What is the recommended dosing of Albuterol (Salbutamol) nebulizer per kilogram of body weight?

From the Guidelines

The recommended dosing of Albuterol (Salbutamol) nebulizer per kilogram of body weight 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, as stated in the most recent and highest quality study 1.

Key Points

• The dosing is weight-based to ensure appropriate bronchodilation while minimizing side effects like tachycardia and tremors.
• For most children under 20 kg, a 2.5 mg dose is appropriate, while children over 20 kg generally receive 5 mg per dose.
• Infants may start with 1.25 mg.
• The medication is usually diluted in 3 mL of normal saline for administration.
• It's essential to monitor heart rate, respiratory status, and oxygen saturation during treatment.
• The onset of action is typically within 5-15 minutes, with effects lasting 2-6 hours.
• Proper technique includes ensuring the child breathes normally through the mouthpiece or mask until the medication chamber is empty, which usually takes 5-10 minutes.

Administration Considerations

• Use large volume nebulizers for continuous administration.
• May mix with ipratropium nebulizer solution.
• Only selective beta2-agonists are recommended.
• For optimal delivery, dilute aerosols to a minimum of 3 mL at gas flow of 6-8 L/min.

Comparison with Other Studies

• Although other studies, such as 1 and 1, provide similar dosing recommendations, the most recent and highest quality study 1 is prioritized for its relevance and accuracy.

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%. An increase of 15% or more in baseline FEV1 has been observed in children aged 5 to 11 years up to 6 hours after treatment with doses of 0. 10 mg/kg or higher of albuterol inhalation solution.

The recommended dosing of Albuterol (Salbutamol) nebulizer per kilogram of body weight is 0.10 mg/kg or higher for children aged 5 to 11 years, as supported by the studies 2 and 2.

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

From the Research

Recommended Dosing of Albuterol (Salbutamol) Nebulizer

The recommended dosing of Albuterol (Salbutamol) nebulizer per kilogram of body weight varies across different studies. Here are some key findings:

• A study from 1990 3 compared two doses of nebulized albuterol in children with moderate to severe acute asthma, with the high-dose group receiving 0.30 mg/kg body weight and the standard-dose group receiving 0.15 mg/kg.
• Another study from 2021 4 examined the association of various weight-based doses of continuous albuterol on hospital length of stay, with weight-based dosage quintiles ranging from 0.07-0.29 mg/kg/h to >0.76-3.2 mg/kg/h.
• A study from 1995 5 used a dose of 0.15 mg/kg per dose of nebulized albuterol in children with severe acute asthma.
• A study from 2007 6 evaluated the efficacy and safety of two different strengths of albuterol solution for nebulization, with doses of 1.25 mg and 0.62 mg, but did not specify the dose per kilogram of body weight.

Key Findings

Some key findings from these studies include:

• The high-dose hourly regimen of 0.30 mg/kg body weight resulted in significantly greater improvement in forced expiratory volume in 1 second (FEV1) compared to the standard dose of 0.15 mg/kg 3.
• There was no difference in adjusted length of stay or adjusted duration of continuous albuterol therapy among the five quintiles of weight-based dosage 4.
• The addition of repeated doses of nebulized ipratropium to frequent high-dose albuterol therapy was both safe and more effective than albuterol alone in patients with acute severe asthma 5.
• Both doses of albuterol (1.25 mg and 0.62 mg) were effective in improving pulmonary function and were well tolerated in children aged 6 to 12 years 6.