Background: Recent research has demonstrated that both Intravenous (IV) as well as inhaled magnesium sulphate (MgSO4) could have a crucial role among severe asthmatic patients.

Methods: We carried out this randomized controlled clinical trial on 86 asthmatic children who were categorized into two groups: Group (A): included 43 children who were managed by intermittent inhaled normal saline (2ml)+ salbutamol alone (received 2.5 mg/dose = 0.5ml) starting at 20 minutes intervals for 3 doses, followed by 0.15 to 0.3 mg/kg/dose every 1 to 4 hours, with a maximum dose of 10 mg/dose, Group (B): included 43 children who were managed by inhaled salbutamol added with Nebulized isotonic magnesium sulphate (150mg) in 3 doses in 1st hour of treatment, Pediatric asthma severity score (PASS) was assessed before treatment and 20, 40, and 60 minutes, 2 hours after treatment with assessment of discharge data.

Results: Statistically significant difference was revealed between both groups as regard triggers of asthma attack (p=0.014), the most common triggering factor for asthma attack is viral upper respiratory tract infection, there was a significant decrease in PASS score in magnesium sulphate salbutamol group (decreased 26.19 %) compared to the normal saline salbutamol group (decreased 15.91%) with p value of 0.000.

Conclusion: nebulized isotonic magnesium sulphate is a safe drug, the use of nebulized isotonic magnesium sulphate in combination with salbutamol in acute asthma exacerbation shows superiority in efficacy to standard treatment normal saline salbutamol but without detected major difference in the rate of hospitalization.