What is the recommended dosage of nebulized albuterol (bronchodilator) for pediatric patients?

From the Guidelines

The recommended dosage of nebulized albuterol for pediatric patients 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. This dosage is based on the guidelines for the management of asthma exacerbations, as outlined in the study published in the Journal of Allergy and Clinical Immunology 1.

Key Considerations

• The dosage of nebulized albuterol for pediatric patients should be adjusted based on the patient's weight, with a minimum dose of 2.5 mg.
• The medication can be administered every 20 minutes for 3 doses, then as needed, with a maximum dose of 10 mg every 1-4 hours.
• Continuous nebulization may be used, with a dosage of 0.5 mg/kg/hour.
• It is essential to dilute the aerosol to a minimum of 3 mL at a gas flow of 6-8 L/min for optimal delivery.

Administration and Monitoring

• The medication should be administered using a large volume nebulizer for continuous administration.
• It is crucial to monitor the patient's response to the medication and adjust the dosage as needed.
• Potential side effects, such as tachycardia, tremors, and irritability, should be closely monitored, especially when using higher or more frequent doses.

Evidence-Based Recommendation

The recommended dosage of nebulized albuterol for pediatric patients is based on the study published in the Journal of Allergy and Clinical Immunology 1, which provides guidelines for the management of asthma exacerbations. This study recommends the use of selective beta2-agonists, such as albuterol, for the treatment of asthma exacerbations in pediatric patients.

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. Children weighing < 15 kg who require < 2.5 mg/dose (i.e., less than a full vial) should use albuterol inhalation solution, 0.5% instead of albuterol inhalation solution, 0. 083%. The recommended dosage of nebulized albuterol for pediatric patients is:

• 2.5 mg administered three to four times daily by nebulization for children weighing at least 15 kg.
• For children weighing less than 15 kg, albuterol inhalation solution, 0.5% should be used instead of albuterol inhalation solution, 0.083% 2.

From the Research

Pediatric Nebulized Albuterol Dosage

The recommended dosage of nebulized albuterol for pediatric patients can vary depending on the severity of the asthma and the patient's weight.

• For children 2 to 18 years old, a dose of 2.5 or 5 mg per dose of nebulized albuterol, depending on body weight, is commonly used 3.
• For children with severe asthma, a dose of 0.15 mg/kg per dose of nebulized albuterol has been shown to be effective 4, 5.
• Some studies have also used higher doses of nebulized albuterol, such as 0.30 mg/kg per dose, which has been shown to result in greater improvement in lung function 6.
• High-dose continuous albuterol nebulization, at rates of 75 or 150 mg/hr, has also been used in pediatric patients with status asthmaticus, with minimal toxicity and a low rate of subsequent mechanical ventilation 7.

Dosage Considerations

When determining the dosage of nebulized albuterol for pediatric patients, several factors should be considered, including:

• The patient's weight and age
• The severity of the asthma
• The patient's response to previous treatments
• The potential for side effects, such as increased heart rate and decreased serum potassium levels 4, 6