What is the recommended dose of salbutamol (albuterol) for acute asthma exacerbation in pediatric patients?

From the Guidelines

For acute asthma exacerbations in pediatric patients, the recommended dose of salbutamol (albuterol) is 0.15 mg/kg (minimum dose 2.5 mg) every 20 minutes for three doses, then 0.15-0.3 mg/kg up to 10 mg every 1-4 hours as needed via nebulization, or 4-8 puffs (90 mcg/puff) every 20 minutes for three doses, then every 1-4 hours as needed via metered-dose inhaler (MDI) with spacer 1. The dosing regimen is based on the patient's response to treatment and the severity of the exacerbation.

• For nebulization, the dose can be adjusted to 0.15-0.3 mg/kg up to 10 mg every 1-4 hours as needed, with a minimum dose of 2.5 mg.
• For MDI, the dose is 4-8 puffs every 20 minutes for three doses, then every 1-4 hours as needed.
• Continuous nebulization (0.5 mg/kg/hour) may be used in severe cases. These dosages provide effective bronchodilation by stimulating beta-2 adrenergic receptors in the airways, causing smooth muscle relaxation and improved airflow 1. Potential side effects include tachycardia, tremor, and hypokalemia, especially with repeated dosing. Oxygen should be administered concurrently to maintain oxygen saturation above 92%, and the patient should be monitored for clinical improvement and side effects throughout treatment. It is essential to note that the dosing regimen may vary depending on the patient's age, weight, and response to treatment, and should be adjusted accordingly 1.

From the FDA Drug Label

For treatment of acute episodes of bronchospasm or prevention of asthmatic symptoms, the usual dosage for adults and children 4 years of age and older is two inhalations repeated every 4 to 6 hours. In some patients, one inhalation every 4 hours may be sufficient Each actuation of albuterol sulfate inhalation aerosol delivers 108 mcg of albuterol sulfate (equivalent to 90 mcg of albuterol base) from the mouthpiece.

The recommended dose of salbutamol for acute asthma exacerbation in pediatric patients 4 years of age and older is two inhalations repeated every 4 to 6 hours. In some patients, one inhalation every 4 hours may be sufficient. Each actuation delivers 90 mcg of albuterol base 2.

From the Research

Salbutamol Dose in Pediatrics

• The recommended dose of salbutamol for acute asthma exacerbation in pediatric patients is not explicitly stated in the provided studies, but the studies suggest various administration methods and their effectiveness 3, 4, 5.
• A study from 1993 compared the efficacy and side effects of salbutamol administered via open continuous nebulization, closed-port intermittent nebulization, and oral route in asthmatic children, finding that the inhaled route was the most effective 3.
• Another study from 2004 found that salbutamol delivered via a metered-dose inhaler with spacer was an effective alternative to nebulization for acute asthma treatment in the pediatric emergency department 4.
• A 2022 review of salbutamol in the management of asthma discussed the pharmacological profile of different salbutamol formulations, including their efficacy and adverse effects, but did not provide specific dosing recommendations for pediatric patients 6.
• A 2008 study compared the efficacy of pulmicort suspension plus salbutamol and ipratropium bromide for management of acute asthma exacerbation in children, finding that nebulized medicine was an effective means of treatment 5.
• A 2024 study investigated the efficacy of consecutive administration of inhaled salbutamol in children with acute asthma exacerbation, finding that a single dose of inhaled salbutamol provided a similar short-term bronchodilator effect as back-to-back administration in children who showed an initial response to salbutamol 7.

Administration Methods

• The studies suggest that salbutamol can be administered via various methods, including:
  • Nebulization 3, 4, 5
  • Metered-dose inhaler with spacer 4
  • Oral route 3
• The choice of administration method may depend on the specific clinical situation and the patient's response to treatment.

Efficacy and Safety

• The studies suggest that salbutamol is an effective treatment for acute asthma exacerbation in pediatric patients, with various administration methods showing similar efficacy 3, 4, 5, 7.
• The studies also suggest that salbutamol is generally well-tolerated, with minor side effects such as tremor and heart acceleration 3, 7.