What is the recommended dosing for an albuterol (bronchodilator) inhaler?

Albuterol Inhaler Dosing Recommendations

For adults with asthma, the standard albuterol metered-dose inhaler (MDI) dosing is 2 puffs (90 mcg/puff) every 4-6 hours as needed for symptom relief. 1

Age-Specific Dosing Guidelines

Adults:

• MDI (90 mcg/puff): 2 puffs every 4-6 hours as needed
• Nebulizer solution: 2.5 mg in 3 mL saline every 4-6 hours as needed
• For acute exacerbations: 4-8 puffs every 20 minutes for up to 3 doses, then every 1-4 hours as needed 1

Children 5-11 years:

• MDI: 2 puffs every 4-6 hours as needed
• Nebulizer solution: 1.25-5 mg in 3 mL saline every 4-6 hours as needed 1

Children <5 years:

• MDI: 1-2 puffs every 4-6 hours as needed
• Nebulizer solution: 0.63 mg/3 mL (for children <15 kg) or 1.25-2.5 mg (for children ≥15 kg) every 4-6 hours as needed 1, 2

Acute Exacerbation Dosing

During acute exacerbations, more intensive dosing is recommended:

Adults:

• MDI: 4-8 puffs every 20 minutes for 3 doses, then every 1-4 hours as needed
• Nebulizer: 2.5-5 mg every 20 minutes for 3 doses, then 2.5-10 mg every 1-4 hours as needed
• Continuous nebulization: 10-15 mg/hour 1

Children:

• MDI: 4-8 puffs every 20 minutes for 3 doses, then every 1-4 hours as needed
• Nebulizer: 0.15 mg/kg (minimum 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
• Continuous nebulization: 0.5 mg/kg/hour 1

Important Clinical Considerations

1. Technique matters: Use of a spacer or valved holding chamber with MDIs significantly improves drug delivery, especially in children and elderly patients 1

2. Nocturnal asthma may require higher doses: Research shows patients may need up to 5 puffs (median dose) to achieve 80% of their personal best FEV1 during nighttime symptoms versus less than 1 puff during daytime 3

3. Dose titration: For severe exacerbations, dosing may be doubled initially 1

4. Warning signs: Increasing use or lack of expected effect indicates diminished asthma control and should prompt medical evaluation 1

5. Maximum dosing: Regular use exceeding twice weekly for symptom control (not including pre-exercise use) suggests inadequate control and need for controller medication 1

Potential Adverse Effects

• Tachycardia
• Skeletal muscle tremor
• Hypokalemia
• Increased lactic acid
• Headache
• Hyperglycemia
• Cardiovascular effects (with excessive use) 1

Mechanically Ventilated Patients

For intubated patients, MDI administration through a spacer device:

• Start with 5 puffs
• May increase to 15 puffs total (10 additional puffs if needed)
• Further increases beyond 15 puffs show limited additional benefit 4

Remember that albuterol should be used primarily as rescue medication. Increasing need for albuterol (more than twice weekly) indicates poor asthma control and should prompt reassessment of maintenance therapy.