What is the prescription guideline for albuterol via nebulizer from an ampule?

From the Guidelines

The standard prescription guideline for albuterol via nebulizer from an ampule 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 recommended by the most recent and highest quality study 1.

Key Considerations

• The dose for children is 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.
• For optimal delivery, dilute aerosols to a minimum of 3 mL at gas flow of 6-8 L/min, and use large volume nebulizers for continuous administration 1.
• Albuterol can be mixed with ipratropium nebulizer solution, and the addition of ipratropium may provide a clinically modest improvement in lung function compared with short-acting β-agonists alone 1.

Administration and Monitoring

• When administering albuterol via nebulizer, the patient should be seated upright and instructed to breathe normally through the mouthpiece until the solution is completely nebulized.
• Patients should be monitored for paradoxical bronchospasm and excessive cardiac stimulation, especially in those with underlying heart conditions.
• Common side effects include tremor, tachycardia, and nervousness.

Comparison with Other Studies

• A Cochrane meta-analysis showed no overall difference between the effects of albuterol delivered by metered-dose inhaler spacer or nebulizer 1.
• Levalbuterol, the R-isomer of albuterol, has produced mixed results in comparisons with albuterol, with some studies showing a slightly improved bronchodilator effect in the treatment of acute asthma in the ED 1.

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. To administer 2.5 mg of albuterol, administer the entire contents of one sterile unit-dose vial (3 mL of 0. 083% inhalation solution) by nebulization.

The prescription guideline for albuterol via nebulizer from an ampule is to administer 2.5 mg (one vial) three to four times daily. The entire contents of one sterile unit-dose vial (3 mL of 0.083% inhalation solution) should be administered by nebulization over approximately 5 to 15 minutes 2.

• Key points:
  • Dosage: 2.5 mg
  • Frequency: three to four times daily
  • Administration: by nebulization
  • Volume: 3 mL of 0.083% inhalation solution
  • Duration: approximately 5 to 15 minutes

From the Research

Prescription Guideline for Albuterol via Nebulizer from an Ampule

• The optimal dose of albuterol to use in the treatment of acute asthma has yet to be established, but studies suggest that doses higher than 2.5 mg every 20 min may not provide additional benefits 3.
• A study comparing 2.5 vs 7.5 mg of inhaled albuterol found no significant difference in improvement of FEV1 between the two groups, and no difference in admission rates 3.
• Another study found that continuous nebulization of albuterol at 7.5 mg/hr (usual dose) and 15 mg/hr (high dose) showed no difference in peak flow improvement up to three hours 4.
• The addition of ipratropium bromide to albuterol therapy may be beneficial in patients with severe asthma, particularly those with very severe asthma, as it may reduce hospitalizations 5.
• A study comparing continuously nebulized albuterol plus ipratropium bromide vs albuterol alone found that combination therapy averaged 6.3% greater improvement in PEFR, but there was no statistically significant difference between the two groups 6.

Dosage and Administration

• Albuterol can be administered via nebulizer from an ampule, with typical doses ranging from 2.5 to 5 mg every 20 min 3.
• Continuous nebulization of albuterol can be used, with doses of 7.5 mg/hr or 15 mg/hr, but the optimal dose has not been established 4.
• Ipratropium bromide can be added to albuterol therapy, with typical doses of 0.5 to 1.0 mg/hr 5, 6.

Clinical Considerations

• Patients with acute bronchospasm should be treated with albuterol via nebulizer, with or without ipratropium bromide, based on clinical judgment and individual patient needs 7, 6.
• The decision to admit a patient to the hospital should be based on clinical assessment, including peak expiratory flow rate, symptoms, and response to treatment 3, 4.