From the Guidelines
For pediatric asthma inpatients requiring continuous nebulization, albuterol is typically administered at a dose of 0.5 mg/kg/hour, with a usual maximum of 10 mg/hour, as recommended by the most recent guidelines 1.
Key Considerations
- The dose of 0.5 mg/kg/hour is based on the child's weight, with a minimum dose of 2.5 mg and a maximum dose of 10 mg/hour.
- Treatment should be initiated at this dose and continued until significant clinical improvement occurs, generally reassessing every 1-2 hours.
- The dose may then be weaned based on clinical response.
- For most children, continuous nebulization is typically needed for 12-24 hours before transitioning to intermittent treatments.
Monitoring and Side Effects
- Vital signs, particularly heart rate and respiratory rate, should be monitored closely during therapy as tachycardia is a common side effect.
- Serum potassium levels should also be monitored as hypokalemia can develop.
Comprehensive Asthma Management
- Continuous albuterol works by stimulating beta-2 adrenergic receptors in the airways, causing bronchodilation through smooth muscle relaxation.
- The continuous administration provides sustained bronchodilation in severe asthma exacerbations when intermittent dosing may be insufficient.
- Supplemental oxygen should be provided as needed, and concurrent administration of ipratropium bromide and systemic corticosteroids should be considered as part of comprehensive asthma management.
Evidence-Based Recommendation
- The recommended dosage is based on the guidelines from the National Asthma Education and Prevention Program Expert Panel Report 3 1, which provides the most recent and highest quality evidence for the management of asthma exacerbations.
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 FDA drug label does not answer the question.
From the Research
Albuterol Nebulization Dosage for Pediatric Asthma Inpatients
- The recommended dosage of albuterol for continuous nebulization in pediatric asthma inpatients is not universally established, with various studies suggesting different dosages 2, 3, 4.
- According to the National Heart Lung and Blood Institute Asthma Guidelines, the suggested dosage is 0.5 mg/kg/h, but there is limited evidence comparing different weight-based rates on hospital outcomes 2.
- A study comparing two continuous nebulized albuterol doses (10 vs. 25 mg/h) in critically ill children with status asthmaticus found that the lower dose was associated with lower fluid bolus resuscitation without increased adjunctive therapies 4.
- Another study examining the effect of high-dose continuous albuterol nebulization (75 or 150 mg/hr) on clinical variables in children with status asthmaticus found that high-dose continuous albuterol nebulization was associated with a low rate of subsequent mechanical ventilation and fairly short PICU length of stay without significant toxicity 3.
- The optimal weight-based dose of continuous albuterol has not been found, and further investigation is needed to determine the efficacy and toxicity of specific continuous albuterol dosages in critically ill children with status asthmaticus 2, 4.
Dosage Ranges
- Weight-based dosage quintiles have been reported to range from 0.07-0.29 mg/kg/h to >0.76-3.2 mg/kg/h 2.
- Continuous albuterol nebulization is generally administered at 2.5-20 mg/hr at most centers 3.
- High-dose continuous albuterol nebulization has been administered at 75 or 150 mg/hr 3.
Clinical Outcomes
- Clinical outcomes, including the need for additional asthma therapies, hypotension requiring fluid resuscitation, and PICU length of stay, have been evaluated in studies comparing different albuterol dosages 2, 3, 4.
- The addition of ipratropium bromide to albuterol and corticosteroid therapy has been studied, but no significant differences in clinical outcomes were found 5, 6.