM. International variation in the prevalence of COPD (the BOLD Study): a population-based prevalence study. Lancet. 2007;370:741.

Rodriguez-Roisin R. Toward a consensus definition for COPD exacerbations. Chest. 2000;117(5):398S-401.

McKay AJ, Mahesh PA, Fordham JZ, Majeed A. Prevalence of COPD in India: a systematic review. Prim Care Respir J. 2012;21(3):313-21.

Aziz HS, Adel I, Shubair MK. Serum Magnesium Levels and acute exacerbation of Chronic Obstructive Pulmonary Disease: Ann Clin and Lab Sci. 2005;35(4):423-7.

Edwards L, Shirtcliffe P, Wadsworth K. Use of nebulised magnesium sulphate as an adjuvant in the treatment of acute exacerbations of COPD in adults: a randomised double-blind placebo-controlled trial. Thorax. 2013;68(4):338-43.

Spivey W, Skobeloff E, Levin R. Effect of magnesium chloride on rabbit bronchial smooth muscle. Ann Emerg Med. 1990;19:1107-12.

Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: Revised 2014. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Available from: Accessed on November 10, 2014.

American Lung Association; Interpreting the PEFR. Available from: Accessed on 12 Nov-2012.

Murata G, Glium DJ, Busby HK. Precision and accuracy of self-measured peak expiratory flow rates in chronic obstructive pulmonary disease. South Med J. 1998;91(10):919-24.

So JY, Lastra AC, Zhao H, Marchetti N, Criner GJ. Daily Peak Expiratory Flow Rate and Disease Instability in Chronic Obstructive Pulmonary Disease. Chronic Obstr Pulm Dis. 2015;3(1):398-405.

Shah, Naik B, Rajab M, Mudassar S, dhobi S, Khan G et al. Serum Magnesium levels in acute exacerbation of COPD: A single centre prospective study from Kashmir, India. J Med Sci. 2010;13.

Bhatt SP, Pooja K, Sudip N, Gloria T. Serum Magnesium is an independent predictor of frequent readmissions due to acute exacerbation of chronic obstructive pulmonary disease. Respiratory Med J Elsevier. 2008;102(7);999-1003.

Celli BR, MacNee W. ATS/ERS Task Force. Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J. 2004;23:932.

Siafakas NM, Vermeire P, Pride NB. Optimal assessment and management of chronic obstructive pulmonary disease (COPD). The European Respiratory Society Task Force. Eur Respir J. 1995;8:1398.

Longo, Kasper, Fauci AS, Hauser SL, Longo DL, Jameson L. Harrison’s Principles of Internal Medicine. 18th edition, Mac Graw Hill publication. 2012.






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