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 first-line treatment for acute bronchospasm is albuterol (INH), as it is indicated for the relief of bronchospasm in patients with reversible obstructive airway disease and acute attacks of bronchospasm 1.
- The dosage for adults and children weighing at least 15 kg is 2.5 mg of albuterol administered three to four times daily by nebulization 1.
- Key points to consider when using albuterol for acute bronchospasm include:
- Administering the entire contents of one sterile unit-dose vial (3 mL of 0.083% inhalation solution) by nebulization
- Regulating the flow rate to deliver the solution over approximately 5 to 15 minutes
- Continuing use as medically indicated to control recurring bouts of bronchospasm 1
From the Research
The first-line treatment for acute bronchospasm is a short-acting beta-2 agonist (SABA) such as albuterol (salbutamol), typically administered via a metered-dose inhaler with a spacer or as a nebulized solution.
Key Points to Consider
- For adults, the standard dosage is 2-4 puffs (90 mcg per puff) every 4-6 hours as needed, or 2.5 mg via nebulizer every 4-6 hours, as supported by recent guidelines and studies 2.
- For children, the dosage is weight-based, generally 0.1-0.15 mg/kg via nebulizer, ensuring safe and effective treatment for pediatric patients.
- These medications work rapidly (within minutes) by relaxing the smooth muscles in the airways, thereby relieving bronchospasm and improving airflow, which is crucial for managing acute episodes effectively.
- During an acute episode, treatment may be repeated at 20-minute intervals for the first hour if needed, with subsequent frequency based on response, allowing for tailored management of symptoms.
- Oxygen supplementation should be provided if oxygen saturation is low, addressing potential hypoxemia and ensuring patient safety.
- For severe cases unresponsive to initial treatment, systemic corticosteroids may be added, offering an additional therapeutic option for managing severe bronchospasm.
- Patients should be monitored for potential side effects including tachycardia, tremor, and hypokalemia, emphasizing the importance of vigilant patient monitoring and management of adverse effects.
- It's essential to address the underlying cause of bronchospasm once the acute episode is controlled, focusing on long-term management and prevention of future episodes.
Evidence Supporting the Recommendation
- A study from 2020 2 highlights the importance of optimizing bronchodilation through the use of short-acting beta-2 agonists for acute relief, aligning with the recommended first-line treatment.
- Another study from 2012 3 discusses the pharmacology and therapeutics of bronchodilators, including short-acting beta-2 agonists, providing a comprehensive understanding of their role in managing bronchospasm.
- The use of ipratropium bromide as an adjunctive therapy for acute asthma exacerbation is supported by a study from 2001 4, although it is not considered the first-line treatment for acute bronchospasm.