Background: Chronic obstructive pulmonary disease, characterised by chronic respiratory symptoms like dyspnoea, cough, sputum production and is often associated with episodes of acute exacerbations which may occur due to various triggers like bacterial or viral infections, exposure to pollutants like biomass fuels, crop residues, woods etc. various treatment modalities have been implicated in the management of these episodes of acute exacerbations of COPD. This randomized control trial aims to compare the effect of intravenous and nebulised magnesium sulphate as an adjunctive therapy during acute exacerbation of chronic obstructive pulmonary disease in this sample population.

Methods: The study will be conducted in within Department of medicine, at AVBRH, a tertiary care teaching hospital placed within geographic region of Wardha District. Study is done when approved via institute moral committee (applied for).The participants with acute exacerbation of chronic obstructive pulmonary disease will be randomized using a computer generated random sequence into two groups, Group A  receiving intravenous injection of magnesium sulphate as a single dose on presentation to emergency department and Group B receiving nebulisation with magnesium sulphate three times at an interval of 30 minutes each time (i.e on presentation, at interval of 30 minutes and then at 60 minutes from the time of presentation, as an adjunctive along with standard treatment for acute exacerbations of COPD. Various investigations will be conducted at baseline and throughout the study period, including peak expiratory flow rate (PEFR), arterial blood gas analysis (ABG), chest x ray, complete blood count and CURB-65, q SOFA and CAT scores will be assessed.

Expected Results: It is anticipated that intravenous magnesium sulphate as an adjunctive in treatment of acute exacerbation of chronic obstructive pulmonary disease will lead to improvement in bronchospasm and improve dyspnoea score, decrease the need for hospitalisation and / or duration of hospital stay among participants with acute exacerbation of COPD whereas nebulized magnesium sulphate may reduce the number of ICU admissions and improve dyspnoea. Positive effect of intravenous and nebulized magnesium sulphate as an adjunct in management of acute exacerbation of COPD and study outcomes are expected. Adherence to the intervention protocol and the safety and tolerability of intravenous and nebulized magnesium sulphate will also be evaluated.