From the Guidelines
Proventil, a brand name for albuterol, is a crucial medication for acute asthma exacerbations and should be administered via heliox-driven nebulization for optimal outcomes, as suggested by the Expert Panel report 1. The dose of albuterol for acute asthma exacerbation can be given as 2.5 mg via nebulization, which is equivalent to 2 g over 20 minutes in adults and 25 to 75 mg/kg in children (up to a maximum of 2 g) 1. Key considerations for the use of Proventil in acute asthma include:
- The importance of maintaining adequate intravascular volume to prevent hypotension during treatment 1
- Avoiding high ventilator pressures to minimize the risk of barotrauma 1
- Considering "permissive hypercapnia" or "controlled hypoventilation" as a recommended ventilator strategy to provide adequate oxygenation while minimizing airway pressures 1 It is essential to note that Proventil is a rescue medication and not a substitute for daily controller medications, and patients should seek medical attention if they find themselves using it more frequently than prescribed 1.
From the FDA Drug Label
Albuterol sulfate inhalation solution is indicated for the relief of bronchospasm in patients 2 years of age and older with reversible obstructive airway disease and acute attacks of bronchospasm. The Proventil drug is indicated for the relief of bronchospasm in patients with reversible obstructive airway disease.
- The drug is for patients 2 years of age and older.
- It is used for acute attacks of bronchospasm 2.
From the Research
Proventil Overview
- Proventil, also known as albuterol, is a long-acting beta 2-adrenergic receptor-selective drug that relaxes airway smooth muscle 3
- It is currently available in the United States in oral and metered-dose inhaler forms, with nebulizer solutions and parenteral preparations also available 3
Mechanism of Action and Side Effects
- Albuterol can produce undesirable dose-related effects, including metabolic effects, peripheral vasodilation, and skeletal muscle tremor 3
- These side effects are most common with parenteral administration and much less prominent with aerosol administration, which yields lower systemic concentrations 3
Clinical Use
- Aerosolization of albuterol or a similar agent with a compressed-air nebulizer appears to be the best first-line management of the patient with acute dyspneic asthma 3
- In the ambulatory patient, aerosolized albuterol administered by metered-dose inhaler is an excellent agent for treatment as needed and/or for prevention of acute bronchospasm triggered by exercise or other predictable cause 3
- Regularly scheduled administration of albuterol by metered-dose inhaler is a widely used and effective maintenance medication for patients requiring long-term prophylactic therapy 3
Comparison with Other Treatments
- Anticholinergic agents, such as ipratropium bromide, oxitropium bromide, and tiotropium bromide, have important uses as bronchodilators for the treatment of obstructive airway diseases, including asthma and COPD 4
- Combination therapy with sympathomimetic and anticholinergic agents may be more efficacious than either one alone in patients with acute asthma 5
- Ad-lib administration of albuterol may be therapeutically as effective as regular, scheduled administration in the management of asthma exacerbation, and may reduce the total dose of beta-agonists received by the hospitalized patient 6
Perioperative Management
- Inhaled beta-2 agonists like albuterol are often relied upon as the sole therapeutic agent for perioperative bronchospasm, but may have limited response 7
- A multimodal approach, including intravenous dexmedetomidine, lidocaine, magnesium, ketamine, and steroids, as well as inhalational sevoflurane, may be more effective in managing perioperative bronchospasm 7