Introduction
The magnesium sulfate (MS) is a medication with bronchodilator properties described for more than 50 years (1) .However, this medication have not been considered in the first-line drug in acute asthma, - in part probably due to the limited number and size of studies (2) in the last century – and their use, now, is more extensive than current guidelines or available evidence appear to support (3)
Growing evidence shows significant improvement in pulmonary function and a reduction of hospital admissions in children (4). The positive effect, in patients with asthma, is mediated through its role as a calcium antagonist, as an enzymatic cofactor of sodium and potassium flux across cell membranes (5) . Theses physiological effects has been reflected in randomized clinical trials in children, reducing asthma severity scores, especially in severe asthma, with no differences in the occurrence of adverse events respect to standard inhaled treatment (6).
Despite this evidence and the frequent use of MS in acute asthma; this drug continues being considered as the second line in pediatric acute asthma exacerbations. A recent meta-analysis has demonstrated their benefit of early use in a patient who did not respond after of rescue within 1-2 hrs to b2-agonist without serious adverse events (7) (8) . The economic impact of these benefits has been not evaluated yet, and obtain this evidence could be important as a prior step to adopt this drug in as first line in the clinical guidelines of asthma. Just their early use in the emergency setting is where this drug could have more economic impact, reducing cost and morbidity associated with treatment failure and mechanical ventilation. This will be more important especially in many hospitals of middle-income countries that have a low frequency of PICU services per habitant, and where this drug can be a cost-saving alternative . This study aims to evaluate the cost-effectiveness of MS in an infant with acute asthma in the emergency setting in Colombia.