What is the recommended dose of salbutamol (albuterol)?

Recommended Dosage of Salbutamol (Albuterol)

For most patients with asthma or COPD, the recommended dose of salbutamol is 200-400 μg (2-4 puffs) via metered-dose inhaler (MDI) every 4-6 hours as needed, with a maximum of 1000 μg (10 puffs) per day for routine use. 1

Dosage by Administration Method

Metered-Dose Inhaler (MDI)

• Standard dosing: 200-400 μg (2-4 puffs) every 4-6 hours as needed 1
• Maximum routine dose: Up to 1000 μg (10 puffs) per day 1
• Acute exacerbations: May increase to 400-800 μg (4-8 puffs) every 15-20 minutes for first hour 1

Nebulizer Solution

• Standard dosing: 2.5 mg every 4-6 hours 1
• Acute exacerbations in adults: 5 mg (can be repeated 4-6 hourly) 1
• Acute exacerbations in children:
  • 0.15 mg/kg (minimum 2.5 mg) every 20 minutes for 3 doses, then every 1-4 hours as needed 1
  • Alternative calculation: 5 mg or 0.15 mg/kg for children 1

Dosage by Severity and Age

Adults

• Mild episodes: 200-400 μg (2-4 puffs) via MDI every 4 hours 1
• Moderate episodes: 400 μg (4 puffs) via MDI every 4 hours or nebulizer 1
• Severe episodes: 5 mg via nebulizer, repeated 4-6 hourly if improving 1

Children

• Acute severe asthma: 5 mg (or 0.15 mg/kg) nebulized, repeated 1-4 hourly if improving 1
• If not improving: Add ipratropium bromide 250 μg and repeat treatment at 30 minutes 1

Important Clinical Considerations

1. Spacer devices: Always use a spacer/holding chamber when administering via MDI for improved drug delivery 1

2. Dose escalation: If standard doses are ineffective, consider:

   • Increasing to 1000 μg via MDI before switching to nebulizer 1
   • For nebulizer therapy, 3 mg may be optimal for balancing bronchodilation with minimal side effects 2

3. Response assessment: The early response (within 30 minutes) is the best predictor of treatment outcome 3

   • Approximately 70% of patients show good response to salbutamol
   • 30% may show poor response despite high doses

4. Side effects: Dose-related increases in:

   • Heart rate and palpitations
   • Tremor
   • Serum glucose levels
   • Potassium reduction 4, 5, 2

5. Continuous nebulization: For severe cases, 0.5 mg/kg per hour up to 10-15 mg/hour may be used 1

Common Pitfalls to Avoid

1. Overreliance on rescue medication: Patients requiring salbutamol more than 2-3 times daily should be evaluated for additional controller medications 1

2. Inadequate delivery technique: Poor inhaler technique significantly reduces drug delivery - always check and correct patient technique

3. Underdosing in acute settings: Don't hesitate to use higher doses (5 mg via nebulizer) in severe exacerbations 1

4. Failure to recognize treatment failure: If no improvement after initial treatments, consider adding ipratropium bromide and seeking higher-level care 1

5. Oxygen delivery: When using nebulizers, ensure adequate oxygen flow (6-8 L/min) for proper nebulization and oxygenation 1

By following these dosing recommendations and considering the patient's clinical status, salbutamol can be effectively and safely administered for bronchodilation in both acute and chronic settings.