From the Guidelines
The recommended dose of albuterol via nebulizer for acute bronchospasm treatment is 2.5–5 mg every 20 minutes for 3 doses, then 2.5–10 mg every 1–4 hours as needed, or 10–15 mg/hour continuously, as stated in the most recent and highest quality study 1.
Key Considerations
- For children, the dose is typically 0.15 mg/kg (minimum dose 2.5 mg) every 20 minutes for 3 doses, then 0.15–0.3 mg/kg up to 10 mg every 1–4 hours as needed, or 0.5 mg/kg/hour by continuous nebulization 1.
- The medication should be diluted to a minimum of 3 mL at a gas flow of 6–8 L/min, and large volume nebulizers should be used for continuous administration 1.
- Albuterol can be mixed with ipratropium nebulizer solution, and the patient should be in an upright position and breathe normally through the mouthpiece until the medication is completely nebulized.
Administration and Side Effects
- Potential side effects of albuterol include tachycardia, tremors, and hypokalemia.
- Albuterol works by selectively stimulating beta2-adrenergic receptors in bronchial smooth muscle, causing bronchodilation through increased cyclic AMP production, which relaxes the airways and improves airflow in patients experiencing bronchospasm due to asthma, COPD, or other respiratory conditions.
Comparison with Other Studies
- While other studies, such as 1 and 1, provide similar dosing recommendations, the most recent and highest quality study 1 is prioritized for its relevance and accuracy in guiding clinical practice.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION Adults and Children 2 to 12 Years of Age: The usual dosage for adults and for children weighing at least 15 kg is 2.5 mg of albuterol (one vial) administered three to four times daily by nebulization. The recommended dose of albuterol via nebulizer for the treatment of acute bronchospasm is:
- 2.5 mg administered three to four times daily for adults and children weighing at least 15 kg 2. For children weighing less than 15 kg, albuterol inhalation solution, 0.5% should be used instead of albuterol inhalation solution, 0.083%.
From the Research
Recommended Dose of Albuterol via Nebulizer
- The recommended dose of albuterol via nebulizer for the treatment of acute bronchospasm is not explicitly stated in the provided studies.
- However, a study published in 1999 3 used a dose of 10 mg/h of albuterol via continuous nebulization for a maximum of 3 hours.
- Another study published in 2015 4 used a dose of up to 20 mg/hr of albuterol via continuous nebulization for 57 hours, followed by 49 hours of continuous levalbuterol (7 mg/hr).
Combination Therapy with Ipratropium Bromide
- Studies have shown that combination therapy with ipratropium bromide and albuterol may be effective in treating acute bronchospasm 3, 5, 6.
- A study published in 1999 3 found that patients given combination therapy with albuterol (10 mg/h) and ipratropium bromide (1.0 mg/h) via continuous nebulization had a greater improvement in peak expiratory flow rate (PEFR) compared to those receiving albuterol alone.
- Another study published in 2016 5 found that ipratropium bromide/albuterol metered-dose inhaler (CVT-MDI) provided more effective acute relief of bronchospasm in moderate-to-severe asthma than albuterol hydrofluoroalkaline (ALB-HFA) alone.
Treatment of Acute Bronchospasm
- A review of guidelines and literature published in 2006 7 found that inhaled beta(2)-agonists, such as albuterol, are commonly used in the treatment of acute bronchospasm in asthma.
- The review also noted that the effectiveness of inhalation devices is dependent on age, cooperation of the patient, and technique.